How do I report fraud and neglect?

Posted
by AshleyPCA AshleyPCA (Member)

Please let me know what you think of this. I know it's long, but here's the info I have, PLEASE read:

Fraud??: I've been a home care PCA for several years now for many different families. One particular client I worked with had autism. She was sweet, gentle, and wouldn't hurt a fly. However, her mother admitted to, and even showed me paperwork, where she proposed that her daughter was violent and had a massive list of diagnoses in order to get her 'round- the-clock PCA care. Later she "started" up a non-profit organization, so she learned how to write grants. She then would write grants for her non-profit organization for money, electronics, etc. She got a few grants, and one of them was for an iPad and other devices, which she claimed her daughter would benefit from. As I worked with my client in their home, my poor client RARELY got to use "mom's" iPad. She's milking the system to get electronics and money for herself!!

More fraud??: Furthermore, this woman has a reputation for having "too many" PCA's and taking advantage of them (treating them like babysitters, having them work overtime so she can go to "meetings" (which were outings with friends by the way)). This is not what the state wants you to use PCA's for. I worked for her and took care of her daughter for over 5 years (simply because I truly cared for my client) and numerous times she was LYING on my time cards so the state would pay for money she had me spend while working with her daughter. She would have me take her to get school clothes, take her out to dinner, and use my own money so she could "add a few hours" on my time card and just let the state "reimburse" me so she didn't have to pay for anything for her daughter. On top of this, the autistic client is now 18 and I am hearing from her current PCA's that her daughter is not benefiting from one dime of her social security disability benefits. The mother is apparently suddenly going on vacations, getting botox, and spending more on herself in general (most likely with her daughter's social security).

Neglect??: Finally, I believe she neglected her autistic daughter. Who cooked for her/took her out to eat, bathed her, dressed her, brought her to and picked her up from school and activities on a daily basis??? Her PCA's did. This was because she had no patience to deal with her own autistic child and cared more about her social life. She's a stay-at-home mom by the way. Once, she had me work later than I was supposed to so she could go to a wine tasting with her friend. Several hours after my scheduled clock-out time she arrived home, via taxi, drunk as a skunk and told me she'd "tuck" her daughter in so I could go home. She was caring for her daughter while intoxicated! I was also stuck between a rock and a hard place several times when she'd call home and say "I'll be home late tonight after your're scheduled to leave, but you can go home. Just lock up before you leave." Should I leave her daughter home alone so I can get a couple hours of study time for my nursing exam in the morning, or should I stay and ensure the safety of my client??!!

Her daughter was 17 when I quit. She still had a bedroom decorated from when she was a baby, she still had a teeny tiny bed which she was too tall for, and only received up-to-date teen fashions so she could fit in because of hand-me-downs and presents from myself and her other PCA's! She clearly would not buy her anything or get her updated or adult things because her daughter "would not know the difference." It's true, she probably wouldn't, but she would get excited and want to wear my old Hollister shirts that I gave her while she was in high school, probably because she saw that's what her classmates were wearing.

Is any of this true neglect?

Anyways, I'm just frustrated with this issue and I have not yet been able to figure out how to properly report her, or if I even can. Is any of this actual and reportable fraud and neglect? If so, how do I report it? Who do I report it to?

Also, I am hoping to pass my NCLEX within the next month so I am also curious about whether or not if I did report her with an active nursing license if the state would take my report more seriously? I do not wish for her mother to serve time or for her daughter to be taken away or anything like that, but I do hope that some justice be served for all the other families out there who deserve home care, but aren't getting any because they aren't being fraudulent like she is and aren't neglecting their special needs children in any way! Maybe just pay a hefty fine, community service, and get PCA hours reduced. That would be the justice!

Please, any advice would be appreciated!

Pangea Reunited, ASN, RN

Has 6 years experience.

You worked for this family for five years and are suddenly concerned about fraud and neglect? Honestly, it sounds like this is personal ...probably due to a friendly relationship with the mother that went sour.

Actually, I am not suddenly concerned...I've been considering reporting her and was actually pressured to do so while I was working for her for those 5 years. So this is not just a sudden decision of mine a year after I quit. Also, I did not have a personal relationship with her which went sour in any way. I was never "friends" with her. Sure, I got along with her for the sake of my job, but never did I develop a close relationship with her. Finally, I am not the only one who is questioning doing this. There's 4 other PCAs that worked for her around the same time I did who have kept in touch with all of us and have discussed reporting her together anonymously.

So, I didn't want opinions about my past relationship with her or assumptions made. All I was hoping for was for someone to read the information I gave and to let me know if any of this is worth reporting. The fraudulent paperwork and grants? Leaving her daughter home alone? Etc. And if so, how do I, and other PCA's, go about reporting it?

meanmaryjean, DNP, RN

Specializes in NICU, ICU, PICU, Academia. Has 44 years experience.

Here's the deal: It sounds like you participated in the fraud part re:falsifying time cards.

