Question:

Dear Nancy,

I'm an RN, and I worked for a family-owned home health agency. On several occasions I noticed that our administrator, who is the daughter of the owners of the company, would clock in herself and several of her family members in the morning, and at the end of the day a family member would come in a little after closing time and clock out themselves and other family members. These family members were not in the office working. Some of them are in college and not showing up to work. Is this legal?

Susan

Nancy Brent replies:

Dear Susan,

Anytime someone falsifies documents, including documents governed by state and federal laws (state department of labor, Medicare/Medicaid, as examples) that form the basis for payment and/or reimbursement, they can face allegations of fraud, abuse. falsification of (official) documents, and other charges — some of which are criminal in nature.

From your description, it seems the scheme of getting paid for work not done is quite well entrenched in the agency. One wonders what other documents are being falsified (e.g., patient care visits, phone calls to physicians).

Additionally, if any of these individuals hold a license to practice a particular profession in the state (e.g., nurse, home health administrator), they can face disciplinary action by the state agency/board that administers and enforces that practice act. Clearly, the home healthcare agency's license to operate as such is also at risk.

You would do best to seek a consultation from a nurse attorney or attorney in your state who works in employment law and who also understands healthcare delivery and licensure of healthcare providers. The attorney can advise you how to proceed with the observations you have made and how to protect yourself in this situation.

Cordially,
Nancy