Help! My Employer is Committing Medicaid Fraud!!

[oreocookie123]

About three months ago, I started work as a staff RN at an adult day health center. While completing patient assessments that I was assigned, I unintentionally uncovered signs that my employer is committing fraud. Patients' ADL sheets are being completed for days that they are not in attendance at the center. Patients' care needs are being exaggerated on MDS assesments and in ADL documentation. After noticing these trends in a couple of patient charts, I did a little digging and discovered that the problem is widespread throughout the facility.

How do I approach this dilemma? The way I see it, I have three options:

1. Continue working there and pretend that I haven't noticed the fraud. Enjoy the great working hours, reasonable pay, and the friendships that I've made. Continue to be accurate in my own documentation.

2. Leave my job. Then, report the fraud. I feel this is more ethical than option 1. However, I am concerned about many people losing their jobs and many patients losing needed services if the business is fined heavily or shut down. I am also somewhat afraid of retribution.

3. Leave my job and never mention the fraud to anyone.

4. Remain at my job and speak openly with the employer, letting them know that I am aware of what is taking place, and that I am not okay with it. I can't predict what would result from taking this route.

I would like to know if anyone else has experienced this dilemma. Are there options available to me that I haven't considered? What would you do in this situation? I appreciate any advice, info, or stories. Am I over-reacting? Is this common in health care?

Please help!

[Not_A_Hat_Person, RN]

2. Save yourself and your license.

[wtbcrna, MSN, DNP, CRNA]

Report Medicare Fraud and get a rewards

[oreocookie123]

Thanks so much. I didn't realize this.

[Hoosier_RN, MSN]

#2. Without a doubt!

[quiltynurse56, LPN, LVN]

Definitely #2

[Lev, MSN, RN, NP]

Number 2.

[AnnieOaklyRN, BSN, RN, EMT-P]

Leave the job for sure! If you are working there and the government figures out that you filled out any of these forms or participated in the fraud, even if it was unintentional, they can bar you from every working at a medicare facility again. Medicare facilities include hospitals, nursing homes, doctor's offices, etc.. Get out!

Annie

[PinayUSA]

Waste of time reporting Fraud

[SmilingBluEyes]

GET OUT...REPORT IT.

[BuckyBadgerRN, ASN, RN]

Your link is for MediCARE fraud, OP is witnessing MediCAID fraud. I would hope reporting it would be similar though.

Report Medicare Fraud and get a rewards

[txbornnurse]

Your link is for MediCARE fraud, OP is witnessing MediCAID fraud. I would hope reporting it would be similar though.

The process is similar. The OP needs to contact the regulatory agency for the program AFTER she quits her job though. No matter what one is told in a small company or unit management usually figures out who blew the whistle.

OP gather as much supporting data as you can without violating HIPAA and find another job ASAP. Then report to the regulatory agency and let them do their job of investigation. It is these types of practices that make it easy for lawmakers to cut Medicaid reimbursements and impose draconian documentation requirements that hinder or even prevent individuals who need the Medicaid funded services from receiving what is required for them to function appropriately. Fraud hurts not only the consumers needing it but all of us who work with these populations.

Just my two cents based on many years working in Medicaid waiver programs.