The Medicare/Home Health Mess in Dade County

[alain_johns]

Sorry if there is a thread on this topic already.

I briefly searched and didn't find one.

I'm a recent graduate, freshly licensed LPN living in Miami, FL.

I've been working home health for the past couple months and it's been very much so extremely beyond belief frustrating to the point of having a complete meltdown.

Apparently, Miami-Dade is the U.S. capital for Medicare fraud. No argument there. The number of shut down home health agencies can surely attest to this fact. But for us LPN's and RN's out in the field, doing our jobs, it feels like a nightmare.

Job security: None. Any agency is apparently able to be shutdown at the drop of a dime upon suspicion of fraud. In and of itself this is fine. Unfortunately, agencies here payout 1-2 months after the work you've done in the pay period. And if the agency you work for shuts down. Whatever work you've done up to date that you had not been paid for... ends up being charity work. The agencies claim their assets/funds get frozen and they cannot pay you for what ends up being 1-2 months worth of patient visits. Furthermore, you're expected to keep providing care to the patients until they've been reassigned to another caregiver. This does not feel right. Is it legal for us not to get paid for services already provided? Are we really liable for not continuing to provide care after the fact? I've searched and found no answers on the topic.

Wages: slashed in half. I get paid per skilled nursing visit as much as a Home Health Aid or CNA gets paid per visit. I've been told this is on account of Medicare's new rule/payout system on a per patient basis. My understanding was that this new rule/law has the purpose of eliminating fraud and effectively lowering the cost of home health to Medicare and is to go into effect as of January 2010. I've had my wage reduced by 50% since mid-November. The agencies I work for state Medicare did not pay out in full for my patients and therefore they cannot pay me anymore. Is THIS legit? I hear of other peers working for agencies that still pay the normal LPN-per-visit amount, or a bit less, but for the most part half. Did Medicare adjust their payout since November? Was the law not supposed to take effect until January? How can I find out? Can this be reported? At the same time, agency owners are always apt to remind you that if you're not happy with it you can leave. No doubt, there are so many LPN's in Miami right now ready to take your job, we've all become utterly replaceable at the drop of a hat. You can't corner your agency into showing you the monthly/quarterly statement from patient A because they will literally get rid of you right then and there. Extremely frustrating.

Where can I find this medicare ruling? How can I become informed of the actual changes? All you hear are rumors. Every agency sings you a different tune as to what Medicare pays out, when the change took effect/will take effect, why they can't pay you more per visit... UGH.

I try looking for a job. Most hospitals now do not hire LPN's. And the ones that do... good luck. With so many LPN's in Miami-Dade it's all up to who you know to get a job (most of the time).

Hospice won't hire me because I don't have 1 yr experience with my license.

Nursing homes are booked. On-call shifts but not much else for recent grads.

Home health agencies are closing left and right. Wages cut in half. No answers. Lots of questions. No clear and distinct higher authority to inquire with.

Anybody else going through the same?

Anyone can point me in the right direction with any of my questions? In any direction?

It feels hopeless. I'm stuck working home health. Making less than what I feel I should given my qualifications.

I understand that all this fraud has been going out and Medicare has paid out hundreds of millions to these agencies but... really? Now we all have to pay for it?

Am I just jaded and misinformed?

I am so frustrated.

[SmilesNoir]

I would contact my senator or US House rep and ask if this is true.

Also, I would write Medicare up in DC and ask the same questions.. The labor board in your county might be able to help.

If it is true, Wow!. If it's not true, Wow!

[erroridiot]

Florida is not the only place that the Medicare fraud mess is causing problems for nurses.

The Medicare mess in Florida is also happening in other states such as Texas, California and Michigan. Michigan in particular has been an area of focus for fraud in the Medicare home care industry.

I have had bounced paychecks from 2 companies in the last year and have worked for several agencies that are now closed. Medicare "freezes" the account of the company and there is no money in or out of the account. You can file a complaint with the wage and hour division of your state government or federal depending on the law in your state. If the company is bankrupt or closed, they will try to get the funds for you, but at times, there is no money to obtain. I was hit with bad check charges on 2 occasions. I was charged with the bad check fees, not the employer. (They knew they would get the fee from me, but not from the employer.)

Many agencies have and will in the future face scrutiny of their records over the entire country and have money taken back into the Medicare system for a variety of reasons such as failure to provide skilled care, inappropriate coding, overutilization of therapy, inappropriate recertification, too many visits, keeping the case open too long, and the list goes on and on. Some agencies will face loss of revenue due to a lack of knowledge and attention to Medicare guidelines (duh.....), and some will face the loss of revenue due to outright deliberate criminal activities.

If you are working in skilled home care, have you considered a move to a more conservative agency where fraud is not rampant? (These agencies are hard to find.) Have you considered private duty? I always keep in mind that the companies that boast of being "ethical" are usually the most heavy duty fraudsters you can find. They have ethics, but the ethics are twisted.

I went to an orientation at an agency yesterday and many of the nurses had driven 100-200 miles just to get to the main office for the orientation!

I don't believe in having just one job. I always have at least 2, or stay listed with more than one company. If a company I am working for wants me to "only" work for them, it is none of their business that I have another job.

I have applied for a couple of jobs in the past 2 months that were looking for LPN only. Since I am an RN, they wouldn't even consider me. One was a "cake" job in a clinic.

Jobs are hard to find for all right now. You do have some experience and keep applying at jobs that you find. I have applied at jobs I am not even interested in and found some work.

What makes Nurse Managers, Physical Therapists, Social Workers and home health administrators and owners cross the line and become obviously involved in outright criminal activity is beyond my understanding. Keep your eyes open, it is very common in the home care industry. The system was designed for easy criminal activity.

[caliotter3]

A former employer decreased wages based upon a report that the medicaid reimbursement rate was being lowered. Later, it was disclosed by someone with the medicaid division at the state level that the proposed decrease in reimbursement never occurred. The employer, not with any enthusiasm, reinstated the previous pay rate to its employees. Needless to say, more respect for the employer was lost. Lesson to be learned: Never assume integrity when dealing with an employer. Trust no employer's word.

Seems like the OP would be better off by leaving the state.

[erroridiot]

A former employer decreased wages based upon a report that the medicaid reimbursement rate was being lowered. Later, it was disclosed by someone with the medicaid division at the state level that the proposed decrease in reimbursement never occurred. The employer, not with any enthusiasm, reinstated the previous pay rate to its employees. Needless to say, more respect for the employer was lost. Lesson to be learned: Never assume integrity when dealing with an employer. Trust no employer's word.

Seems like the OP would be better off by leaving the state.

No kidding.

They lie when their lips move. That is my belief and I'm sticking to it!

A sad commentary all around.

[caliotter3]

The employees never questioned what was going on. One of them used to talk a lot with a patient, complain and complain. This patient talked to his medicaid worker and the nurse ended up conversing with the medicaid worker. This is how the truth came out and the issue came up with the employer. If that nurse had not been unprofessional with the patient and the patient had not blabbed what she told him to the medicaid official, most likely nothing would have ever been done. At some point in time the lower wages would have been forgotten about and just accepted without question. Needless to say nobody had anything good to say about the manager who made this move and kept up the deceit.