Home Care Fraud - How to escape.

[erroridiot]

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.

[Blackcat99]

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

OMG!!!!!!!! How shocking!!!!! I'm sure glad I found out about this important information!!!!!

[copperkettle]

Wow. I don't want to sound like a Pollyanna here, but I've worked for this agency connected to a hospital for a few years. Our bosses are absolute sticklers about compliance and documentation. Most of the kinds of fraud mentioned in the previous posts, I have never even thought of happening. We are very aware of when a skilled need exists or does not; we teach patients and families and caregivers to do simple wound care, injections, what to look for and report, with the goal of them being as independent as is safe for their situation. We are in the midwest; people here seem much more willing to do this. We discharge as soon as they are safely able to get out for outpatient care or do it themselves. We can always readmit later if they change.

I'm sorry to hear of so much fraud. Frankly, I'd encourage anyone knowing about intentional fraud, not just mistakes, to report them to Medicare. It is our collective honor and reputation at stake. If it's wrong, stop enabling.

[jnette, ASN, EMT-I]

I agree.. I can't even imagine our ageny pulling this stuff, either. No way, no how. I love our agency, and I KNOW we go above and beyond. We, too, are real sticklers about stuff like this. Wow. What a shame. Stuff like this can cause the loss of a wonderful and much needed service to so many who depend on HH. Shame on them.

[sugarfreecookie]

I love my company! I have worked for this same nationwide company in three different states and they put patients and the nurses first. They have never asked me to do anything against the law, such as admit a patient who is not homebound. I have a friend who works at a different agency and their primary concern is their bottom line. They make their nurses do things that are against regulations. She butts heads with them a LOT! I feel valued and respected by my company. I know how lucky I am. I've worked for few shady or disorganized companies, not fun.

[CFitzRN, ADN]

I started work as a Clinical Supervisor with a local (franchised) agency 2.5 weeks ago. Not one of the biggies - a more obscure one with a good reputation. I am AMAZED at the lengths to which they go to be sure all documentation is impeccably done. I myself check, check again and check a third time to be sure ONLY the services which are on the plan of care are being billed - and I must double check the time sheets to be sure the CNAs and Nurses are actually performing them (it would be easy for them to initial the service, but the client always has to sign off, and we tell them NOT TO SIGN if there is ever any problem, or if the worker is not performing every service). Of course there are times they are unable to get to everything on the POC but they must document by exception and explain exactly why they didn't. I haven't seen one sign of fraud since starting and have been incredibly impressed with the office staff - the front office mgr, the Director, the schedulers (one is the CNA cases scheduler, one is the PDN scheduler), the Clinical Supervisor over the PDNs - and then there's me - Clinical Supervisor over the CNA cases. And I can promise you that I will be hell on wheels if I catch any whiff of fraud from ANYONE.

I work for Maxim seasonally doing flu shot clinics, and can I just say that I would never work for them - on a regular basis that is - if my very life depended on it? They are just horrible (at least here where I live).

[nursel56]

Yeah, CFitz there is an entire thread about Maxim, it's amazing that there are so many uniformly negative opinions of them from all over the country. I guess for now at least I will side with the Pollyannas. I've worked for 2 agencies in 6 years, never seen the type of fraud I am reading about. A lot of people have to be corrupt and/or incompetent for serious fraud to be successful. The agency, the case manager, the LPNs and aides, the doctor, the Medicare/Medicaid case workers, even vendors and RTs sometimes.

What I have seen are nurses who sign in for a shift, leave, come back and sign out. Unless there is a rampant culture of that type of thing at an agency, neither the patient or the other nurses will put up with it for very long.

What I see more often is supplies are over-ordered, but that often is only because nobody takes the time to inventory and keep track of what is used, how often, etc. There is a certain mentality that people have. . .if they aren't paying for something, there's no incentive to be efficient with it.

[CFitzRN, ADN]

I'm sorry, I totally digressed when speaking about Maxim. I never saw any fraud with them, just massive screw-ups. I had been reading the Maxim thread before this one and got the two confused.

[erroridiot]

Wow. I don't want to sound like a Pollyanna here, but I've worked for this agency connected to a hospital for a few years. Our bosses are absolute sticklers about compliance and documentation. Most of the kinds of fraud mentioned in the previous posts, I have never even thought of happening. We are very aware of when a skilled need exists or does not; we teach patients and families and caregivers to do simple wound care, injections, what to look for and report, with the goal of them being as independent as is safe for their situation. We are in the midwest; people here seem much more willing to do this. We discharge as soon as they are safely able to get out for outpatient care or do it themselves. We can always readmit later if they change.

I'm sorry to hear of so much fraud. Frankly, I'd encourage anyone knowing about intentional fraud, not just mistakes, to report them to Medicare. It is our collective honor and reputation at stake. If it's wrong, stop enabling.

In some areas of the country, if you don't enable, you don't eat - or worse yet become homeless and if you report fraud, you will be blacklisted.

[Blackcat99]

In some areas of the country, if you don't enable, you don't eat - or worse yet become homeless and if you report fraud, you will be blacklisted.

I worked at a LTC many years ago. The boss at the nurses meeting told us nurses that we had to initial all of the treatment boxes on the MARs saying that we had done all of the treatments as ordered by the doctors. The nurses said "We don't always get all of the treatments done." The boss said "You have to initial all of the boxes all of the time." After the meeting, one of the nurses told me that he was not going to initial the box unless he had in fact actually done the treatment. He was fired 2 weeks later.

[caliotter3]

I worked at a LTC many years ago. The boss at the nurses meeting told us nurses that we had to initial all of the treatment boxes on the MARs saying that we had done all of the treatments as ordered by the doctors. The nurses said "We don't always get all of the treatments done." The boss said "You have to initial all of the boxes all of the time." After the meeting, one of the nurses told me that he was not going to initial the box unless he had in fact actually done the treatment. He was fired 2 weeks later.

Yep. When you don't follow the employer's instructions, the employer will find sonmeone who will. At the facilities where I worked, the majority of the nurses didn't have to be coaxed to fill in the boxes because that was their normal MO, since they were usually likely to miss doing the treatments. Some of them deliberately didn't do the treatments, but they were smart enough to initial the boxes to make it look like they were doing their jobs.

[nursel56]

I worked at a LTC many years ago. The boss at the nurses meeting told us nurses that we had to initial all of the treatment boxes on the MARs saying that we had done all of the treatments as ordered by the doctors. The nurses said "We don't always get all of the treatments done." The boss said "You have to initial all of the boxes all of the time." After the meeting, one of the nurses told me that he was not going to initial the box unless he had in fact actually done the treatment. He was fired 2 weeks later.

Wow. . . he was fired for doing the right thing. How awful. I do see stuff initialed on other shifts that I doubt were done, but I wasn't there, and I don't make waves. If a manager or DON told me to falsify a record and I had to do it or starve, it would be an awful dilemma. As my good friend M., who taught me a lot of "the ropes" in home health used to say, "thanks God" that has not happened yet. Yet. . .

[erroridiot]

Wow. . . he was fired for doing the right thing. How awful. I do see stuff initialed on other shifts that I doubt were done, but I wasn't there, and I don't make waves. If a manager or DON told me to falsify a record and I had to do it or starve, it would be an awful dilemma. As my good friend M., who taught me a lot of "the ropes" in home health used to say, "thanks God" that has not happened yet. Yet. . .

Having knowledge of certain things that happen turns a person into a candidate for the witness protection program.

All of these incidents are disturbing to say the least.