Medicare Fraud

[bwsvs]

HELP!! My employer is under an investigation for medicare fraud. Could my nursing licence be in jeopardy? I love my job but not enough to risk my license!

[leslie :-D]

HELP!! My employer is under an investigation for medicare fraud. Could my nursing licence be in jeopardy? I love my job but not enough to risk my license!

nope, not if you only did bedside care.

it is those who do the billing, that'd likely be investigated.

no worries on your part.

leslie

[ErinS, BSN, RN]

Actually, it would depend on if you were actively involved in the situation they are being investigated for. If the company is being investigated for false billing, and your documentation supports that false billing, you could be charged. If you actively took part in the Medicare fraud, you could be charged. It depends on what they are looking into as fraud.

[tewdles, RN]

I just read an article the other day about Southern Care accused and guilty of Medicare fraud, now paying a 40+ million dollar fine...

[SoCalRN1970]

Welcome to hospice and the nasty world of ADR's and medicare fraud.

There are pretty strict guidelines on what is disease specific for medicare and hospice qualification. LMRPs... disease specific lists essentially that show a patient is adequate and appropriate for hospice care.

One of my employers had a nasty habit of ignoring my requests for discharging stable patients who had NO decline month after month. What I learned to document was what I saw. IE, patient status unchanged since last nursing visit. Patient declines any distress, pain or symptoms otherwise not controlled... etc. I'd mention the supporting facts that I had, no changes in weight, no new orders or changes in plan of care. I'd document in a nurses note, will discuss with IDG possibility for discharge due to extended prognosis. That in itself takes you off the hook if they retain an inappropriate patient.

The simple comment, will discuss possible extended prognosis with IDG is enough to have the focus off you and onto the company who will not discharge a patient who does not meet needs.

[ErinS, BSN, RN]

So I had confirmation of this the other day. I am sort of a part of management and sit in on all interviews. We had a nurse come in who told us that their hospice had been disposing meds improperly. When the state (not Medicare, but I suspect it would be the same) came in and did an investigation, every nurse was put on 2 years probation and got a $1500 fine. She had not even taken part in the improper disposing, but she knew about it and did not report it.

So if you are concerned, it may be time to get a lawyer.

[Ginapixi, BSN, RN]

So I had confirmation of this the other day. I am sort of a part of management and sit in on all interviews. We had a nurse come in who told us that their hospice had been disposing meds improperly. When the state (not Medicare, but I suspect it would be the same) came in and did an investigation, every nurse was put on 2 years probation and got a $1500 fine. She had not even taken part in the improper disposing, but she knew about it and did not report it.

.

what do they consider improper disposal?

when my dad was on hospice i was told to just dispose of left over meds (that was 6 years ago)

now that i work hospice we hand out government guidelines for proper disposal to each patient/family; but many times the RN who pronounces gets to dispose; some of us use cat litter, some other means; some families do not want the meds in their own garbage! when i first started every one flushed every thing, i refused! and ow we are not to flush any longer-- Thankfully!!! they used to look at me when i was concerned about flushing meds down the toilet because they all go into the drinking water..... i still think pharmacies should have to take them back and properly dispose of them (i asked ours and they just flush OH NO!) the coroner on the other hand incinerates;

[ErinS, BSN, RN]

Improper disposal= nurses taking meds out of the home and returning them to the main office so that they may be redistributed (that is what the nurse that was happening, anyhow). Yikes!

[Ginapixi, BSN, RN]

Improper disposal= nurses taking meds out of the home and returning them to the main office so that they may be redistributed (that is what the nurse that was happening, anyhow). Yikes!

oooops no go!!! the pharma industry would not make enough profit so it is out-lawed!!! I wish we could send unopened meds overseas so they could be of use instead of discarding every thing!!! sad what a waste, but redistributing OUCH! i often throw meds in my car but then dump them at home in a big container (should not do that either, however they do get properly destroyed!)