what do you do when you find out information about a pt from a source outside of work that directly affects the pt's care?
*edited to add more info*
the information relates to possible fraud by the pt and wife. i am concerned about my liability if it's discovered that i knew and said nothing. i did not discuss the pt with anyone, the source coincidentally knows this person and had another reason to talk about him; i just happened to realize during the conversation that she was talking about my pt.
Tazzi, I agree with another poster. Get RM or legal department on it if you feel this affects the agency claims for care provided. The have ways to check on info to cover the company and protect the business IF they feel it is warrented.
If I'm understanding this correctly, you have Information A, which came from the wife. The person you call the source stated Information B and said that it came from the wife as well. A and B conflict and place in question the merits of the claim. Neither A nor B have a diorect bearing on the medical aspects of the case.
If this is correct, you have no obligation to report anything. Not only that, but you would be wise to take a giant step back and pretend you never heard a word.
Information B is hearsay. It comes, not from the original source--the wife--but from another party entirely. You cannot vouch for its accuracy. There are all kinds of possibilities to consider. Was the wife bragging? Do she and the source have any sort of "history" that could influence the way the words were spoken, heard, or related to you? Is there a conflict among the involved parties that you know nothing about?
The situation would be different if you heard both pieces of conflicting information from the wife or the patient. First, you would be reporting something firsthand instead of hearsay. Second, the people in question would be your direct responsibility and you could speak to those within your agency without violating confidentiality. It would be a closed circle, so to speak.
You would also have a different situation if the information involved the patient's health. Even then, you would have to tread very carefully with secondhand info, but you would probably feel more urgency to act.
Should your source ever mention this again, you might suggest that they contact someone else (let them figure it out) if they are so inclined. Then change the subject. If the source isn't complaining about the situation but merely gossiping, change the subject anyway and hope you have a short involvement with the patient in question.
It's on the conscience of the people asking for the care, not yours.
Tazzi, I agree w/ the posters ... risk management needs to be involved. You got this information from a third party, not the pt him/herself. Do you think you're the only one this person has shared the info with? In any investigation, it can be proven that you had knowledge of the possible fraud. This leaves you and your employer open to all kinds of problems, I should think.
Perhaps, if you don't trust your risk mgmt people, you have an attorney of your own with whom you could discuss this. That discussion would be confidential under attorney-client privilege. He/she might even be able to help with any notifications that might happen, keeping you out of the middle (lawyers make great middle-men!). Lawyers are expensive but this is just the kind of situation in which they earn their money.
A third course might be to talk to your pt. While this would "out" you as one who knows about the possible fraud, it might also lead to the pt giving up the plan and prevent any fraud from actually occurring. After all, you got this from a 3rd party ... seems like this plan isn't as secret as the pt would like. S/he might not even really be aware that whatever s/he's doing is fraudulent. Pretty risky for you, though, personally and professionally.
You're a smart lady and an ethical person ... I know you'll do the right thing, whatever it turns out to be. Courage!
taz, i have to respectfully disagree with you about it being gossip. gossip is the discussion, of an intimate nature, behind someone else's back. it does not have to be malicious, or even untruthful. you said "the source coincidentally knows this person and had another reason to talk about him; i just happened to realize during the conversation that she was talking about my pt." so, unless you were in an authoritative position (basically, the person that this incident should be reported to,) there was gossip involved; and, you are under no obligation to go any further with the information received. the reliability of the source has no bearing on the information given to you in this form of conversation, since your source had no legitimate reason to be discussing this matter with you in the first place. thinking that you wouldn't know who was being discussed isn't a legitimate reason to be discussing something about him/her. techinically speaking, we are all gossiping about the source and your clients right now. even though our intentions may be to help, we really are gossiping.
I have to agree with Loricatus. What you've got is heresay. It may or may not be true, but you have no evidence that this is true, no matter how reliable you believe the source to be. For all you know that source could have a hidden agenda in saying what s/he did.
If you personally witness something that is contrary to what the wife said, then I'd say you might have to talk to someone. Going by what a third party says could land you in bigger hot water than if you say nothing.
i know better than to reveal the source. and i did not communicate about this pt. the person who told me does not know the pt is mine, does not even know i know him. it's a whole sticky situation that honestly belongs in a soap opera, because if i weren't involved in this i would never believe it would actually happen!!!!
lol sounds like something that would happen to me. hang in there.
Every response seems to think that what the pt said was a lie and what the third party said was the truth,but what if the pt told the truth.How did this third party find out this info?It doesn't sound like it was anybody's business but the pt's.Why would the pt tell someone something that could get him caught if he was planning to commit fraud?
If I was really concerned about this I would speak directly to the pt and ask him,tactfully of course.
trust me, please.....it wasn't gossip. i can't say anymore without going into details that i can't go into, so i will drop it now. thank you all for your input.
Ever hear of 'heresay'. If a person IS indeed trying to do anything fraudulent, they wouldn't hesitate to sue you for slander. So, if you don't know something to be fact, I personally would keep my mouth shut. I wouldn't think fraudulent activity is going to affect the type or amount of treatment a patient needs. And lucky for us, who hear the 'hearsay', the MD decides on type and amount of treatment based on the diagnosis that they come up with. But, I wouldn't hesitate to pass on appropriate assessment data to assist the MD in making a final diagnosis. :)
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Tazzi, I agree with another poster. Get RM or legal department on it if you feel this affects the agency claims for care provided. The have ways to check on info to cover the company and protect the business IF they feel it is warrented.
Good look!
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