A question about the MDS

Charles S. Smith, RN, MS · Mar 7, 2002

Nurse Karen...I am always amazed at the depth of your resource base! You are a wizard! Thank you for keeping such timely, accurate and legal information flowing foward.

my best

chas

Rustyhammer · Mar 8, 2002

As an MDS coordinator. I can tell you that the MDS should remain in the chart for 15 months. If a resident goes out (say a fx hip) and returns to the facility then the old MDS's get pulled from the old chart and put into the new one.

The MDS is what determines medicare payment, it determines acuity based staffing in many facilities and quality indicators. Raps are triggered from the MDS and care plans are generated from the raps (resident assessment protocol)

If your MDS's are not in the chart I would suspect that someone is hiding something or is ignorant of the law.

The words medicare and fraud in the same sentence is a scarey thing.

-Russell

MQ Edna · Mar 8, 2002

Thanks to all. Well since I'm agency at the place I don't really care much about not being called back. It's just that I've been through this before and I know I will probably have all the kindly administrators in a tiz by a couple of innocent questions and remarks. If in fact there is a sinister purpose for the MDSs to be off limits. It's a moral-ethical dilemna. An administrator said to me following my "investigation" at the last place:"You know that sometimes we are unable to place these people and there is nowhere for them to go". So does that make it OK to cheat medicare or the HMO to keep a beloved resident? What kind of money is this place bringing in? Is there just a little cheatin going on because there's nowhere for grandma to go? Maybe there is no fraud here and I'm just too suspicious. Would an RNAC upcode an MDS to please his or her employer? How prevalent is that sort of thing? Having an inherent dislike of snitches makes me proceed with caution. However I have a greater dislike of greedy corporations making major bucks illegally. I'm off for a couple days and will use this time to plan my next move.

Rustyhammer · Mar 9, 2002

Personally I'm not willing to go to jail for my facility.

Home Health Columnist / Guide · Mar 9, 2002

If you trully suspect fraud, you need to do some soul searching.

A visit here might be beneficial in your search:

Fighting Fraud and Abuse in Medicare and Medicaid

http://www.hcfa.gov/fraud/

Seeing more stories of videeo camera's being used in SNF these days...wonder if they would ever pick charting at nurses station?

Video urged in nursing homes

http://www.jacksonville.com/tu-online/stories/012502/met_8436014.html

Legislative support grows for cameras in nursing homes

The long-term care industry has managed to block the use of cameras in nursing homes for years, but legislators appear more ready than ever to consider allowing family members to install them.

Wall Street Journal (subscription required), March 7, 2002

Tim-GNP · Mar 9, 2002

Actually, if you suspect fraud, you might want to get in touch with the OIG's office [office of the inspector general]. If you agree to help them [anonymously], if they recoup any funds they give you a cut. Visit them at: http://oig.hhs.gov/

Click on fraud prevention and detection link.

Home Health Columnist / Guide · Mar 10, 2002

More info for you:

WHISTLEBLOWING AS A FAILURE OF ORGANIZATIONAL ETHICS

James J. Fletcher, PhD; Jeanne Sorrell, PhD, RN; Mary Cipriano Silva PhD, RN (Dec. 31, 1998): Whistleblowing As a Failure of Organizational Ethics

Online Journal of Issues in Nursing.

http://www.nursingworld.org/ojin/topic8/topic8_3.htm

Response by John Phillips to

"Whistleblowing as a Failure of Organizational Ethics"

I wanted to note, after reading "Whistleblowing as a Failure of Organizational Ethics," that nurses and others who choose to blow the whistle do have some job protection if they file whistleblower ("qui tam") lawsuits under the False Claims Act.

http://www.nursingworld.org/ojin/letters/t8e19.htm