Is this "fraud"?

  1. One of our staff wants to know if it is considered fraud to send a patient to a facility with a script for an expensive chemo drug to fill himself through Medicare and bring it to the facility as a home med, knowing that the sub acute rehab would not accept him if they had to pay for the med themselves as part of a capitated payment?
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    About adlockwood

    Joined: Apr '09; Posts: 56; Likes: 35
    Mental Health; from US
    Specialty: 22 year(s) of experience in Critical Care, Insurance Case Management


  3. by   d'cm
    If the subacute billed CMS for the drug, it would certainly be fraund, otherwise no - and certainly not your end.
  4. by   Copper4
    I am not sure if this would be considered fraud or not. The subacute facility I work for no longer allows patient's to bring any of their own medications. Apparently the lawyers have determined that we cannot do this ( we did in the past). My understanding of the rational is that when a patient is going to an ltc for rehab under medicare payment, the facility is required to provide for their needs,as part of their rug rates. Medications are included. I do not know how other facilities work this out,although I know they do, but we are no longer able to do so.
  5. by   RNMNCMN
    If the patient is discharged to home, or agrees to pay out of pocket, then no. If the patient is being admitted to the facility directly from the hospital, then yes. It is the post acute facilities responsibility to provide everything, including medications for their patients, to be paid from their daily per diem. It is, however, the responsibility of the hospital to inform the post acute facility of the incoming patient's current condition and plans for chemotherapy, so the SNF can make an informed decision when considering accepting a patient, based upon the level of care they will need, along with projecting potential expenses.