Mommy&RN, BSN, RN

Specializes in Med/Surg & Hospice & Dialysis. Has 6 years experience.

I agree with Meanmaryjane. If you accepted government funds from having extra hours tacked on to your pay, you benefitted from the fraud.

She's definitely not the first parent to take care of her child after drinking. If that was negligent, I wonder how many people would "pay a fine" as you are suggesting for the mother.

I think she is committing fraud, but your hands aren't clean either.

If you participated in the fraud in any way, you need to keep your mouth shut and learn your lesson. The time to do any reporting was at the beginning when refusing to become part of the problem instead of part of the solution to the problem. All you are doing is implicating yourself.

You state that you abandoned your patient and you want to report this woman?!!! Think!!! I certainly would not be letting anyone know that I had abandoned a patient in the past were I getting ready to take the NCLEX!! You are asking for trouble, for yourself. If none of this was important enough for you to take the appropriate action at the time it was occurring, nobody is going to do anything about it now, unless they take a good look at YOU. There are time frames for reporting neglect and abuse and they are hours, not years. You need to let this go and learn from it.

I in no way EVER abandoned her. I never left her alone and did not quit without training in 2 new PCA's first, even thought she already had several others. That was a very unnecessary accusation! I don't understand where you got that idea from. I in no way participated in fraud myself either. She is the one that filled out my time cards and submitted them. This did not keep happening either, after I learned of her doing that for me, I told her I preferred not to use my own money and get "reimbursed." I think readers are taking all of this in a wrong way.

If you were "reimbursed" just once that can be used against you for fraud. Even if she did turn in the time sheet herself you could have told your agency that you only worked this amount of hours and were over paid. I agree with the above posters I would keep my mouth shut if I knew I didn't exactly have my ass covered 100%. I was in a similar fraud situation. My pts parent wanted to sign my time sheet as working 30 hours a week while I would come in 10 hours a week and we would split my 20 hours pay. I told her oh sure(it was my actual first day as a new grad nurse, now I know how to react in a situation like that) but as soon as I got to my car after work I called my boss and told her I had to speak to her in persona. The next day I told my boss everything that had happened.

nursel56

Specializes in Peds/outpatient FP,derm,allergy/private duty. Has 45 years experience.

The issues with her nonprofit and grants are really none of your business. You are not an expert on that and I wonder why you even have knowledge of it.

If you let someone else fill out your time sheets nobody will take your claims of fraud seriously.

Not having cute or age appropriate bedroom decorations isn't neglect. The mom may have had PCAs do things she could have done, but the child had the care so was not neglected.

If you and your friends are hell-bent on pursuing a vendetta against this mother I know every state has tip-lines or what-have-you for that reason. I have to be honest though. Your apparent outrage a year after you've left this case after working there for 5 years just doesn't sound above-board.

SDALPN

Specializes in Peds(PICU, NICU float), PDN, ICU.

This sounds fishy. This doesn't add up at all. Just being honest and offering an honest opinion. Your story doesn't add up. Your story comes across as someone who got burned and wants to retaliate. This should have been reported a long time ago. You are just as responsible for the neglect and issues by not reporting them. You say you are becoming a nurse. I wouldn't want to work with a dishonest nurse who isn't concerned about a patients care until 5 years of issues have gone by.

You need to report this. You will probably be held accountable. But better now, than when someone else catches it and reports it. You will be in worse trouble. Also, you have posted it on the internet for the world to see. If any fraud investigator comes across your post, they can find ways to find out who you are. You may have ruined your nursing career before it ever started. You can report the issues to your states version of cps and you can report the fraud to whoever insures the patient.

Your post has tons of red flags. In my opinion, this is so bad that I hope you are a troll and this isn't real. But I have a bad feeling this really happened. This is wrong on so many levels.

CloudySue

Specializes in Pediatric Private Duty; Camp Nursing. Has 6 years experience.

Just playing devil's advocate here, perhaps the OP didn't even realize that the situation was really that bad until she learned more about everything in nursing school. Perhaps a series of "aha" moments made her realize she was part of something gravely wrong, not just going along with a bit of fudging here and there. I know it's easy for us to think "Hey, everybody should know these things no matter what your job is" but the fact is, HHAs are not privy to much of what nursing and the legal implications really entail. It's a rabbit hole that goes much deeper than simply giving meds and treatments!! Let's give her credit for wanting to do something about it now. If we scare her off she's not going to come back for any help. What's done is done. Let's help her move forward and be the better person and nurse that she aspires to be.

CloudySue

Specializes in Pediatric Private Duty; Camp Nursing. Has 6 years experience.

One more thought... going on the theme of assumptions here, I can also assume that the OP might be a young person, and perhaps started working w this client right out of high school. A young person can learn and mature quite a bit in 5 years. After all, she no longer works with this client. At some point she drew the line and made a run for it. I'm not condoning anything or siding w anybody. Just sayin'.