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Posts tagged ‘julianne haydel. haydel consulting services’

May 14

11 Comments

The VA’s Dirty Little Secret List

A couple of years ago, I was in a client’s agency when a woman came in to ask about her father’s home visit schedule.  The case manager was confused because the gentleman had been sent to the VA hospital in Texas a few days prior and the agency had no idea he had returned home.

I pulled his chart while they were talking.  The nursing notes described a stasis ulcer to the lower extremity with wound care for almost a year.  The wound continued to deteriorate.  The patient had a physician at the VA clinic in Alexandria who took excellent care of the patient and worked together with the nurses to get the leg to heal.  It did not heal.  In fact, it continued to deteriorate.  The odor of rotting flesh was so bad that the nurses had to ensure that the windows were opened for their visits.  The doctor referred him to the VA hospital in Texas for an amputation.  After less than 24 hours, the patient was discharged because he had less than an ‘honorable discharge’.

The daughter explained that she finally found out that when father returned home from Viet Nam, he did not return a rental car in Washington DC.  He left it at the airport but forgot to turn in the keys.  Pardon me for being overly cynical, but I figured there was more to the story.  The case manager placed a call to the VA’s office in Alexandria and confirmed the story.  It didn’t seem to matter that he had been receiving VA benefits for years and did not apply for Medicaid when he was eligible because he was a vet and he trusted the VA system.  It did not matter that he had been disabled for years but he would not be eligible for Medicare until he had been on Medicaid for two years.

He was just a vet – a sick and damaged individual no longer of use to the country he served.

The hospital wheeled him out to the sidewalk and luckily he had a niece in Texas who came and picked him up and took him to her house until his daughter could make the six hour ride to Houston in a truck that did not start very often.

We called The Department of Health in TX and left a message.  The immediately returned my call but explained that they did not have the authority to survey VA hospitals.  She gave me a number to call and I called it numerous times for about a week.  I left messages.  The agency did the same thing.  Nobody was interested in the vet with the necrotic leg.

Now they have a secret waiting list that shows that veterans are waiting months for appointments but they altered their data to show that patients are being seen within the guidelines.  The wait time is horrible in itself.  The complicated steps to hide the list and create the appearance of compliance with the VA rules is nothing short of immoral.  My clients would be accused of fraud if they altered any records and I would be in the courtroom testifying against them if they allowed people to die and hid the evidence.

This type of disrespect for our veterans of war could only be the result of a culture that fires anyone who presents a problem.  Only in a system where individuals know that nothing they can do will ever make a change would this sort of thing happen.

Secretary Eric Shinseki has failed as a leader.  He has created a culture where it somehow makes sense to lie, cover up and let people die rather than report the truth about how our veterans are treated.  If this were one hospital or a dozen patients, I could believe it was hidden to him.  He had a responsibility to know about 40 deaths on his watch.  If he didn’t, it was because he chose not to know.

In spite of that, I do not want Secretary Eric Shinseki to resign.  I want to see him fired.  He does not deserve the dignity of being allowed to resign.   If the President wants to show any conviction regarding the state of our VA hospitals, he needs to step up to the plate and get rid of Shinseki loudly and publicly.

It isn’t enough for Eric Shinseki  that we send these young men and women to battle fields to risk their lives for our freedom.  It doesn’t matter to Eric Shinseki that a good many of these same men and women who make it back home are permanently scarred or broken because of the battles they fought for him.  The only thing that matters to Eric Shinseki is that he doesn’t look bad in the press.  He fires a couple of people and assumes the situation will go away because that is how narcissists handle problems.  They blame everyone else and sever ties with those that do not reinforce their inflated self image.  I would have had so much more respect for the man if he was as horrified as I was about the delays and set about working towards a solution instead of defending his image.  He should have stuck with making bad decisions about army fashion.

The toll-free number for the Veterans’ Benefits Office is 1-800-827-1000.

You can also go here to contact your elected officials and most government agencies.   I am running very short on time this week but I will take the time to email everyone I can about this.  I hope you do, too, because the who have been tasked with taking care of our veterans are an embarrassment to the United States.

Your comments are most welcome.  Please feel free to include a link to this post in your correspondence if you agree with it.  If you know anything that I don’t know, please share.

Feb 25

7 Comments

Farewell, Bill Borne

 

Contrary to what you might think (and frankly, it surprises even me), I take no great joy in the announcement that Bill Borne has stepped down as CEO of Amedisys.  For the sake of Amedisys, it needed to happen but there would be no Amedisys at all if not for Bill.

