Jump to content

Fraudulent Documentation

Posted

Specializes in Case Management, Home Health, UM. Has 39 years experience.

One of the nurses who works for our HHA was suspended last week, for documenting a visit which was never done. Tomorrow the HR director will give her a choice of either resigning or being fired. It's a shame, for she has only been working here for a few months. I just don't understand why someone would want to risk their job and their license for a few extra bucks, but it happens every day. Maybe this will be a wakeup call for the other nurses in our HHA who have also been under the delusion that they can get away with doing whatever they please.....:madface:

Jo Dirt

Has 9 years experience.

I am assuming your nurses are paid by the visit.

We recently had a case in the private duty division where it was discovered that a nurse had not been coming in to work but had been signing in and writing nurse's notes as if she had been there all day. Even documenting what the patient ate, what they did during the day, etc.

The way I discovered this is when I made a little "surprise" visit. The little old man was sitting in the living room and told me the nurse was down in her back but she had been calling in to check on him several times a day.

When one nurse calls out another nurse is supposed to be called in so I thought this was strange. Turns out this is not the first time she had been caught documenting and collecting payment for services that were never done. No telling how long it had been going on.

And it wasn't just a little flub up. The comany has turned this over to the state and I expect she will be required to meet with the BON over it.

I also know of a private duty case where the family is very poor (which I'm sure was a motivator in this deal) and the nurse works

whatever hours she wants to work and when she leaves the family takes over care of the patient and she gives them payment for whatever hours she was out. What I hope the nurse who is doing this realizes is, if something was to happen to her patient during

her shift, if the family decided they were not going to vouch for her that she was there, she would be in a heap of trouble. Of course, the family would be in trouble for fraud as well, but they don't have near as much to lose as this nurse does.

CseMgr1, ASN, RN

Specializes in Case Management, Home Health, UM. Has 39 years experience.

I am assuming your nurses are paid by the visit.

We recently had a case in the private duty division where it was discovered that a nurse had not been coming in to work but had been signing in and writing nurse's notes as if she had been there all day. Even documenting what the patient ate, what they did during the day, etc.

The way I discovered this is when I made a little "surprise" visit. The little old man was sitting in the living room and told me the nurse was down in her back but she had been calling in to check on him several times a day.

When one nurse calls out another nurse is supposed to be called in so I thought this was strange. Turns out this is not the first time she had been caught documenting and collecting payment for services that were never done. No telling how long it had been going on.

And it wasn't just a little flub up. The comany has turned this over to the state and I expect she will be required to meet with the BON over it.

I also know of a private duty case where the family is very poor (which I'm sure was a motivator in this deal) and the nurse works

whatever hours she wants to work and when she leaves the family takes over care of the patient and she gives them payment for whatever hours she was out. What I hope the nurse who is doing this realizes is, if something was to happen to her patient during

her shift, if the family decided they were not going to vouch for her that she was there, she would be in a heap of trouble. Of course, the family would be in trouble for fraud as well, but they don't have near as much to lose as this nurse does.

No, she gets paid hourly. And I hope both of these nurses get their licenses yanked for what they did, for committing Medicare fraud is a felony. I've worked for at least two HHA's whose owners served time in federal prisons for defrauding the government, and one of them was an R.N. She didn't even appear in front of the BON, surrendering her license before they

called her on the carpet. It's ALL about greed, and what GOES around COMES around!

Jo Dirt

Has 9 years experience.

No, she gets paid hourly. And I hope both of these nurses get their licenses yanked for what they did, for committing Medicare fraud is a felony. I've worked for at least two HHA's whose owners served time in federal prisons for defrauding the government, and one of them was an R.N. She didn't even appear in front of the BON, surrendering her license before they

called her on the carpet. It's ALL about greed, and what GOES around COMES around!

My step-son (who is my age and who I have never met as he is estragned from his father from a very young age and only recently started talking to him again... he also lives 1,100 miles away) was the assistant DON of a LTC facility, his buddy was the DON. They started an "agency" supplying RN's to this facility. Only they weren't RN's, many of them weren't even LPN's (but the "agency" was getting reimbursed for RN's).

