Probable Fraud. What do I do?

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Im going to try to keep this short. I am a manager at a home care company. I had a patient who passed away, however his nurse submitted a visit note for 2 days after he passed. I spoke with her, she has since given me 3 different stories about what happened, the most recent being that she saw the patient earlier in the week and forgot to change the date. I don't believe her. My bosses do believe her and want to do nothing about it. We are due for our DPH audit literally any minute now and I am nervous about doing the wrong thing. What would you do?

Consult with an attorney through your malpractice carrier.

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Specializes in CMSRN.

Oh WOW!. When I worked in home health, every visit had to have a patient or family member sign to confirm a visit was complete. It was all done electronically and trying to document days later would have NEVER been okay. While this person may not have been trying to commit fraud, this was absolutely an unacceptable thing to do in my book and I think a PIP is the right thing to do.

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