In the early 90’s Amedisys was a very young company fueled by a handful of un-medicated junior execs with severe ADD bouncing around like Brownian motion.  There were no senior executives to set limits for us but we had Bill with his pipedream of one day being the largest homecare provider in the US.  Nobody knew what they were supposed to be doing doing but we always made it a point to be doing something.

There are certainly psychologists and urban anthropologists who study corporations and behavior.  An entire graduate thesis could be written about how Amedisys went from being an unknown agency in a southern city to one of the largest and most successful post-acute care providers in the nation to being the company with the 150M settlement and tarnished reputation. 

An advanced degree isn’t required to see that the real problem is that Amedisys simply grew up.  The values that were held close in every task and idea by the younger Amedisys were gradually replaced with Corporate cliché’s.  The practiced speeches where key points were repeated three times because the speech coach recommended it took the place of genuine communication.   

The grown up Amedisys and the grown up Bill Borne just weren’t fun anymore.  The primary outcome used as a benchmark by almost everyone in the organization was the price per share of stock.  Image mattered more than ever.  The spontaneity, imagination and creativity that drove a young company to greatness were so ingrained into the fabric of Amedisys that no one ever really noticed them.

The grown-up Bill Borne lived to please investors to keep the price of stock high.  He got so carried away with making the shareholders happy that he forgot that others had invested a hell of a lot more than money in his company.  Those of us who bled Amedisys Green didn’t think there were other options for us until we no longer had a choice.  We were well prepared – that much  I will say.

To this day, I am grateful for everything I learned from Bill Borne and from Amedisys.  I learned from Bill that I can simply blaze my own trail if I don’t like the one laid out for me.   I made friends that will last much longer than Amedisys.  I learned the difference between being driven to accomplish a mission and ambition for the sake of power.  I know from my time at Amedisys that being passionate out loud about your job is dangerous but being silent for the sake of playing nicely in the sandbox is cowardly and I have seen how ugly well-behaved cowards can be.

I am even more grateful to be gone. 

Bill Borne walked away from Amedisys this morning but he gave his company away years ago.   The shareholders replaced patients as a priority and the board of directors replaced his employees as the people to whom he was accountable. Patients are not commodities and the answer to problems isn’t terminating a scapegoat. 

The Bill Borne wanna-be that walked away this morning had but a passing acquaintance with authenticity.  For those of you who never met the authentic Bill, you missed someone important but he hasn’t been around for years. 

I wish Bill luck and love in abundance.  I mean that.    I hope he finds a little flame and sets the world on fire for a cause other than the price of stock. 

I wish Amedisys luck in finding their way in this healthcare maze.  They have the ability and resources to redesign home health and set the industry standard or put all of their energy into trying to get the stock price back up to where it belongs.  We shall see.

Oct 7

2 Comments

God Bless Tech Support

Click Here for New Inservice designed to help you avoid F2F denials. 

I carefully considered the requests I received from those you who wanted to know if I had the time and ability to provide an inservice on the Face-to-Face document.  The problem is that the expense for travel as well as the practicality of travelling to multiple states presents a daunting challenge.  Obviously, you would pay the travel expenses but who would sit here and write appeals if I were away?

So, like you, I had to embrace the technology available to me and find some way to provide you with the required information at an affordable price in a manner that did not take me away from doing the work at hand.  I went through two online vendors last week and finally settled on one called SkyPrep.  Now, to be certain, these guys aren’t bad at all but like all computer vendors, they have issues.

The biggest issue is that they take weekends off.  So, all weekend long, I converted PowerPoint presentations and uploaded them various different formats for your viewing pleasure.  None of them had any audio included.  So, I spoke louder.  You may notice that as you watch the presentation.

Sometime around Saturday afternoon, I decided I was too far in to back out now in terms of time.  I continued to record, increase my volume, slowly upload, convert files and sort files like a trooper.  By Sunday morning, I was like a pointman in the marines determined to lead this adventure to a victorious ending or at least one where there were no casualties.  By two o’clock Monday morning, I realized I was defeated.

So, I came to the office this morning and the nice people had returned from their weekends off and informed that the FoxFire browswer was not supported.  That would have been relevant information, don’t you think?

