nightmare HHA to work for (long vent)

caliotter3 · Sep 29, 2011

No, it is not typical. Off direct deposit in advance of any demands to come in, here's my letter of resignation. That would be my answer to them. It is one thing to be requested to come in to correct notes, blunders on your part, quite another to put up with repeated demands based upon somone in the office "discovering" another aspect of nursing notes not previously addressed by the QA person. You are being taken advantage of because the QA person does not know how to do their job. The other questionable practices are just icing on the cake. Step up your job hunting efforts. They are messing with your pay for someone else's lack of competence, they have no respect for you. Go.

Isabelle49 · Sep 29, 2011

I have one word for what your DON has you doing, but getting recerts, etc. signed by patients without appropriate clinician doing the assessment - FRAUD! By getting any of these signed without the appropriate visit you are included ind the Fraud.

hopesgramcracker · Sep 29, 2011

thanks for the responses so quickly, i have stressed about this for months now, i walk around with a lump in my throat thinking that i am not adequate, i feel like i am in this abusive cycle that i can't get out of. the only option i have is to not see my pts for the week and take my money out of my account on friday morning (so she can't take it back out) and then quit on friday afternoon. i have put my visits for this week off (they go into next pay period) until friday and saturday and i feel terrible because i will not be seeing them but it's the only way to leave that place because i know i won't get my check if i give a two week notice. all of my notes are caught up as of last night. two weeks ago they were caught up and then this happened again so i don't have a choice but to do it this way. i feel better that someone understands. thanks again

KateRN1 · Sep 29, 2011

This is not a vent, it is a valid concern. From what you describe, it sounds like there are some serious issues that need to be addressed.

I've noticed in home health that quite frequently there are few requirements beyond "warm body with license" for QI and DON positions. Unfortunately this only serves to cause problems such as what you are experiencing. It sounds like the QI nurse and possibly the DON are learning on the fly and passing this on to you. Not illegal, but terribly unethical and bad for the agency overall as it results in poor relationships with employees. Your QI and DON nurses should be effective resource persons with oodles of experience in home health, not beginners.

However, the issues you describe with taking HHABNs and OASIS forms for signature can certainly be fraudulent. The OASIS form is an assessment and should be signed by the patient during the RN's visit. If the patient didn't sign the form at the time of the visit, there's a good chance the visit was not made, the assessment not done, therefor fraudulent. However, it could also be that the assessing clinician did not know that the patient had to sign the form. If it's the former, then yes, it is illegal and would be considered Medicare fraud.

Recerting Medicare patients who are not homebound is certainly fraud, but you must first be certain that the patients are not homebound. If the patient is participating in social activities outside of the home or there is not a taxing effort to leave the home, then the patient is not homebound. If the patient is going tothe senior center to play bingo daily, or even weekly, then no--not homebound. But, if the patient is going to the pharmacy to pick up prescriptions or to obtain health care, then the patient is still considered homebound if it is a taxing effort and requires the assistance of another person or an assistive device. Patients who simply don't drive aren't necessarily homebound, and patients who do are not necessarily NOT homebound. it all depends on the amount of effort that is required, use of assistive devices, and frequency. This is often a gray area for beginners to home health care. If you are struggling with this, make a list of reasons that the patient IS homebound and a list of reasons that the patient is NOT homebound and see which way the scale tips.

If your most frequently referring physicians are under investigation or have been indicted for Medicare fraud, then you are probably in a very scary place and need to bail ASAP. The OIG does have a hotline for Medicare fraud 1-800-HHS-TIPS (1-800-447-8477). It is completely anonymous so if you don't wish to leave your name, you don't have to.

Best of luck to you and let us know what happens.

