Terminating the employment of someone due to illicit or unethical behavior is a good move, but it is just one step your home healthcare organization must take to protect itself, potential future employers of the person, and prospective patients. Simione Healthcare’s Thomas Boyd, MBA, CFE, CHFP, Vice President of Reimbursable Services has seen such terminations in practice and has some solid advice on the next, important steps to take.
Recently, I learned of an agency having to pay unemployment insurance benefits to an RN employee who was fired for falsifying clinical notes. The agency reported that fact to its state employment office but was still charged for the unemployment claim.
We had a former client who fired its contracted physical therapist 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 the services the caregiver had provided.
Why stop there? I suggest that both agencies should also:
- Report the matter to the caregiver’s license board—Each state has a licensing office or board. Serious complaints can spur an investigation of the incident, prevent the renewal of a license, result in license revocation or lead to penalties for the violator.
- Report the matter to the Office of the Inspector General—Each state also has an Office of the Inspector General, which handles complaints of legal violations of Medicaid and other official standards. These offices typically handle quality-of-care reviews, investigations of employees and contractors, safety monitoring, and fraud. They also may undertake special projects addressing matters of broader implication, which your specific case may be part of even if you don’t know it.
- Report the matter to Medicaid—The Centers for Medicare and Medicaid Services works hand in glove with states, insurers, and medical providers to verify the quality, quantity, and cost of services that rely on public funding. Any breach of service or payment standards must be corrected as a matter of law, and financial recompense is required. Companies that don’t report findings of faulty activity can be sanctioned.
- Report the matter to the local authorities as criminal acts—Breaches of licensing and billing rules are serious infractions, sometimes constituting criminal acts. Since such behaviors can jeopardize the health and financial well-being of others, it is important to inform local authorities so they can pursue authorized means to uncover all the facts of and participants in illicit schemes. If a crime has been committed and your organization has duly reported it, you may receive leniency in any official action as well as coverage under fidelity or other liability insurance you carry.
The caregivers who were terminated will try to go to work for other healthcare providers. They likely will continue their illegal practices. Their practices may cause health problems or complications and even death for the patients they treat.
If I were 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.