Still being charged for meds after discharge

[Eschell2971, BSN]

The pharmacy still sends meds to patients, long after they are discharged, sometimes for weeks. How can nurses & administrators stop this? Do nurses have a duty to notify discharged patients so they can correctly reconcile their medical bills?

I work in a skilled nursing unit. When patients are discharged, the admissions/discharge nurse sometimes (ok, many times), forgets to notify the pharmacy by faxing over a copy of the discharge orders.

When this happens, we continue to get medications for patients that have long been discharged and/or deceased. These patients are still being billed/charged for these medications, even-though they are not receiving the medications. Also, this is an extreme waste of resources, as we all know how costly medications are/can be?

What is my responsibility? After the patients are discharged, I'm told, "It's hard to get the physicians to re-write a discharge order, because they may not even remember the patient." Also, the patient chart is no longer accessible on the unit, and it's really a HIPAA violation to go back into a patient's file after being discharged.

It seems when I notify the supervisor and/or unit manager, there is nothing being done. I'm relatively new at this facility and from one or two of the good nurses, one of them was my preceptor, I'm told, "Nothing changes around here."

Again, what is my responsibility. Even if we send back the meds to the pharmacy (unopened), the patients are still being charged and, the meds still go to waste. I think this is a gross waste of resources, not to mention a non-compliance, possibly ethical concern.

Is there a way I can legally, ethically, notify my patients about this so they can reconcile their medical bills? I understand that the main problem is the broken loop in my facility, but, I also feel a sense of obligation for my patient's medical bills. I know if I start asking questions, this will cause some to feel threatened, but, so what?

I have even re-faxed notice to the pharmacy, but, the meds keep coming. I was also told that even if we fax over notice to the pharmacy and/or call them, the pharmacy will continue to send meds until the physician sends over a discharge order.

[amoLucia]

You really can't go back some way and notify pts but ...

Is your discharge order something that can be written as a telephone order that could be faxed over at the time of discharge?

I would be concerned for the facility for their role as part of a potential fraudulent practice.

I hate to say this, but maybe the responsibility for the discharge order should become part of the unit's discharge protocol - that is, the floor nurse/charge nurse whose unit is discharging the pt needs to be the one to make sure that that part of the dc process is completed.

That should be part of a chart audit for discharges. I mean we used to do audits for admissions, why not for discharges? That's freq a QA issue or for medical records.

Just a question - is your unit in a hospital or a LTC/NH facility?

[txbornnurse]

The pharmacy has no way of knowing when a patient is discharged unless the facility notifies them of that fact. Most of the facilities that I provided QA services for while working for a closed door pharmacy had a discharge sheet that they faxed to the pharmacy as part of the discharge process. It contained patient name, DOB, room number and date of discharge. It takes a minute or two to fill out and fax it. Easy way to fix this problem.

[xoemmylouox, ASN, RN]

This problem can actually get your facility in a bit of trouble. I'm surprised there isn't more concern about this. Do you have a compliance officer? If so they should be made aware of the issue.

[ApotheKitty]

Are you sure the meds that are sent back to the pharmacy unopened are wasted or discarded? I'm currently an RN student, but I was a Certified Pharmacy Technician for 9 years until this semester, most recently at a state run residential facility for developmentally disabled individuals. The scenario you described happened very frequently, and for a variety of reasons, we would dispense to units sometimes very expensive medications that were no longer needed. Once these medications were returned unopened, we returned them to our stock and the patient billing was reversed. I agree it would be unethical and also illegal if insurance companies/Medicare/Medicaid paid out for medications not received by patients. I applaud you for being concerned about this matter at your facility. Having been on the "other side of the pharmacy counter" for many years, I have not seen many healthcare professionals ever worry about medication billing and its legal and ethical implications. I would suggest calling the pharmacy at your facility and asking them how this matter is handled on their end, and if charges are indeed reversed when unopened meds are returned. A good pharmacist or technician should be able to explain their procedures for this, or find out for you if they don't handle billing themselves. I hope my prior experience with this type of situation helps.

[Mia415]

wow interesting situation, and all good advice here. If you can call the pharmacies as stated above, and clarify their perspective on this, perhaps you can push to change discharge policy at your facility to avoid it. easier said than done lol but if you want to put in the time and energy and have ANY success in addressing this issue, that is something amazing to put on your resume and mention in all your futures interviews as a great example of leadership, system change, and advocacy! best wishes to you and your facility.