Medicaid paid company, but company didn't pay me! ADVICE PLEASE!!!

enuf_already · Nov 3, 2014

From what I know, it is illegal to withhold pay for hours worked. Did you leave the house while you went to lunch? If so, were you gone for an hour?

Did you get a copy of your employment contract? If not, I'd go to the office and not leave until I had one. Then I'd call the labor board.

Check out dol.gov or your state's labor board for rules.

If you are 'taking lunch' but are actually working or watching your patient while you are eating, you are not taking lunch.

caliotter3 · Nov 3, 2014

I would suggest that you consult with an employment attorney after you consult with your local labor board. If the labor board takes care of the problem, then you may feel that speaking to an attorney is not necessary. And it goes without saying, find a new employer.

lifelearningrn, BSN, RN · Nov 4, 2014

My suggestion is first- start looking for another job. These people don't sound like they are on the up and up. Second, tell them that you will be bringing this up with the state for labor violations, and third, let the know that will probably throw a flag up with medicaid, and will likely mean an audit.

No company likes state getting involved. My bet is you'll get that money on your next check.. but you probably want to be on the lookout for another job.

SDALPN · Nov 4, 2014

Ok, so I just graduated nursing school then passed the NCLEX... I got hired over the phone with a "home health agency" although I actually am a private duty nurse doing 8-12 hour shifts. The service is paid for by medicaid. Medicaid pays my company and then the company pays me. I clock in and out using the clients mothers phone (my client is pediatric).
On 2 separate instances (once in August and once in September) the clients phone was unavailable, so as instructed by my supervisors, I called management, with the fathers phone, and they were supposed to clock me out. In BOTH cases the managers never clocked me out and I received a call from the office the following mornings wanting to know why I had not clocked out. I never got paid for these two days. I spoke with the owner of the company numerous times and she insisted they would be on my next paycheck. But paycheck after paycheck came and the hours were never added.
Then, the owner calls me just last week and tells me she will not be paying me for those two days as she had just found out I have been taking a lunch break. I was told by the woman who hired me, the pt's mother and the nurse who has been working for this company that lunch breaks were allowed. There is NOTHING in my contract that says we are not allowed a lunch and I have not even taken a lunch everyday. I might get to take a lunch 2 days out of 5 that I work. I spoke with the medicaid case manager about it and she said the company was paid for all of my days, including the two where the office had to manually enter my departure time the next day. The owner of the company said that the only way she will pay me for the two days is if she goes back from my start day (over 6 months ago) and takes 1 hour lunch out for every day... Which would make me owe her money!!!!
So just to summarize, the company was paid during every lunch I took, and was also paid for the two days where my managers did not clock me out, but I was not paid for the two days because "of the lunches" i have taken. I am no longer taking lunches now that I know that it is not allowed, but I was counting on that money and I feel its not fair that the company was paid for doing nothing while I am being shorted for almost 25 hours of work! I am still a new nurse, this is my first nursing job and I just feel like it isnt right.
They have hired 7 nurses total for this case and I am the only nurse who has stuck with it. The rest of the nurses quit due to pay issues as well, but this has been my first negative experience. I have had several people tell me they are not allowed to just take my pay like that. Does anyone know legally or from any aspect how all this works?
Thanks in advance for your help!

First mistake, new grads don't belong in PDN (home health is visits, PDN is shifts. Neither are good for new grads).

Next, this is PDN...you don't get a lunch break. You work straight through your shift and eat as you can. Insurance requires you to be in the same room with the pt at all times. If you aren't doing this and you are taking a break away from the pt to eat while still getting paid, its fraud. It also means you left your pt unattended. If a parent is giving you a break and you leave for a lunch break, you must clock out.

We can't give you legal advice per terms of service. If that's what you are looking for, you should contact a lawyer or use your local resources such as the labor board, and insurance compliance line.

This stuff happens all the time. This is one reason why new grads don't belong and why its important to know insurance requirements and how PDN works. Medicare/medicaid also requires one year of nursing experience (although that could possibly vary by state). If you are representing yourself as a nurse with a year of experience, that is fraud in some states. Sounds like you are learning a tough lesson and you have much more to learn.

You would be better off working in a facility for a while and learning how things work before trying PDN. Learning what insurance requires of us will also help. Nursing school doesn't teach this stuff. Nursing school just gives you a snapshot of the larger areas of nursing. Nursing school gives you the minimum you need to know to be a nurse.

Good luck.

brillohead, ADN, RN · Nov 5, 2014

Okay, lots of stuff being said here that needs to be clarified.

First of all, what does "taking a lunch" involve?

If you left the home, you needed to clock out and clock back in and not be paid for that time, unless you have an employment contract that states that meal breaks will be paid in full. If you just sat down in the home to eat your brown bag lunch but were still available to care for the child while doing so, then you did not "take a lunch break" -- you were still on-duty and available to care for the patient, so you need to be paid.

Secondly, insurance does not require you to be in the same room as the patient at all times -- that's pretty darn preposterous.... am I supposed to put my 16yo male patient into the Hoyer lift and drag him into the bathroom with me every time I drain his urine bag after cathing him, or if I need to pee myself? If I need more briefs from the boxes in the basement, am I supposed to strap him on my back and carry him piggyback style down the stairs to go fetch the necessary supplies? However, you do need to be AVAILABLE to care for your patient at all times, present in the home and able to hear alarms, etc.

Obviously, if you leave the home to go get lunch somewhere else, you're not available to care for your patient. But sitting down to eat where you can see/hear alarms and get up to care for your patient if needed is totally different and totally allowed.

