Fraudulent visits - yes I brought it up!

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Specializes in Oncology, Med-Surg.

I'm a DON at a HHA. I have an LPN who we've caught a few times and has been accused many times of fraudulent visits. She's on probation with the BON for the same thing in the past. Every time I bring it up to my administrator for disciplinary action, she never wants to do anything!! All the people in the office and in the field can't stand her because she's making $150,000/year while they make 50-60 and actually do their visits. My administrator wants proof, but when I give it to her, she says it isn't good enough.

I have started expressing these concerns on her BON quarterly report, but the state simply extended her probation for another year. I even have MD's calling to say that they don't believe the blood sugars she charts. Her patients have really high HG A1C's or she claims they have high blood sugars, gets them on a sliding scale and boosts their visits to tid.

There are several people we know she doesn't see tid. She's very charming and I can't get any of the clients to rat her out. It happened once, but since the patient was psych, it was dismissed. She refers many clients to the agency, which is why I think the administrator doesn't want to get rid of her. She also insists on taking all these patients and has 26 visits/day!! It just isn't possible to do that many. Any ideas on how to "catch" this person? How does your agency handle these types of nurses?

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Specializes in Pain, critical care, administration, med.

First I want to say nice salary for a LPN. You know I always thought that reporting people for fraud and abuse was the right thing to do. What I have found these people are protected and ok one says anything. We have a educator who works a 6 hour day maybe and signs in that he has worked 8 hours. This low life leaves early for his other jobs. I have even reported through our compliance hot line and to the CNO and he still gets away with it. He also does nothing all day but sit surfing the net. I have resigned because this is the culture you have to embrace to survive. I have started a letter to the governor since it is a state owned facility.

The only suggestion I have is to report to Medicare or the insurance commission of your state.

Good luck hopefully honesty will prevail.

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Specializes in Oncology, Med-Surg.

Do you think this relatively common in home health? the only other agency I worked for was the VNA and they would fire people for even any hint of impropriety - they did fire a lot of nurses they shouldn't have IMO. Why do you think an administrator wouldn't be worried about her agency (she also owns the agency)?

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She's very charming and I can't get any of the clients to rat her out.

maybe there is nothing to rat her out for. and what on earth are you asking these patients?

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Does she chart her times in and out of each home? How is it physically possible to do 26 visits in one day? Is this in one building or is she driving between patients?

I'd think your administration would be all over this. If the LPN is really doing this, it's Medicare Fraud, and if the agency knew anything about it, but didn't act---they could take a fall, too.

Seriously, $150,000/year for an LPN?!! I know Nurse Practitioners that don't make that much.

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Our agency recently terminated an employee for falsifying times on his visit notes. He'd only stay 10-15 minutes at a home and chart that he was there for 30.

We're paper, not computerized.

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i missed the part about 26 visits. 26 visits??? wow

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Specializes in Peds/outpatient FP,derm,allergy/private duty.

Medicaid and Medicare take fraud pretty seriously. I'd check whether you can do that anonymously. I've never heard of such an extreme case, but fudging the numbers does happen with certain people, usually those who kiss up to management. This enables them to bypass the Case Manager altogether. I still say something because I look at that as stealing. They usually give them a slap on the wrist and it's business as usual within a few weeks. The morale in offices like that is so low the good people often end up leaving.

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I don't think there is any limit written in stone on the max number of visits a nurse can make in one day, but 26 has to be way over the limit.

Your administrator is obviously not going to do anything about it, and I'm thinking that if you keep pushing it, you may find yourself without a job. Just keep up with the dates and times that you informed your administrator of these things.

You're caught in a tough place if you're the one who has to make the schedule and put those 26 visits a day on her. I wouldn't want to have anything to do with that.

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Specializes in Pedi.

Who schedules this person for 26 visits/day? This should not be allowed from the administration side. I think the most I've ever done in a day is 7... 26 sounds impossible unless all 26 patients live in a group home or something and need something very simple like a quick wound check or a shot.

I've not experienced this problem. My patients are children and you bet the parents would be calling the agency if the nurse wasn't showing up as scheduled.

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I think the administrator doesn't want to get rid of her. She also insists on taking all these patients and has 26 visits/day!! It just isn't possible to do that many. Any ideas on how to "catch" this person? How does your agency handle these types of nurses?

A) My Administrator would not want to get rid of her either

B) My Administrator would want me to ask you to send us her resume

C) My agency handle these types of nurses by begging for more

That's a little tongue in cheek. But the following is not joking.

At an agency where I work, we do have an exceptionally charming LPN who does 70 visits a week in a four day week. I know that is not 26/day every day but I know there are days she has seen close to 25. We are the preferred HHA at an ILF. All her clients are in the same twenty-some story building. She rides to the top floor and walks/works her way down. NO ONE in this building would rat her out. Certainly not her clients, her agency, nor building management. She keeps EVERYONE happy and making money. Clients' family are thrilled. The building has happy residents and no vacant suites. The agency is making money and earning praise.

You are welcome to cry foul, dump in everyone's punch bowl, but expect a boatload of enemies and a tough time ever finding another job in home care.

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Specializes in Leadership, Psych, HomeCare, Amb. Care.
Do you think this relatively common in home health? the only other agency I worked for was the VNA and they would fire people for even any hint of impropriety - they did fire a lot of nurses they shouldn't have IMO. Why do you think an administrator wouldn't be worried about her agency (she also owns the agency)?

No, it's not common.

Some clinicians are more generous with their visit frequencies, but outright fraud is rare. As DON your license is in jeopardy if you tolerate probable fraud, and your administrator is at risk.

I suggest follow up validation visits. High A1C? Go in later that day, or the next day, and do a repeat, no-charge visit. Or pull some visits from her, and You, or someone you trust, does the visit without her

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