Well, when it was all over each of these dudes were ordered to pay back $300,000 to Medicare, got hit with a conviction of grand larceny, spent 5 months in the slammer, got their licenses suspended for a year to be reviewed by the state board in a year, and they do not talk to each other anymore.

I imagine even if they get their licenses back there won't be any chance of getting a job where they manage money.

I don't know how, but even with no license step son got a job as some kind of supervisor with a HH agency and is making a decent salary.

Him and his buddy were definitely driven by greed and I doubt either of them has learned a thing from it.

But who can say bigger agencies/companies aren't guilty of the same thing they just have the savvy to get around it?

I used to work for a company (that is still in existence) that was extremely crooked. I overheard one of the underlings telling another underling, "he's got it worded right."

I guess the root of all evil is still the most important thing in the world.

CseMgr1, ASN, RN

Specializes in Case Management, Home Health, UM. Has 39 years experience.

My step-son (who is my age and who I have never met as he is estragned from his father from a very young age and only recently started talking to him again... he also lives 1,100 miles away) was the assistant DON of a LTC facility, his buddy was the DON. They started an "agency" supplying RN's to this facility. Only they weren't RN's, many of them weren't even LPN's (but the "agency" was getting reimbursed for RN's).

Well, when it was all over each of these dudes were ordered to pay back $300,000 to Medicare, got hit with a conviction of grand larceny, spent 5 months in the slammer, got their licenses suspended for a year to be reviewed by the state board in a year, and they do not talk to each other anymore.

I imagine even if they get their licenses back there won't be any chance of getting a job where they manage money.

I don't know how, but even with no license step son got a job as some kind of supervisor with a HH agency and is making a decent salary.

Him and his buddy were definitely driven by greed and I doubt either of them has learned a thing from it.

But who can say bigger agencies/companies aren't guilty of the same thing they just have the savvy to get around it?

I used to work for a company (that is still in existence) that was extremely crooked. I overheard one of the underlings telling another underling, "he's got it worded right."

I guess the root of all evil is still the most important thing in the world.

They ALL are. As a matter of fact, our office manager approached me right after I started work at the HHA I'm at now and asked me about "fixing" others' deficient chart documentation. I politely told her no, that there was nothing to "fix".

And sadly, this is only one of MANY symptoms of another badly managed HHA that I don't want ANY part of. Just two months into this job, I've started looking for another one. NO thank you!

Tweety, BSN, RN

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac. Has 28 years experience.

I'm sorry to hear your new job isn't working out. I agree. You'd better run away from this job.

The should fire this nurse and report her unethical behavior to the BON for disciplinary action.

CseMgr1, ASN, RN

Specializes in Case Management, Home Health, UM. Has 39 years experience.

Well, ladies and gentlemen, here is the latest and greatest...

Our nurse is back at work, because the higher-ups took pity on her after she complained to them she had received little or no orientation...even though she

admitted to not making the visit...and the fraudulent documentation had been well-documented by our Admistrator.

Only minutes before, I had to attend a five-minute meeting, whose attendees included her, one of the Team Leaders and the VP (I should have figured something was up, when she showed up late and in her scrubs, ready for work). In that meeting, we were all told by this VP that this nurse had

committed nothing more than a "careless mistake", and that she was a "good

nurse and a long-term employee". End of discussion. Finis.

I sat behind closed doors with the office manager after this Dog-and-Pony Show, almost sick to my stomach as she then told me what had really

happened. This nurse had not committed a "careless mistake", as this VP had

maintained. She had committed pure, unadulturated fraud, and all I could think about was the tears in my Administrator's eyes last week as she

sat me down in front of her desk, showed me the evidence and told me that she had suspended and was going to have to fire this nurse. Instead, she

got away with it, which sends a long, loud and clear signal to anyone else who is considering to commit Medicare fraud that it is OK...as long as you don't have to be held accountable... like the other nurses in this HHA don't! :angryfire

I'm not going in tomorrow. I will be out and about considering other options, because I have NO desire to be associated any longer with a HHA who allows its nurses to commit fraud, nor do I want to have to be supoenaed as a Federal witness, should they be sued by the government. :trout:

Tweety, BSN, RN

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac. Has 28 years experience.

Wow.

Guest
This topic is now closed to further replies.