What Would You Do?

middleagednurse · Feb 14, 2015

That is seriously illegal. You need to report her to someone.

JustBeachyNurse, LPN · Feb 14, 2015

That is seriously illegal. You need to report her to someone.

Report this. You are covered by federal whistleblower statutes and if there is fraud found you are entitled to a portion of fines/overpayment collected.

lasair · Feb 14, 2015

Can you ask her to sign beside what she changed and if she refuses report it. I would not let this lie.

westieluv · Feb 14, 2015

Hi everyone. I work for a small homecare company. From time to time we take mediaid cases. I completed an assessment for a medicaid client and it was sent to mediaid for approval to receive reimbursement. A few days a ago a coordinator informed me that my DON changed my assessment. At first I was confused so I checked the assessment and sure enough she changed my assessment. She said the client has cognitive impairment and she can't feed herself. She even wrote a whole paragraph about her abilities. I know she has never seen the client. I was angry because my signature & credentials are on the assessment. I spoke with boss and told her it was wrong because it's my license on the line. I told her that the client can feed herself and has no cognitive impairment. She apologized, but I'm still upset that she went behind my back and lied. What would you do?

What would I do? I would get out of that company ASAP before they get criminally charged with Medicaid fraud.

I worked for a regional hospice and home care company for one month because I learned shortly after being hired that they were "bending the rules" to get patients admitted to their hospice and grow their census. They had a lady at their main HQ whose job it was to dig through their home care patients' charts to try to find out if any of them could be transitioned from home care to hospice, even though none of them were hospice appropriate or even wanted hospice. Their marketer once laughingly told me about a woman who lived with her daughter and they were both recent immigrants from an Asian country and "had no concept of what hospice is, so this one will be easy to sign on", and he also told me that if a potential patient's PCP wasn't on board with hospice admission and did not feel that their patient was appropriate, not to worry because "Meh, I never let a PCP get in the way. If we want to sign them up, we'll find a second doctor who will agree, don't worry." (when a patient is admitted to hospice, both the hospice medical director and their physician have to agree and sign a form stating that the patient is hospice appropriate to help to avoid Medicare fraud).

Like I said, one month was all the time I gave to that company. When they go down, and they will go down unless they change their ways, I am not going to go down with them. I worked too hard for my license to be charged with admitting patients that I knew were being admitted fraudulently, and I will never have any part in tricking an unsuspecting patient into something that they neither want nor need.

Libby1987 · Feb 15, 2015

I wouldn't tolerate that, I suppose I might demand to read all 485's/OASIS before they were locked.

But just grasping at straws here, would you say without doubt that she was able to safely feed herself while alone? She needed no assist or supervision at all?

caliotter3 · Feb 15, 2015

I am also in the camp of leaving this employer. There are many, many nurses willing to take my place who would not have batted an eye at this situation, but I am not one of them. Also, she is telling on herself. She apologized and offered no explanation because she had no explanation.

NewTexasRN · Feb 15, 2015

Before she apologized she tried to say there's a fine line with cognitive abilities. I kept syaing no! The client has no cognitive impairment and can definitely feed herslf. I am definitely planning to leave, but not just like that. I need to know this won't come back to haunt me. Also, it is so petty because they don't need the money. It also makes me question what else are they doing?

sjalv · Feb 15, 2015

It does not matter if the client is cognitively impaired or not. The issue at hand is that she falsified documentation, and did so in your name. She should be reported to the BON, as should the agency, and you should leave. This is my advice.

Gooselady, BSN, RN · Feb 15, 2015

She changed your charting so the client would 'meet criteria' for medicaid reimbursement.

This is pretty bad.

Granted, this stuff happens all the time. I did utilization review for four years, and I knew what the insurance company was looking for. Blatant falsification wasn't something I was willing to do no matter how badly the patient wanted or needed services, but I could 'highlight' certain symptoms and issues in order to say 'all the right words' and get my patient's insurance to preauthorize. Even then, there were certain cases that were 'weak' and I worried that it might LOOK LIKE I was exaggerating, and that it would be considered falsification.

Your manager did this in order to maintain the client base. This is also known as fraud, because it is deliberate.

This homecare company is not a safe place to work. Not at all

xoemmylouox, ASN, RN · Feb 15, 2015

I saw something similar happen. A new nurse was working at the LTACH I was at. She was informed that all of her documentation from the week prior had to be changed. The problem is we used 24 hr flow sheets and worked 12 hr shifts. So they just made all new sheets and changed her documentation and the other nurse's documentation for those days. They also just forged the other nurse's signatures. I quit right after that shift.

BuckyBadgerRN, ASN, RN · Feb 15, 2015

Fraud. It's Medicaid fraud and that's a serious issue. If your don won't take your name off of the assessment, I would report her and leave the agency. I'm sure your state will not be pleased to learn of her actions, it's possible that your report will trigger an audit of other Medicaid cases that your agency carries. Word may spread and affect other non-Medicaid cases creating a domino effect that will not be good for the agency.

it sucks because I'm sure this client would benefit from home nursing care, but it has to be done in a legal and ethical way. Good luck, OP!!