What Would You Do?

[NewTexasRN]

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?

[icuRNmaggie, BSN, RN]

This is very very serious. Medicare Fraud means jail time and at least five years on the OIG fraud list which will make you unemployable forever.

Keep notes and get out now. Check with your malpractice carrier first, then report the incidents to the CMS to protect yourself because I guarantee you,

they will be making the you, the home care nurse, the fall guy when the investigation starts. Do not discuss this with anyone, especially anyone at work.

I strongly advise you to contact the admin desk and have this post removed. If your employer sees this, you will certainly be facing some kind of retaliation to discredit you. Be smart and proceed with caution.

[CryssieD]

Since she is your boss, I would go to the owner or director of the company--you need to go over her head; your charting is legal documentation, and she cannot edit or change it. Doing so is a serious infraction. If you want to be more comfortable about the situation, could you ask other healthcare providers who have dealt with this patient--just to be sure you aren't missing something that other people are seeing? But I'm just fishing there--it really sounds like your boss is cooking the books, so to speak, to make the patient qualify for services/Medicare payment, which is very bad! Go to her boss, or report her to medicare.gov-- good luck!

[Skip219, BSN, RN]

Line up a new job before anything! Otherwise you may get tied up in this case and be unemployable. She is lying so they maximize Medicaid billing and company profits.