Ethical Question

[luvyluvy]

I recently resigned from a job I held for over 2 years, upon resigning I learned that my name and credentials along with a couple of other nurses (I was not given the names) was signed without my knowledge to some patient visits and submitted to Medicare. These visits were not completed or the persons signing could not find them for a Medicare Audit.

I want to report it to both Medicare and the Department of Regulations, however I am afraid of some sort of retaliation, besides the fact that I am not sure how to report and who do I go to first, the Regulations Department or Medicare. I was also informed that Administrators approved of this and several people helped in this fraud. The owner of the company was conveniently out of town, and knows the law.

Please if anyone out there can help me figure this out I would appreciate it, just thinking about it causes me great anxiety.

[llg, PhD, RN]

I don't have any expertise in this area ... but perhaps you should talk to an attorney before sticking your neck out. I would. Things could get ugly and you will want to be as prepard as you can be.

Good luck!

[chloecatrn]

I would definitely touch base with a lawyer, but also report it. If your name is on those documents and Medicare gets wind of the fact that the visits were not completed, you could be excluded from further participation as a Medicare provider, which could make it hard to get a job. (That's a question that you have to answer on a lot of applications these days.)

I would also call the owner of the company that you used to work for and bring it to his/her attention. That may be enough and he or she may self report to Medicare. Explain the quandry that you are in and that you feel obligated to report the violation. You should experience no retaliation, because you're covered under whistleblower laws.

http://www.whistleblowerlaws.com/

Good luck.

[HouTx, BSN, MSN, EdD]

I completely agree - you are obligated to report this. Failure to do so would be interpreted as collusion & you never want to be associated with fraudulent billing practices. Chances are, this was not a one-shot occurrence. Unfortunately, this type of practice has been fairly common in homecare.

Chloecatrn is absolutely correct - as a whistleblower, you are immune from any retaliation by your former employer and cannot be prosecuted unless you were involved. If the Feds investigate and discover fraud has been committed, it will trigger a Qui Tam lawsuit - and you would actually be entitled to receive a portion of any funds that are recovered as a result.