Home Health daily visits for insulin injections, is that fraud?

  1. I work as a a home health nurse in a small HH company. I have been asked to recertify a patient who has been getting insulin shots daily in the am in an ALF. The patients daughter is unable to inject her in the mornings. I was trained under the impression that home health is just a temporary service. I am
    not sure if I should proceed or not, should I just document that I spoke with the daughter and she is unable to do it in the morning? How could ALF personal refuse you inject ?
  2. Visit esla profile page

    About esla

    Joined: Nov '09; Posts: 49; Likes: 1
    from FL , US

    2 Comments

  3. by   Libby1987
    Good question!

    It is a covered service if there is not willing or able caregiver and the ALF is not licensed to administer injections. (Ours aren't).

    Don't think of it as fraudulent, it is not at all lucrative for traditional Medicare and Medicare Replacement Plan patients. (I don't know if fee for service commercial plans cover daily visits, it's never come up for us). Our wage reimbursement for the SN alone would be $3,900 for long term daily visits. Recert your patient and then ask your agency what's the Medicare reimbursement for this patient.

    https://www.cms.gov/Regulations-and-...s/bp102c07.pdf

    40.1.3 - Intermittent Skilled Nursing Care
    (Rev. 208, Issued: 04-22-15, Effective: 01-01-15, Implementation: 05-11-15)
    The law, at §1861(m) of the Act defines intermittent, for the purposes of §§1814(a)(2)and 1835(a)(2)(A), as skilled nursing care that is either provided or needed on fewer than7 days each week, or less than 8 hours each day for periods of 21 days or less (withextensions in exceptional circumstances when the need for additional care is finite andpredictable.)
    To meet the requirement for "intermittent" skilled nursing care, a patient must have amedically predictable recurring need for skilled nursing services. In most instances, thisdefinition will be met if a patient requires a skilled nursing service at least once every 60days. The exception to the intermittent requirement is daily skilled nursing services fordiabetics unable to administer their insulin (when there is no able and willing caregiver).
  4. by   esla
    Thank you so much!! I feel much better

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