Really need help with this issue, LONG

[vintagechic13]

Hi everyone,

I have been reading the posts on here for several years, however, this is my first time posting. I am just really lost with how to handle this situation.

I have been an RN for 11 years and have worked in a variety of areas, my most recent job was a case manager at an insurance company which I left to go to work for a hyperbaric oxygen center, this is where the issue comes in.

I was hired at the hyperbaric center to be a case manager there also, do the insurance verification stuff, coordinate the patient's care, ect ect. The center is very small, only 2 chambers, but it was close to my house and it seemed like a new interesting area to work. So I started work and the weirdness began.

The first day, I was given some charts of patient's that were currently being treated at the center for a variety of "unusual" things that aren't usually covered by insurance, things like strokes, cerebral palsy, autism, ect ect.....I was told to go through the charts and see if I could "find" anything in them that would be covered under their insurance plan. Ummmm, first red flag. Needless to say, I didn't "find" anything in the charts.

Fast forward a couple of days and I was having a discussion with the doctor who runs the place and had been doing hyperbaric medicine for over a decade, or so she said......Come to find out, she wasn't an MD, but rather had a phD in early childhood, which after I looked, she earned the phD at a nonaccredited online university.....HUGE red flag......

I spent the next couple of days just going through the charts, looking at information and digging around where I really wasn't supposed to be......The amount of insurance stuff that was questionable/fraudulent would blow your mind. The "dr" was writing prescriptions for the oxygen administration in the chambers, her prescriptions were photo copied off of some online website, she signed everything as an MD and her patient's all thought that she was an MD as well.

I left after those few days, it wasn't worth it to me to, my license means much more to me then that crazy job, but I find myself really disturbed at the whole situation. I feel really bad for all of those patients, and I feel bad for the other brand new nurses that were hired to run the actual chambers......I don't think they have a clue about the legalities of the whole place.

Sorry, that was so long, here is my question, who would I contact and how would I go about reporting this place? I tried to look at the insurance commisioner for my state, but it was really difficult to navigate that site and nothing really applied to this situation. I know that you can report medical doctors to the medical board, but this is weird because she isn't a medical doctor, and I have no idea how to persue this further. I

Any advice would be appreciated, sorry this is so long, I'm just really baffled with the weirdness of the situation.

[AmericanChai]

No advice as I'm a student nurse, but WOW! I wonder if the BBB would be appropriate for reporting something anonymously.

[tokmom, BSN, RN]

Boy oh boy...what about the Attorney General in your state? They would at least tell you where to begin! Keep us posted.

Thank God they never killed anybody!

[netglow, ASN, RN]

Or

U.S. Department of Health and Human Services.

[sparklie.lady]

I would say start with the state medical board. If they don't handle it, then they should know who does. Or the cops. I believe it's illegal to practice medicine without a license in all states.

Wow. This is some crazy stuff. Good luck!

[PostOpPrincess, BSN, RN]

Attorney General.

For Major Insurance Fraud.

[meandragonbrett]

Contact your State Department of Health and the Attorney General

[txredheadnurse, BSN, RN]

You can also report this to Medicare and Medicaid hotlines; and any private insurance carriers that were noted in the charts. Most insurance companies are very motivated to investigate any fraudlent billing practices.

[TDCHIM]

I'd probably start with the state board of medicine and your local police or sheriff's office, but it's very possible lots of other agencies will play a role. You might also contact the DEA if she listed a DEA number on those prescriptions. That's an incredible mess, and I'm glad you got out of there quickly!

[Zookeeper3]

I'm glad too you got out, I don't have anything else to add, because you've been pointed in the directions you need to go... what you do from here is solely up to you.

[heron, ASN, RN]

You can also report this to Medicare and Medicaid hotlines; and any private insurance carriers that were noted in the charts. Most insurance companies are very motivated to investigate any fraudlent billing practices.

I agree most heartily with this post ... call CMS now, please. If the details you describe are accurate, this lowlife is committing major fraud and should be in jail.

She's also practicing medicine without a license ... the state medical board will be interested in that. Not to mention the state licensing authorities. Copying prescriptions off the internet? If true, YIKES!

You might think about checking out your state for whistle-blower protection and establish a working relationship with a lawyer who knows this field.

If you choose to report, you need to accept the fact that it's gonna suck to be you for a while and be prepared for that.

It possible, though, to make an anonymous report through the hotlines mentioned in the quoted post. Probably less effective, but also a little less dangerous.

You might also consider asking the mods to delete this entire thread before taking action. This is a public board and your scenario is pretty identifiable. If anyone involved in the situation sees it, they would likely be able to figure out who you are and retaliate ... and that can get nasty.

Good luck and be careful.