Medicaid Fraud

What is Medicaid Fraud?

Medicaid providers include hospitals, nursing homes, ambulance companies, doctors, dentists, durable medical equipment suppliers, occupational and physical therapists, speech pathologist, orthotic appliance and prosthetic device suppliers, prescription drug dispensers, podiatry service, laboratory services, vision services, rural health clinics, non-emergency transportation broker / companies, HOME HEALTH CARE PROVIDERS, nurses and other suppliers of authorized specialty services.

Some examples of fraud include, but not limited to:

  • Services not rendered / add on services
  • Billing for unnecessary services
  • Substitution of generic drugs
  • Kickbacks
  • Double billing
  • Falsifying documentation
  • Omitting information on nursing notes (i.e. doctor appointments)

It is considered FRAUD to omit or falsify documentation. This includes nursing note, timesheet, and MAR’S.  Timeheets and nursing notes must reflect the actual hours worked.  If you are 10 minutes late your nsg. note and timesheet must reflect the actual hours worked. Please be vigilant and accurate with all documentation!

KEY POINTS TO REMEMBER

NURSE:

  1. Always fill out the time sheets with the actual time you worked.
  2. Make sure your nursing notes / time sheet reflect the actual time you cared for your patient.
  3. If scheduling changes need to be made, please contact the office.  Do not just discuss this with the parents; the office needs to be aware of your schedule.
  4. Always write your notes during your shift.  Do not write your notes ahead of time.
  5. Never allow another person to write your nursing notes for you.
  6. Never falsify nursing notes/time sheets or omit information.

Please remember that Medicaid Fraud is a federal offense.  If found guilty of fraud you could serve time in prison, pay restitution, pay a fine of $10,000 and lose your nursing license.

PARENTS:

  1. Always check the time sheet to make sure the nurses actually worked those hours.
  2. Do not sign a blank time sheet.
  3. Look at the nursing notes to make sure what is written has actually been done.

Please remember that Medicaid Fraud is a federal offense.  If found guilty, you could serve time in prison, pay restitution, pay a fine of $10,000 and your child could lose their Medicaid eligibility.

IF YOU SUSPECT FRAUD OF ANY TYPE, WITH REGARDS TO PROFESSIONAL NURSING SERVICES’ NURSES OR FAMILIES, PLEASE CONTACT THE OFFICE IMMEDIATELY

White Blood Cells

Leukocytes, white blood cells, are one of the three cellular components of the blood.  The white blood cells can be further broken down into two groups.  One group is the granular leukocytes, are non-granular leukocytes which consist of the monocytes and lymphocytes.

 Neutrophils are present in the bloodstream and act as out primary defense against bacterial infections through a process know as phagocytosis.  In this process, the cells ingest the bacteria and other small unwanted particles.

The eosinophils are involved in our body’s allergic responses and the destruction of certain parasitic worms.  Basophils function as part of the inflammatory response by bringing anticoagulant substances to inflamed tissues during an injury or infection.

Monocytes, one of the non-granular white blood cells, can leave the bloodstream to become part of the injured tissue in order to remove dead or injured cells.  Finally, lymphocytes, which can be found in the lymph system and the bone marrow, participate in cellular immune response and humoral immune response.

The cellular immune response involves specific white blood cells know as T-cells.  These T-cells protect the body from the following:

  1. Chronic bacterial infections (TB, Leprosy)
  2. Many viral infections (measles, chicken pox)
  3. Fungal infections (candidiasis)
  4. Parasitic infections (pneumocytis pneumonia)
  5. Transplanted or transferred cells (tissue transplants)

 

B-cells are involved with the humorally – medicated immune system.  Through antibodies and immunoglobulin’s, these cells provide major immunity against the following:

  1. Bacteria that produce acute infections (streptococcus)
  2. Bacteria (tetanus, diphtheria)
  3. Viruses that enter the bloodstream (hepatitis)
  4. Organisms that enter the body from mucosal tissue (cold viruses, influenza)

Along with other values, a complete blood county with differentials (CBC with Diff) will give the complete white blood cell count along a with a complete break down of the different types.

Normal WBC count = 5,000 – 10,000 / mm3

Differential count = 100%

Neutrophils                 55 – 70%

Eosinophils                  1 – 4 %

Basophils                     2 – 6 %

Monocytes                  2 – 6 %

Lymphocytes              25 – 40%