But at last, I have a presentation for you that costs what it would cost you to pay for my services for one appeal.  The beauty of this, though, is that hopefully, you can prevent future denials.

I am hopeful that other organizations who are taking this battle to Washington have great success in permanently relaxing the regulations regarding the Face-to-Face encounter.  Meanwhile, take advantage of my experience in appealing these denials and learn what it is Medicare is looking for.  More importantly, check out the actual denials.  They are the real McCoy.  It’s one thing to read the instructions but still another to see how they are implemented.   Also, see for yourself denials that should have never happened and learn why so you can be victorious in your appeals.  I assure you there is no way I can do every appeal that needs to be done!

I hope you take the hour to watch the presentation and gain from our experience.  I was having fun putting it together for a little while and then SkyPrep took the weekend off and ruined my in turn.

Let me know what you think.

Jun 29

7 Comments

The Face to Face Document

I really get Medicare’s emphasis on Fraud and Abuse but I have to wonder if maybe they didn’t think this face to face thing through prior to implementing it.  If you think you know all there is to know about the face to face document then I invite you to take our little quiz. 

If you have any face to documents that met all requirements and were still denied, please email me.  I would like a sanitized copy if you don’t mind.

Some Good News for a Change

All of you HealthcareFirst users out there who have Business Intelligence have probably noticed a remarkable improvement in the Episode Master Edits.  I have been helping them for a while now trying to refine, update, improve and add new edits.

Only a small portion are up but look for more.  If you see any errors, please let HealthcareFirst know or you can let me know and I will forward them on.  If you have any great ideas for new edits, let me know.  As Picasso said, Talent borrows, Genius steals which is actually an Oscar Wilde quote serving to prove that Picasso was a genius.  Make me look as good as Picasso and I will help HealthcareFirst give you the tools to get paid and hold on to your money.  How’s that?

Mar 25

7 Comments

Who’s Beverly Cooper?

New Place of Residence for Beverly Cooper

New Place of Residence for Beverly Cooper

Why should you even care who Beverly Cooper is? A friend, Kelly, sent a link to a recent HEAT team arrests.  Because I have worked so much with fraud over the past couple of years, almost nothing surprises me anymore.  Here’s the exception.

Beverly Cooper admitted to Federal Authorities that as a registered nurse:

‘she and others conspired to defraud Medicare through home health care companies operating in the Detroit area, including Reliance Home Care LLC, First Choice Home Health Care Services Inc. and Accessible Home Care Inc.  According to court documents, Cooper fabricated nursing visit notes and other documents to give Medicare the impression that she had provided home health care services, when, in fact, home health care was not needed and/or was not being provided’.

Wow!  We are not talking about a rogue nurse.  This woman systematically with cooperation from her employers signed legal documentation for the sole intention of defrauding the government.  The total billed fraudulently was over 5M.

This is the stuff that makes headlines and sets examples of what happens to people who commit fraud.  It is dramatic and so far away removed from our daily practices that we just look at it in awe.

What we miss is that the worst part about this case isn’t the legal implications at all. It is the clinical documentation that is now part of a patient’s medical history.  It is the patients who were not seen.  It is those patients who did not meet eligibility requirements and were seen.

So, while it may not take a lawyer to determine that the behavior here was illegal, I wonder if the lawyers and judges understand the gravity of the compromised clinical care.  Do they fully understand the the harm that could come to a patient when a hospital or other provider relies upon fiction stated as fact in a clinical record?  Do they even understand how easy it would be for a patient to die because medications or allergies weren’t documented appropriately?

There’s one way to ensure that they do.  The judge presiding over the case, The Honorable Victoria Robertson, can be contacted at:

United States District Court
for the Eastern District of Michigan
Theodore Levin U.S. Courthouse
231 W. Lafayette Blvd., Room 123
Detroit, MI 48226

Chambers Telephone Number
(313) 234-5230

Let Judge Robertson know, if she does not already, that this case is about so much more than fraud.  If we, as nurses, do not speak up, who will?  Who better understands the ramifications of fraudulent documentation than a nurse who has tried to take care of a patient who is relying on poor (though not fraudulent) documentation of a prior caregiver?

I hope they allow Ms. Cooper a computer in the Federal Penitentiary so she can spend her money on the internet.  I hope the Amazon order is enough to offset any regrets she has about compromising patient care. Most importantly, she should take up a healthy lifestyle because there are many nurses who would not be comfortable taking care of her should she become ill.

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