Medicare fraud

klone, MSN, RN · Sep 15, 2016

Avoid and Report Medicare Fraud and Abuse

To report Medicare fraud or abuse, you can do any of the following:
Call the Medicare fraud tip line at 1-800-HHS-TIPS (1-800-447-8477). The TTY number is 1-800-377-4950.
Email: You can also send up to 10 pages describing the incident to [email protected].
Fax your report (up to 10 pages) to 1-800-223-8164.
Mail the report (up to 10 pages) to Office of the Inspector General HHS Tips Hotline, P.O. Box 23489, Washington, DC 20026-3489.
Florida residents only can call 1-866-417-2078 or email [email protected] to report abuse or fraud. This agency investigates and prosecutes those who intentionally defraud or abuse the state of Florida's Medicare system.

allnurses Guide · Sep 15, 2016

Good on you, Magnoliaflowers..." look the other way" is the prevailing attitude with so many of our peers in home health as well. :up:

Buyer beware, BSN · Sep 18, 2016

I've been at this facility for 2 years. There have been some questionable things going on but this last event is Medicare fraud with possible injury to the patient. Mrs Doe our elderly patient is admitted to the LTAC for UTI. She is placed on oral antibiotics post UA collection. UA comes back normal. The docs have been told to find a reason to keep the patients for the 25 day stay. Mrs Doe is then prescribed an IV antibiotic for 7 days. Mrs Doe is stuck 6 times to obtain IV access. That was my last day and I've been off two of my three days. I'm hoping sincerely she does not have a PICC when I return. This has bothered me all weekend. The patient should have been discharged. We do a lot of wounds and are quite good at what we do but we are a tiny facility that has had low census for a while. Your thoughts are appreciated.

Lots of weird here. 1. A person with a UTI alone doesn't sound like they would meet criteria to be admitted to an LTAC. 2. U/A comes back normal. So no UTI. Why keep her there for 25 days? (I know it's a rule to maintain LTAC licensure) but no apparent medical reason to keep her based on the information provided.

4. Even if only placed on oral Abx, she could be discharged home. (providing nothing else wrong with her)

So you think this may be a conspiracy to plunder Medicare? Could be. Is this a pattern you have consistently seen?

"The docs have been told to keep patient," by whom? Need more information. But depending on your state there are intermediaries for Medicare issues. For instance in Florida it would be FMQAI= Florida Medical Quality Assurance INC. So your state will have an analogue entity you can report concerns to.

Make sure your heart and facts are true on this one because you want to be a credible historian.

You say you have seen other questionable things, as well. I have always believed that our first responsibility is to advocate for the patient above all else. Unfortunately, in a situation like this, when push comes to shove, you will find out whether that ethic holds true for your institution and colleagues or it is just self serving lip service to give misguided solace to those functioning in a corrupt system. I hope this is not true.

Good luck with this and tread softly and carefully.

Buyer beware, BSN · Sep 18, 2016

I've been at this facility for 2 years. There have been some questionable things going on but this last event is Medicare fraud with possible injury to the patient. Mrs Doe our elderly patient is admitted to the LTAC for UTI. She is placed on oral antibiotics post UA collection. UA comes back normal. The docs have been told to find a reason to keep the patients for the 25 day stay. Mrs Doe is then prescribed an IV antibiotic for 7 days. Mrs Doe is stuck 6 times to obtain IV access. That was my last day and I've been off two of my three days. I'm hoping sincerely she does not have a PICC when I return. This has bothered me all weekend. The patient should have been discharged. We do a lot of wounds and are quite good at what we do but we are a tiny facility that has had low census for a while. Your thoughts are appreciated.