Finally, the issue of whether the agency got paid for the days has no bearing on labor law --- if you did the work, you are entitled to the pay. It would, however, behoove the agency to make sure that what they've billed to Medicaid matches with the work that was actually performed.

SDALPN · Nov 5, 2014

Okay, lots of stuff being said here that needs to be clarified.
First of all, what does "taking a lunch" involve?
If you left the home, you needed to clock out and clock back in and not be paid for that time, unless you have an employment contract that states that meal breaks will be paid in full. If you just sat down in the home to eat your brown bag lunch but were still available to care for the child while doing so, then you did not "take a lunch break" -- you were still on-duty and available to care for the patient, so you need to be paid.
Secondly, insurance does not require you to be in the same room as the patient at all times -- that's pretty darn preposterous.... am I supposed to put my 16yo male patient into the Hoyer lift and drag him into the bathroom with me every time I drain his urine bag after cathing him, or if I need to pee myself? If I need more briefs from the boxes in the basement, am I supposed to strap him on my back and carry him piggyback style down the stairs to go fetch the necessary supplies? However, you do need to be AVAILABLE to care for your patient at all times, present in the home and able to hear alarms, etc.
Obviously, if you leave the home to go get lunch somewhere else, you're not available to care for your patient. But sitting down to eat where you can see/hear alarms and get up to care for your patient if needed is totally different and totally allowed.
Finally, the issue of whether the agency got paid for the days has no bearing on labor law --- if you did the work, you are entitled to the pay. It would, however, behoove the agency to make sure that what they've billed to Medicaid matches with the work that was actually performed.

They actually do require you to be in the room at all times. They of course allow you to use the bathroom. But sitting outside of the room and things like that aren't allowed.

I'll add that if someone is clocked in and not with the pt and something goes wrong, the nurse is held responsible.

psu_213, BSN, RN · Nov 5, 2014

They actually do require you to be in the room at all times. They of course allow you to use the bathroom.

Those two statements are contradictory. Plus, in all fairness to Brillo, your first post did make it sound like you can never ever under any circumstances let the client out of your sight.

LadyFree28, BSN, LPN, RN · Nov 5, 2014

Those two statements are contradictory. Plus, in all fairness to Brillo, your first post did make it sound like you can never ever under any circumstances let the client out of your sight.

This.

In my experience of working Home Health PDN (yes, that's and appropriate title), you are allowed a lunch break and should be paid for the hours worked; one should NOT be working straight time and not being paid, OR not getting a break at all; in my experience, I also have arranged time to have a break, even when I am with a patient alone in the house, as well as bathroom breaks.

I will also add, I began my career as a new grad; granted, I was given a very thorough orientation and didn't have any complex cases (ie vent cases) until a year later, and went to a class and subsequent CEUs before taking cases.

The positives of PDN, is the honing of autonomy, advocacy and pt/staff education; you do get to hone some very important skills for your practice, but no two agencies are alike, and it is not for everybody.

I suggest, OP, that you find another agency that values their employees and follows proper labor laws.

SDALPN · Nov 5, 2014

This link has the info that explains that the agency is responsible for making sure that the nurse has a year of experience/training. I'm still looking for the link about staying in the same room.

I'm just stating what the rules are. I don't make them, I follow them. I'm not a betting person, but if I were, I'd bet that the OP had no clue about all the documentation requirements on that link...but they are responsible for it even if they don't know. Many nurses don't realize this stuff. But its up to us to find out...the agency will never have our backs.

Edit: Forgot link http://www.google.com/url?sa=t&source=web&cd=2&ved=0CCAQFjAB&url=http%3A%2F%2Fwww.ncdhhs.gov%2Fdma%2Fmp%2F3G.pdf&ei=GZ9aVP6eL4uqgwT5_IPABQ&usg=AFQjCNGpQ9RQp3WDzMXSzlQEzoyf6bf5bA

SDALPN · Nov 5, 2014

This.
In my experience of working Home Health PDN (yes, that's and appropriate title), you are allowed a lunch break and should be paid for the hours worked; one should NOT be working straight time and not being paid, OR not getting a break at all; in my experience, I also have arranged time to have a break, even when I am with a patient alone in the house, as well as bathroom breaks.
I will also add, I began my career as a new grad; granted, I was given a very thorough orientation and didn't have any complex cases (ie vent cases) until a year later, and went to a class and subsequent CEUs before taking cases.
The positives of PDN, is the honing of autonomy, advocacy and pt/staff education; you do get to hone some very important skills for your practice, but no two agencies are alike, and it is not for everybody.
I suggest, OP, that you find another agency that values their employees and follows proper labor laws.

I'm not sure who you work for or what state, but getting a break like that is a rarity. And if you are taking a break on the clock with insurance, its fraud and it will catch up to you. Insurance is paying by the hour for pt care, not breaks. Now if the agency is paying you for your break, that us up to them and lucky you if that really is the case.

LadyFree28, BSN, LPN, RN · Nov 5, 2014

I'm not sure who you work for or what state, but getting a break like that is a rarity. And if you are taking a break on the clock with insurance, its fraud and it will catch up to you. Insurance is paying by the hour for pt care, not breaks. Now if the agency is paying you for your break, that us up to them and lucky you if that really is the case.

I worked for several companies that are nationally known and participated in Medicare and Medicaid, and I can assure you it is NOT fraud in terms of getting a break. :no: Labor laws don't go out the window; The agency has to adhere to labor laws AND CMS policies; interpreting as you have does nothing but cause misinformation and misinterpretation of what is the reality. :blink:

I have posted in the past with you and have provided CMS regulations in response of your usual posts; I behoove you to go to the CMS and Labor Website, not google, and get familiar with what they allow; you may have a case if your agency is NOT paying you for a break that you are not taking.