Recently an industry list serve had much discussion of an agency having to pay unemployment insurance benefits to an RN employee who was fired for falsifying the clinical notes. They reported that fact to their state employment office but were still charged for the unemployment claim.
We had a client who fired their contracted PT because she was having some of her visits done by her cousin who was a PT assistant and licensed in another state. The client did not bill Medicare for any of her visits.
In both of the above cases the agency properly fired the caregiver and did not bill for services the caregiver had provided.
The agency should also check out the employee and the independent contractor on the Office of Inspector General exclusions list http://exclusions.oig.hhs.gov/.
“No program payment will be made for anything that an excluded person furnishes, orders, or prescribes. This payment prohibition applies to the excluded person, anyone who employs or contracts with the excluded person, any hospital or other provider for which the excluded person provides services, and anyone else.” (OIG)
The list is updated monthly and every provider should be checking all their employees and contractors upon hiring and on a regular basis thereafter. (See http://oig.hhs.gov/newsroom/video/2011/heat_modules.asp for 4 1/2 minute video if wanting more information.)
Why stop there? I suggest that both parties should also;
1. Report the matter to the caregiver’s license board.
2. Report matter to CMS.
3. Report the matter to Medicaid.
4. Report the matter to the local authorities as criminal acts.
The caregivers who were terminated will go to work for other health care providers. They likely will contiue their illegal practices. Their practices may cause health problems or complications and even death for the patients they treat.
And if I was a successor employer and found myself sued for malpractice or investigated I would look back at the history of the caregiver and involve former employers to share the responsibility, the blame and the costs.
When engaged in house cleaning you don’t sweep the dirt under the rug (so my wife tells me).