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I think I'm in trouble...Please help. Im stressing

Posted

Specializes in Wound Care. Has 1 years experience.

So I work in home health as an LVN. I was assigned a pt back in April who I saw 5 times. The pt was then d/c. I submitted my route sheets and was paid. Yesterday I get a call from that pt saying she received her bill from her insurance company and she is being billed for several visits from the PT that were never done. I didn't think much of it and just told her to contact the office as they handle billing.

Today I get a call from my office saying that the pt called in and said they neither ME nor the PT every saw her. Now I know this lady is crazy because I have been to her house 5 different times, I have photos of her wounds as well as text messages between us setting up visits as well as photos of documentation that she received from her dr after a dr visits (I took photos for my records so I could chart on the info later). Not only that, but two times when i arrived at her home the PT person was leaving and our paths crossed so while I can't account for all of his visits I know he was there at least 2 times (The PT was from a different company then our agency.

Well my boss e-mailed me over my route sheets and asked me to get them noterized/confirmed and send them back to her so she can submit them to the patient and the insurance company to dispute the claims. No biggie I think....until I open the e-mail.

They have 5 visits from me 3 of the visits are clearly the pt's signature as they match my records...the last two visit look nothing like the pt's previous signatures and I can't find my copies of my route sheets. Now I am starting to freak out because I can't remember If this was a time I had the pt's mom sign for her or what. Clearly they are route sheets I submitted because my signature at the bottom where the nurse signs and all the writing on the form is mine...but it looks like either someone else signed for the pt or the pt did a different signature all together...

I went back and reviewed my charting on this pt and clearly I saw her these two days because I called in report to the office letting them know a medical concern I had with the pt, submitted photos backing up that medical concern and have a phone record of a call made to the pt pcp. My worry however is the signature on the route sheets...if the pt is saying Me nor the PT ever visited I don't want them to come back at me saying that I forged her signature because at this point that exactly what it is looking like...

I am so scared I don't know what to do.

Edited by pnkgirl25

Jensmom7, BSN, RN

Specializes in Hospice. Has 36 years experience.

I don't want you to feel like you're being lectured, because you're stressed enough right now. But for future reference:

Whoever signs the sheets needs to sign their name, not the patient's. It can be any adult in the home (family member, caregiver, etc.). The signature is, indeed, proof that the visit was made. Ideally, the patient should provide their signature, someone else signing should be the exception.

Take a breath, you have anecdotal information that indicates yes, you did those visits.

Frankly, it sounds like the lady is trying to weasel out of paying her portion of the insurance bill.

xoemmylouox, ASN, RN

Has 13 years experience.

What a mess. Either the patient has a mental illness or is not wanting to pay her share of co-pays/deductibles. You have a decent amount of proof. As the PP said the person who signs must sign their name, not the pt's name. It might have even been the pt, but perhaps they were busy and just scribbled? I know when I'm in a hurry my signature is not the same as when I have a bit more time. Don't panic.

Lev, BSN, RN

Specializes in Emergency - CEN. Has 7 years experience.

Be careful with the photos.....Good luck!

iluvivt, BSN, RN

Specializes in Infusion Nursing, Home Health Infusion. Has 32 years experience.

Do they not also have a record of the schedule and what your assignments were for those days? I know it is not as good as your signed nursing note with a patient signature but it adds to the mounting evidence that you made the visit! You do have a nursing note for the visit right? I find it suspect that she is claiming that both disciplines did not make visits . It is obvious she is either trying to get out of paying her share or has some kind of mental or cognitive impairment. Also when you get a signature other than the patient have them put what their relationship to the patient is

AnnieOaklyRN, BSN, RN, EMT-P

Specializes in ED, Pedi Vasc access, Paramedic serving 6 towns.

FYI NEVER take pictures of anything patient wise with your personal phone!!

Annie

Jensmom7, BSN, RN

Specializes in Hospice. Has 36 years experience.

FYI NEVER take pictures of anything patient wise with your personal phone!!

Annie

While that is definitely true, OP didn't specify if it was her personal or work phone. I'm hoping she sent them to the doc via a secure work email.