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Patient Recruitment


Today, in Baton Rouge, someone was sentenced to prison for recruiting patients.  While goofing off on the internet, I came across this story by Investigative Reporter Terri Langston published in the Houston Chronicle.   Click on the image to read the full text which involves over 100M dollars in fraud and again, patient recruitment.

Now, color me clueless, but I really do not understand the difference between recruitment and marketing in the context that normal people use the terms in daily life.  If you look up ‘patient recruitment’ you find tons of articles on how to recruit patients……….  for clinical trials.

The dictionary defines recruit as, ‘to seek to enroll’ as students.  This does not seem worthy of jail time either.  Solicitation doesn’t seem all that horrible either.  When I write a post and tell you to please call if you need help, wouldn’t that be soliciting your business?

So who better to consult than a health care lawyer.

Christopher Johnston has the distinction of knowing more people who have been or will go to jail than anyone else I know. (It is relevant that I have a very good friend on the SWAT team.) This is because he is one of the best lawyers for keeping healthcare providers out of jail or reducing their sentences. He also has to work with what he gets from clients and sometimes, well…… a couple of years is better than twenty.  Chris’s success rate for clients who call him before they are in trouble is stellar.

He has a list of commandments to follow should you want to stay clear of any accusations of inappropriate marketing. Read them and share with your marketers.  Chris is not a cheap lawyer and I am giving away his advice for free. Take it and run with it.  Or don’t.  Just remember that in this period of intense scrutiny, a reduction in your sentence may be the best anyone can do for you after you get caught.

  1. Do not bribe, harass, coerce, or intimidate any patient into selecting or changing agencies.   (Julianne’s note:  In reading Animal Husbandry Weekly, I gather it is okay to sell cattle per head.  In reading the HEAT Task Force News page, I gather it is NOT okay to sell or buy referrals per head.)
  2. Do not allow any of your employees to bribe, harass, coerce or intimidate any patient into selecting or changing and agency.  (Julianne’s note: What do you think a marketer will tell the investigators when they are caught?  Do you think they will say their employer knew nothing about it or will they throw you under the bus?)
  3. Do  not falsely advertise about any services, awards or credentials or anything that may mislead the public.  (Julianne’s note:  A nurse without a license is not a nurse for the purposes of home health. If you advertise nursing care, please send licensed nurses only.)
  4. You may certainly respond to inquiries about home health but DO NOT initiate the conversation.  (Julianne’s admission of guilt: I might have to go to jail if I heard of someone who really needed home health but I would NOT – and do not – recommend specific agencies.)
  5. Do recommend that the patient contact his or her physician but do not recommend a physician to the patient.  Under NO circumstances should you ever bring a patient to the physician or the physician to the patient’s home. (Julianne’s note: If you do not believe this happens, talk to your folks at MD offices.  The waiting rooms are filled with aides bringing patients to MD offices.)
  6. Do not go into people’s homes or call them on the phone to tell them about the availability of home health.  (Julianne’s note: We did not need a lawyer to tell us this, I hope and yet, I know of instances where it has happened.)
  7. Do not conduct marketing inservices in people’s homes.  Stick to the physician’s office.
  8. Never, ever offer anything of value to anyone in an effort to select your agency or refer to your agency. (Julianne’s note: See the way Chris used both of the words, ‘never andever’ in his advice.  I know from experience this  means he is deadly serious about giving people cool stuff in return for being your patient or referring to your agency.)

Specifically excluded from these guidelines is community education.  If you think about it, when providing support groups and speakers for community functions, you are generally not interacting with people who would meet the home health requirements for homebound status so there are no ‘patients’ involved.

The truth of the matter is that every time an agency gets closed down or someone goes to jail, it reduces my pool of potential clients.  And remember, it is all about me.

And it is about you.  My experience is that nurses who violate these guidelines typically are unaware that they exist.  I am not completely innocent here. I have paid for drugs on occasion and also food.  (Attention:  if you are a federal agent or work for a contractor who has the authority to arrest fraudulent nurses, I haven’t been in the field since the 90’s.  Surely there is a statute of limitations.  If not, can I write my blog from prison?)

We can’t do this anymore.  We absolutely must put safeguards in place to protect us from having to tell a client we are so sorry they have no meds or food but can’t anything about it.  Because nurses are not wired to do that and we will end up in trouble if we don’t act preemptively.  This means hooking up with your local food banks and indigent pharmacies and getting to know how they work before you need them.  And when  you have a few dollars to give away, donate them to the pharmacy or food bank.

And if you don’t have a formal compliance plan, contact me.  If you have unwittingly participated in any of the above, contact Chris.  We can help you.  There I go again – soliciting business.  It actually works.  Sorry you can’t participate.

Thanks for the Visual

A friend of mine who practices health care law politely pointed out to me today that nowhere in CMS regs does it state that Physical Therapy must be rendered by therapists wearing clothes. Yet, try sending a nude therapist to a patient’s home and you will find yourself in regulatory hell. Thanks for the visual, Chris. I will have nightmares tonight.

My wise friend went on to say that at this point in time, the emphasis should be on over documentation as opposed to under documentation. Whether your concern du jour is RAC audits, payment, outcomes or state survey, your clinical records will determine your fate.

And of course attorneys and consultants have the luxury of really focusing on clinical records. We are not trying to schedule three resumptions on an afternoon when two nurses called out sick. We do not have to verify visits to ensure that our staff gets paid. When troubled clients call us we ask them to schedule an appointment. An agency nurse should have her ears boxed for taking that approach with a distraught family member. So when exactly do you look at clinical records?

A quarterly review is better than nothing but you are hard pressed to go back and draw lab that was ordered and missed two months ago. But, a quarterly review will give you the information you need for educating your staff.

Daily review of visit notes as they are submitted to the office will avoid a lot of problems but not all. A note can seem perfect outside of a chart and in the context of the entire record it is lacking important information.

But you have to bill every sixty days. There are requirements that the care provided during an episode meet the standard of being reasonable and necessary and that care be rendered under the orders of a physician. This is the perfect time to read through the last episode to ensure that the documentation is complete and meets guidelines. Certain tasks can be delegated to non-clinical folks such as ensuring that orders are signed and that all visits are in the chart. In doing this, the nurse has to read only an episode worth of notes to ensure that the care plan has been followed and that documentation meets Medicare payment guidelines as well as the guidelines of any other payor source.

When cash is tight and nurses are scarce, it is tempting to omit this last step of a billing audit. Nowhere in CMS does it say that a nurse must audit the chart. But, when your turn comes to be viewed under a regulatory microscope, it would be best if you had all your clothes on or you will find yourself in regulatory hell.

NOTE:  Christopher Johnston, one of my favorite attorney’s is available at the Gachessin Law Firm in Lafayette, LA.  I hope you never need him but if you do, here is his phone number:  337-235-4576 or   If nothing else, he is good for disturbing visuals you can share with your staff to drive a point home.

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