Is is just me?

1) the insurance benefit is there, so "someone" is using it

2) doesnt sound like you will ever get caught for fraud, lol. Since you are reluctant to bend that rule....

If this is a medicare case, labs are only done if we are there for another skilled reason. Medicare no longer pays for home care visits to just draw a lab.

Patients/families typically want us to come draw their labs instead of going to the lab, but they will not hesitate to go to the mall, bingo, restaurant, casino, etc.

1) the insurance benefit is there, so "someone" is using it

2) doesnt sound like you will ever get caught for fraud, lol. Since you are reluctant to bend that rule....

The agency owner and/or administration is usually charged with fraud, not the individual nurse. However, the individual nurse can suffer such things as loss of pay, bouncing paychecks, etc. if the agency is caught, closed down, has its account frozen, has money taken back by medicare, etc.

If an agency is rampamt with fraud, it is in your best interest to move on to safer ground before they are caught and closed down. This does happen and will happen more in the future.

The agency owner and/or administration is usually charged with fraud, not the individual nurse. However, the individual nurse can suffer such things as loss of pay, bouncing paychecks, etc. if the agency is caught, closed down, has its account frozen, has money taken back by medicare, etc.

If an agency is rampamt with fraud, it is in your best interest to move on to safer ground before they are caught and closed down. This does happen and will happen more in the future.

This is what I'm thinking. I'm new to this, so I have no idea how often this is happening with the other cases but I'm sure I'm not unique. So, what do I do? Everytime I hear someone is going to Big Lots to go shopping, I tell my manager? I have before, and she says "they are allowed to do short errands". The labs I'm doing are usually PT-INR's and they're in part of the visit for post CABG - however, I still think that if the spouse can take the patient to church, or to the surgeon for a f/u appt, or out for a drive they can certainly take them to a lab. And, if the patient can go out and do these things, why are we seeing him, even is he is 2 weeks post CABG???

Me thinks it's time to leave.....but the question is, leave without another job on the horizon?

mc3

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This is what I'm thinking. I'm new to this, so I have no idea how often this is happening with the other cases but I'm sure I'm not unique. So, what do I do? Everytime I hear someone is going to Big Lots to go shopping, I tell my manager? I have before, and she says "they are allowed to do short errands". The labs I'm doing are usually PT-INR's and they're in part of the visit for post CABG - however, I still think that if the spouse can take the patient to church, or to the surgeon for a f/u appt, or out for a drive they can certainly take them to a lab. And, if the patient can go out and do these things, why are we seeing him, even is he is 2 weeks post CABG???

Me thinks it's time to leave.....but the question is, leave without another job on the horizon?

mc3

http://questions.cms.hhs.gov/cgi-bin/cmshhs.cfg/php/enduser/std_adp.php?p_faqid=9070&p_created=1207329475

This link will take you to CMS definition of homebound.

They can go to religious service and medical appointments.

Big lots - no. The absence from home must be infrequent and of short duration.

Thank you - this helps a lot!

mc3