Does this seem wrong?????

caliotter3 · Jul 11, 2007

Have you ever considered writing a text for home health or a reference book on the subject? My community nursing instructor in school was good but she was able to just scratch the surface and I don't even remember our text. Maybe we didn't have one. We had one in health sciences but it was a poor text. Just an idea.

Jo Dirt · Jul 20, 2007

I recently started a new job as a case manager. As I am finally getting to look back into records I am seeing that this agency has a strong pattern of never discharging anyone they can get a new 485 signed on. So many patients have many (9+) cert periods, I haven't seen that in years. Amazingly they get 10-12 visits from therapy every cert period. never more or less. They all seem to have either muscle weakness or diabetes as primary diagnosis. I really became alarmed when a patient's son told me his late stage alzheimer's mother gets PT just so the agency can make an extra 2 grand. It made no difference in her functional ability. Where I come from and in my many years in home health I have never seen this as being an OK thing. I know what I have to do for my own integrity, I just want to know if this is seen anywhere else. I could give more instances but I don't want to get identified. I got chastised as a rabble rouser my first week when I asked if something I saw would be upcoding and therefore fraud. Anyway I would appreciate some feedback

It is done in spades at the HH agency where I used to work. Once they get a patient they don't let go. We were told to be creative and put down reasons we needed to keep coming. I became so disillusioned with the whole deal and the waste going on. No wonder Medicare is in financial straits.

Aside from IV's and wound vacs and technical things and maybe one or two visits for patient teaching, there was not a reason I could find to justify staying in these houses month after month for teaching and assessment/management of disease processes. The nurse who left before me tried to discharge patients who obviously were no longer in need of HH and management threw a fit. Ugh.

BTW, this company is now under a full investigation by Medicare and Medicaid (they also handle private duty cases), the IRS, the labor board and they have several lawsuits pending against them. On top of that the agency has been shut down while an investigation is being done by the state on allegations of patient abuse. That place is a sinking ship, glad I got out.

runrn · Jul 22, 2007

I recently started a new job as a case manager. As I am finally getting to look back into records I am seeing that this agency has a strong pattern of never discharging anyone they can get a new 485 signed on. So many patients have many (9+) cert periods, I haven't seen that in years. Amazingly they get 10-12 visits from therapy every cert period. never more or less. They all seem to have either muscle weakness or diabetes as primary diagnosis. I really became alarmed when a patient's son told me his late stage alzheimer's mother gets PT just so the agency can make an extra 2 grand. It made no difference in her functional ability. Where I come from and in my many years in home health I have never seen this as being an OK thing. I know what I have to do for my own integrity, I just want to know if this is seen anywhere else. I could give more instances but I don't want to get identified. I got chastised as a rabble rouser my first week when I asked if something I saw would be upcoding and therefore fraud. Anyway I would appreciate some feedback

I am not sure if what you describe falls into the category of fraud, but I wouldn't hesitate to say abuse at the very least. In either case, if medicare starts to review these cases you will start seeing all that money do a backwards flow. And if that flow is too substantial to recover from, then the whole ship sinks. Doesn't seem worth the risk does it? Not to the average semi-educated individual, but to folks who don't truly understand the rules and risks thereof, more money is simply just that: more money. Amusing thing about that is when a nurse stands up to improper services given to patients or improper billing, the owners or managers of these agencies get fired up and make you feel like YOU are stealing from THEM. How dare you try to wrongly take away our income? Then they remind you of all the patients that have to be cared for and all of the employees that would be out of a job. I wonder if medicare ever feels like this? Except only thing is, their responsibility is to millions of people, not only those currently on medicare, but to their children and grandchildren, etc. also. I would say their stakes are somewhat higher.