Home Care Fraud - How to escape.

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I have never reported an agency to the authorities for fraud, but I have been accused of doing so and have been blacklisted.

I have seen so much horrifying fraud in home health care that I don't want to work in this field any longer. Sad to say, home care turns my stomach. Part of the problem is the amount of QA I have done at a lot of agencies, usually agencies in some kind of trouble. I see it all and it irks me to the point that I can no longer look at it.

I can't seem to escape home care at all as no employer will give me a chance to do something different. Nursing jobs are scarce in this area. I attended an orientation for a contingent position this week with nurses who had driven 1-2 hours or longer to get to the office. Of course, if was just another agency signing up lots of new staff and having very little work to offer anyone.

Any discussion about getting out of home care, handling fraud and handling blacklisting would be appreciated.

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Blacklisting is something that time takes care of eventually after that first new job. Sometimes moving out of the area will help. Try to go to an area that has more available work.

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hh fraud is rampant, the only real solution, don't get involved in it and don't say nothing about it, be indifferent.

your problem is less about being blacklisted and more about a crap economy.

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Specializes in Home health.

I've been in home health since the early 90's and fraud has always been a problem. There are many unethical agencies out there. I understand your frustration and you should be commended for taking the high road.

Are you saying you've tried looking for other jobs and have been blacklisted?

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What kind of fraud happens in home care?:eek: I am new to home care. What should I be looking for that might be a sign of home care fraud?

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The most prevalent type of home care fraud has to do with billing for services that are never provided. Or billing for a different, more lucrative service, than what is warranted. Another common fraudulent practice is that of nurses putting fraudulent time on their pay sheet with or without the knowledge and complicity of the client. I have seen that happen so often it makes me think that the grapevine must be abuzz with criminal solicitation where one nurse gets her friends to go with an agency that "doesn't know any better".

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Specializes in COS-C, Risk Management.

Ummm . . . . yeah. Seriously? How about admitting patients who aren't homebound for starters. That's a biggie. Then there's admitting patients for daily insulin injections who are capable or have a caregiver. Continuing to recert patients who don't have a skilled need. Billing for supplies that aren't being used. Daily wound care visits for an extended period of time, like months. Fudging your functional scores on admit OASIS to make the discharge OASIS look better (or fudging your discharge OASIS scores to make it look like patient improved more than s/he did). Having supervisors change your OASIS answers to pad the RAP. Documenting skilled visits that didn't occur. Those are just off the top of my head, there are oodles of ways to commit Medicare fraud. Familiarize yourself with Medicare Conditions of Participation (COPs) and find out everything you can about home health rules, regs, and reimbursements. Know what you're doing, don't wait for your employer to tell you.

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I've been in home health since the early 90's and fraud has always been a problem. There are many unethical agencies out there. I understand your frustration and you should be commended for taking the high road.

Are you saying you've tried looking for other jobs and have been blacklisted?

Yes, that is what I am saying. I do have one small amount of contingent work at 1 agency.

I would like to get out of home care and seem to be trapped.

Too many unethical agencies is right. Even surveyors look the other way.

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You will have to do what everyone does who wants a change of scenery. Keep trying to get a job elsewhere until you get one.

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What kind of fraud happens in home care?:eek: I am new to home care. What should I be looking for that might be a sign of home care fraud?

some indications of fraud:

admission without proper verbal or written order from a physician

admission on the suggestion of a marketer

passing patients from one agency to another

sending therapy to visit patients who do not need it

giving patients services or gifts not covered by medicare such has housekeeping, shopping, transporting patients, and of course, paying patients to sign up for home care

an agency sending someone not authorized to do an OASIS to fill out a worksheet and/or OASIS and get the admission consent signed, bringing it to the office and having a RN or PT sign it

and the list goes on and on

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Wow!!!!!:eek: Thanks all for the information. I know when I got hired they said to call "Conduct Concern" if I had any concerns about fraud. However, this conduct concern number is not an outside agency it is part of my agency." So if in the future, I had concerns and called this number I wonder if I would be considered a "trouble-maker"? I wonder if I would be blacklisted for calling and maybe even be fired?:confused:

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Wow!!!!!:eek: Thanks all for the information. I know when I got hired they said to call "Conduct Concern" if I had any concerns about fraud. However, this conduct concern number is not an outside agency it is part of my agency." So if in the future, I had concerns and called this number I wonder if I would be considered a "trouble-maker"? I wonder if I would be blacklisted for calling and maybe even be fired?:confused:

Those numbers are used to "fire" employees. That is all they are for........

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