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Company 1

Take heed

Suzanne May, age 61, served as the administrator of a hospice referred to by the Feds as Company 1 for more than a decade She was a both a registered nurse and a certified hospice administrator. She signed a plea deal admitting to fraud on December 3, 2019 and now faces five years in prison followed by three years supervised release, a $250,000.00 fine and to top it off, a $100.00 special assessment. Hopefully, her lawyer can negotiate a deal where the special assessment is knocked off of the overall penalties.

Altering Legal Documents

To keep it short and simple unlike the official documents, Ms. May has admitted to:

  1. Using white-out on a Certificate of Terminal Illness. If you can’t figure out why that might be a problem, it’s best that you resign now.
  2. Adding dates to Notices of Election after the clinical records were requested from Medicare. I do not know how Federal Investigators knew when the dates were added.
  3. Ms. May relieved some patients of the burden of initialing forms by adding their dated initials to forms. The Feds are alleging that it is not possible to sign and date documents after death.

In an impressive display of organizational skills, Company 1 employees, led by Ms. May, kept a log of all changes made to the documents after the request for records was received.

This audit, performed in 2017, followed a 2015 audit in which close to $400,000 was returned to Medicare. As a certified hospice administrator Ms. May knew what was required of the hospice in order to be paid. And, to her credit, she made sure every detail was complete but only after her clinical records were requested by Medicare. Timing is everything.

Look Again

This post teaches you how to go to jail. Free meals, a warm place to sleep and a break from your needy relatives may be your ticket to jolly holidays. Surely the worst prison food is better than fruit cake and squash casserole.

In no way am I condoning the actions of Ms. May. I also recognize that the criteria for payment is sometimes preposterous. Claims for reasonable and necessary care provided to eligible beneficiaries are denied payment every day but that is a subject for another post.

In this case no patients were harmed as a result of Ms. May’s actions. Nobody dies from a date added to a document after they die. If jail is your ideal vacation, this seems to be the way to go if you don’t want any patients to be hurt along the way.

If you wish to remain home with your loved ones, I assure you that no matter how tempting it is to add a date to a form because the patient didn’t, and you know the correct date and personally witnessed the patient sign the form, it isn’t worth it. When a physician doesn’t date his or her signature and you know when the orders were signed, adding the date seems more like a courtesy than a felony but you would be wrong in making that assumption.

If this sort of behavior was evident on a state survey and a plan of correction to the state was required, it would probably include an educational piece like, ‘The DON will hold an inservice to teach the nurses things that they already know but didn’t do.’

If you are finding these problems during clinical record and billing review despite teaching the nurses repeatedly it’s time to try something new.

Cut your employees some slack. Home health and hospice nurses who provide excellent care to your patients are worth a little extra time. Review their paperwork with them as it arrives at the agency – which usually occurs before the time (and possibly the patient) has passed to get an ethically dated signature. Help them develop habits.

On the other hand, if a nurse blatantly commits fraud, investigate first and then terminate them. You are also obligated to report them to Medicare and their State Board. A good orientation will ensure they know the rules. Protect your nurses and the agency by providing a complete orientation including compliance. 

Do not bill (or alternatively, pay back the money) if you have found out that a nurse was taking shortcuts. It is painful to take the right steps but not as painful as the quarter million fine Ms. May will pay (plus the assessment fee).

If you are a visiting nurse, you know the rules. You know what to do and mostly you get it right but it only takes a couple of bad care plans or notices of election to cost an agency tens of thousands of dollars.

More concerning to me is the probability that some nurses are encouraged to ‘do what it takes’ to get billing out the door. Without using the words, ‘go commit fraud’, some employers leave employees feeling like their jobs are on the line if they hold up billing. If you feel that the only way to keep your job is to fill in the blanks omitted by a patient or a physician, I guarantee that unemployment is a better option.

Everything else aside, ask how Medicare knew the documents were altered by Ms. May and friends after the patient died. The Feds are not psychic. They did not have a seance summoning J. Edgar Hoover who revealed the exact time that dates were placed on documents. They obviously knew something that was solid enough for them to request 100 charts.

I’m willing to bet that Company 1 is not the real name of the hospice and that this story has just begun. Until we find out more, do yourself and your patients a favor and do things the right way. If you are preoccupied with compiling charts for an audit, care to your patients will be compromised. I’ve seen it too many times.

As always, your comments are welcome or you can email your thoughts.

5 Comments Post a comment
  1. Gail Hammond Batson #

    I am out of the rat race. I retired. Praise Jesus. But, I still torture myself from time to time by reading Haydel and “Show Me Your Stethoscope.” It is apparent that Medicare only cares about the money and has no concern whether or not the company is taking good care of their patients and ignoring the fact that we are all human and HEAVEN FORBID have forgotten to sign and/or date paperwork. The white out faux pas is really bad though. The first thing I was told when orienting to Home Health was NO WHITEOUT; mark through (so that the original documentation can still be read) and legibly make your corrections. EMR did help that problem a bit. No whiteout anyway and corrections were dated and timed in the record, so that solved that little problem. Also, I was oriented to NOT try to make corrections to a record AFTER is was requested for a review. We actually did find some paperwork that had been filed in someone else’s chart and other such lucky accidents, but again, EMR pretty much took care of that issue. So, PRISON for fraud that took 10+ years to “prove.” I’m still stunned. Monetary fines? Sure. Prison? I don’t see it. The moral of this story is keep your hands off of medical records after Medicare has asked for them.

    December 17, 2019

    • You can always write amendments to clinical records but you shouldn’t go into the records and write something above yours or anyone else’s signature. I always have a notebook. You might think I’m nuts if you saw it but there is enough to create an accurate note or addendum.

      As far as this story goes, I think we may find out there’s a little more to Company 1. I may be wrong but it would not surprise me if I was right.

      December 17, 2019
      • Gail Hammond Batson #

        Yes. Indeedy. We did make addendums to the clinical records as explanatory or to edify the situation. I meant to mention that in my first comment. But altering already existing notes is a big ol’ no-no for sure. If they were trying that long to get the goods on them, maybe you’re right and they are just really good at whatever it is that sneaky. But, 5 years? Lord have Mercy; child molesters don’t get that much time.

        December 18, 2019
  2. Carol Schmidt #

    I have been thinking about going back into Home Health or Hospice. I miss it so much. But reading this story brings back some bad memories of a bad place where I once worked. The pressure to do what it takes made me cry every day on the way to the office. I am sure there are still some agencies out there that are the same and I never, ever want to work like that again. So now I am thinking maybe I will just hold off and continue to miss it and the patient care that used to bring me so much joy. I feel sorry for this administrator who lost sight of the fact that the job is not worth your career and your life. We work to live. We should never live for work.

    Thank you for all you do and may the future be brighter for all of us in health care.

    December 18, 2019

    • Carol, there are so many good agencies out there. You can find one, I assure you.

      Look for agencies that offer a reasonable schedule that allows you time to deliver the patient care you want. State surveys are public information. Call the licensing agency. Most agencies have a couple of tags. But be leery when they have too many and include Nursing Services. Look at their published outcomes but be suspicious of agencies with near perfect outcomes.

      I would ask about average length of stay, live discharges (if hospice), and pay and other benefits.

      A good agency pays well. A bad agency pays even better. Sometimes you have to ask if you’re really worth what is offered in the open job market. I know that personally your worth ten times more:)

      When I work on a project in someone’s office, I notice the demeanor of the nurses coming in and how they are addressed by staff.

      Because really we need good, intelligent nurses and nurse management in home health and hospice. Managing yourself is often harder than managing staff and you care enough about patients to do that.

      December 18, 2019

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