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So this already has taken place, but I am feeling paranoid for some reason. this got long...
What confidentiality applys when reporting a company for medicaid fraud? Are reporters protected by anything (I kind of know about the whistle blower laws...)?
Last week, as I was preparing to leave my job, I was auditing my files to make sure I was current and not missing anything. I found a bunch of fake notes for my outpatient children's group therapy group. It looks like they were padding billing for when groups only had two or three clients show up, there were about 6-7 days with at most 8 kids having fake notes for those days. I had suspected they were doing something like this in March, and my boss talked about how it was a mistake, someone had misunderstood that "every client needed a note for the group" blah blah blah. I gave them the benefit of the doubt, and trusted she would take care of it appropriately (she said she would submit a billing error report for any kids that were billed that were falsely reported). She also said she would deal with the people who were submitting the fake notes (in medical records). One reason I tried to give the benefit of doubt was because a lot of these people have a high school education, and are really small town and pretty ignorant overall (owner gave a bunch of his family members jobs that they are totally incompetent to perform... I digress).
So when I noticed all these notes last week, I was done. I documented everything and copied the fake notes. The notes were from days that I actually held groups, but they were a completely different intervention, and they had the psychiatrist sign off on them (she will sign anything you put in front of her I guess...). I also printed off blank copies of the actual group note I made for that day (does that all make sense?)
I called the Department of Mental Health, which is where everything told me to report it to. When I called she asked for names of clients who had been over-billed on, Medicaid ID #s for them, and also asked that I fax in the lists I have of the notes, emails regarding the first situation, and the fake notes I had.
I mean, I don't think I need to be worried about breaking confidentiality of their names or Medicaid #s- I mean the department has access to that and who the clients are recieving services from because they do audits all the time, right? And they wouldn't ask for something that I shouldn't be giving? (obviously the notes with their reaction were fake, so I guess you can't really break that confidentiality when nothing really happened). But I am just feeling paranoid that they will get vindictive and try to sue me or make a complaint against my license or something... Thoughts? Anyone been in this situation?
Also, for any Seinfeld fans.... I named names. lol
(I will probably get more paranoid and delete the content of this post for privacy, so please don't quote.)
What confidentiality applys when reporting a company for medicaid fraud? Are reporters protected by anything (I kind of know about the whistle blower laws...)?
Last week, as I was preparing to leave my job, I was auditing my files to make sure I was current and not missing anything. I found a bunch of fake notes for my outpatient children's group therapy group. It looks like they were padding billing for when groups only had two or three clients show up, there were about 6-7 days with at most 8 kids having fake notes for those days. I had suspected they were doing something like this in March, and my boss talked about how it was a mistake, someone had misunderstood that "every client needed a note for the group" blah blah blah. I gave them the benefit of the doubt, and trusted she would take care of it appropriately (she said she would submit a billing error report for any kids that were billed that were falsely reported). She also said she would deal with the people who were submitting the fake notes (in medical records). One reason I tried to give the benefit of doubt was because a lot of these people have a high school education, and are really small town and pretty ignorant overall (owner gave a bunch of his family members jobs that they are totally incompetent to perform... I digress).
So when I noticed all these notes last week, I was done. I documented everything and copied the fake notes. The notes were from days that I actually held groups, but they were a completely different intervention, and they had the psychiatrist sign off on them (she will sign anything you put in front of her I guess...). I also printed off blank copies of the actual group note I made for that day (does that all make sense?)
I called the Department of Mental Health, which is where everything told me to report it to. When I called she asked for names of clients who had been over-billed on, Medicaid ID #s for them, and also asked that I fax in the lists I have of the notes, emails regarding the first situation, and the fake notes I had.
I mean, I don't think I need to be worried about breaking confidentiality of their names or Medicaid #s- I mean the department has access to that and who the clients are recieving services from because they do audits all the time, right? And they wouldn't ask for something that I shouldn't be giving? (obviously the notes with their reaction were fake, so I guess you can't really break that confidentiality when nothing really happened). But I am just feeling paranoid that they will get vindictive and try to sue me or make a complaint against my license or something... Thoughts? Anyone been in this situation?
Also, for any Seinfeld fans.... I named names. lol
(I will probably get more paranoid and delete the content of this post for privacy, so please don't quote.)
