home health compliance/fraud worry

[FarrarSanchez]

I'm an administrator in home health in TX and discovered a nurse was charting visits she did not perform. When I notified my boss of this, she directed me to "stop digging". I feel that we need to investigate and find ALL visits that may be fraudulent, not just the visits on the original reported patient, so that we aren't billing for services not provided. I did a full investigation into all visits I felt she had most likely not performed and sent it to corporate, but nothing has been done. what is my responsibility as a nurse. Do I leave it up to corporate leadership, who will probably sweep it under the rug? Is my license at risk by their actions?

[londonflo]

I am retired but some years ago, I attended Medicare Fraud training. I believe it is required to report Medicare fraud which includes charging for visits billed but not actually performed. I was told at that time, if you had knowledge of something like this but do not report you may also be sanctioned by the government. I tried to do a quick Google search to find the regulations but couldn't find out the current information. 

[fromtheheartRN]

Interesting. What about cases that involve discrepancies with SOC functional status? In order to improve STAR ratings and reimbursement?

[Mapleandhoney2468]

I’m having the same problem. I have found two instances. One difficult patient had two bath aides show up only once and then fraudulently chart the rest of the visits. Another had a PT only show up once and then skip the rest of the visits. Both times I had no way to prove this and only the patient’s word for it. We are supposed to have a sign in sheet in the patient’s house, but the healthcare staff other than me often do not sign the form. I’m so frustrated that my patients are not getting the care that they are supposed to and I have no way to hold them accountable. Can we GPS these healthcare staff? That’s what I do. I always have a GPS running tracking all my mileage and all my locations of where I am so that I always have proof. I wish we could require the other staff to do the same. Even if Medicare investigates I doubt they will have any way to exact justice or prove these people indeed didn’t show up. 

[Bkwar]

You can absolutely GPS them. Electronic Visit Verification is going into effect in different states. If you are using an app for HH like Timeero to track caregivers mileage, GPS and time, then you will have proof of where they’ve been. Several home health and mobile health companies have been doing it this way.