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    Falsification of records and billing

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    Falsification of records and billing are serious offenses and must be treated as such. When in an administrative position, you will be called upon to monitor staff to be sure that records and billing are accurate. Read the scenario below and respond in at least 150 words or more.:
    You are the assistant manager of operations for the Smith Home Health Care Services. Part of your job is to do impromptu visits to monitor the home health nurses and aides for the company. You have been observing Barbara Smithers, who has been a home health aide since the company was established in 1995. You notice, before one of your monitoring visits, that Barbara's billing totals seem higher than the average worker. When you observe her home services and compare them to the services rendered, there is a discrepancy. Going back in her service records, this has been a pattern for at least four years. You report this to your supervisor, Ron James. Mr. James meets with Barbara, who finally admits that she has been "padding" the billing for at least 10 years, at the demand of nursing supervisor, Donna Strickland. Mr. James asks you to sit in on a conference with Ms. Strickland and Ms. Smithers and contribute to questioning them and helping make a final decision.

    What will you ask? What records do you need to review before the conference? If accusations turn out to be true, what would be your recommendation in this case? Be sure to cite standards from the False Claims Act. You are also allowed to do further research if you wish (site any additional sources).

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    Solution Preview

    My first question is going to be to Barbara, to verify she has admitted to padding the billing. I will then ask why. If she has done so at the request of Donna Strickland I will then ask Ms. Strickland why she had made such a request and what she thought she had to gain in doing so. I will also ask both parties if they are aware of the legal ramifications for what they have done?

    To prepare for the meeting I will review the records of hours worked by Barbara and by other aides. In many home health care settings ...

    Solution Summary

    Falsification of records and billing is examined.