(You're not in Miami are you?)

hopesgramcracker · Sep 29, 2011

Thank you KateRN for validating this, I have been struggling with this for some time. The DON who is the owner of the company does the SOC's, Recerts etc for all my pts when I bring back the signed forms which I know is wrong. On occassion she does go out to the home to get a recert herself but thats when I have suggested a discharge (talk about milking the system). She has been in business for two and a half years so I know she is still learning, as a matter of fact she sits in the office all day reading guidelines for Medicare. As far as the homebound and nonhomebound goes, I have passed up my pts on the road and have pulled up next to one of them at the grocery store, one goes to college on campus, one goes camping on the weekends, and one goes to the liquor store and grocery store. I have told her this numerous times but it falls on deaf ears, as a matter of fact our contracted OT discharged one of them because she saw him driving. Oh one thing I forgot to mention, she hired one of the office managers (as a marketer) from the clinic that was shut down due to fraud. They are calling all the old pts from that clinic and sending a new home physicians group if they still want our services. Basically they are telling the pts "you have a new doctor and we will still be your home health care agency" but they still have a doctor in town that was not part of the indictment. Most of the pts were seeing the PA's in which have all scattered like roaches after the arrest. The DON does not have any clue that I know all this, she has never had a meeting to discuss this and what to tell all of our pts. To me thats just shady.

KateRN1 · Sep 30, 2011

One phone call is all it takes to get the ball rolling. However, the OIG can take years to investigate cases if they don't have any kind of documentation or someone willing to talk to them about the complaint. If the agency is a franchise, calling the franchiser may be all it takes to put a stop to it, but it doesn't sound like that's the case.

Be aware that you should be documenting homebound status on each and every visit note. Keep careful records of who you notify and when and write up case conference notes if you have them. Keep a copy of all of your notes for yourself.

If you want more information on how to protect yourself in a situation like this, feel free to PM me and we can talk privately.

Isabelle49 · Sep 30, 2011

I would definitely make the call on Medicare fraud, you might get a percentage reward! Make it worth your while!

MaheaRN · Oct 1, 2011

As a home health nurse, I can tell you by experience how difficult it is to remain in compliance. MCR spins even the most dedicated. It is completely normal to go in with entirely good and honest intentions and find yourself having to well...do somethings that make you want to run far away. There will always be compliance issues and questionable requirements but that's why home health is a GREAT challenge. I have been in the heart of it for 2 years now, and am learning new things every single day. We are forced to check, double check and triple check everything we do, and believe me when I say this; it is like playing the hardest chess game ever... stay at least 5 steps ahead and you just may be ok.

If your supervisors/DON are not on the same wavelength as you are, protect YOUR license and quit on the spot.

MaheaRN · Oct 1, 2011

:nurse:As a home health nurse, I can tell you by experience how difficult it is to remain in compliance. MCR spins even the most dedicated. It is completely normal to go in with entirely good and honest intentions and find yourself having to well...do somethings that make you want to run far away. There will always be compliance issues and questionable requirements but that's why home health is a GREAT challenge. I have been in the heart of it for 2 years now, and am learning new things every single day. We are forced to check, double check and triple check everything we do, and believe me when I say this; it is like playing the hardest chess game ever... stay at least 5 steps ahead and you just may be ok.

If your supervisors/DON are not on the same wavelength as you are, protect YOUR license and quit on the spot.

hopesgramcracker · Oct 1, 2011

Can someone tell me if the ABN form needs to be presented by the RN who does the soc & discharge OASIS or is it legal for me as an LPN to present a blank one to the pt and should the information such as services not being covered and costs etc, be listed on it as well?

KateRN1 · Oct 2, 2011

The HHABN should be presented at the time that the services are reduced. The discharge notice (aka Notice of Medicare Non-Coverage or EDN) should be presented at least 48 hours prior to the date of discharge or it is null and void. Both the EDN and HHABN are intended to give the patient the opportunity to dispute the reduction or cancellation of services. In either case, the forms should be completed prior to the patient signing them. Under no circumstances should a patient be asked to sign a blank contract of any kind.

See the Instruction manual if you need ammo:

http://www.cms.gov/BNI/downloads/HHABN%20Instructions%20effective%209_1_2006.pdf