A PIG IN A POKE – Nursing Talk

Nursing Talk

Dear Cassandra:

Why did the company switch to using Clockworks instead of timesheets? Why do we have to call in from the parent’s phone rather than using our cell phone? Why do we have to submit copies of our nursing license and both sides of the CPR card?

Just Asking in Aurora 


Dear Just Asking:

Say you have lived in your house thirty-four years. A few years after you moved in, you had a new roof installed. You chose asphalt shingles with a twenty-five year warranty. Now the shingles are curling, and you are noticing extra granules in the gutters. You need a new roof. You find a flyer in your door from an out of town roofing company. The flyer says they are doing work in your area and would like to give you a free estimate. You ask for the same high quality asphalt shingles with a twenty-five year warranty. The price is agreeable, and you have the work done. You pay the bill. A year later you discover that cheap, poor quality shingles were installed. When you try to contact the company, you discover that the company is out of business. You learn that the Better Business Bureau has received numerous complaints about this company. You are a victim of fraud. You are devastated.

Fraud is a deliberate misrepresentation which causes another person to suffer damages. Defrauding people or entities of money or valuables is a common purpose of fraud. It is a crime. In the Middle Ages, meat was scarce, but feral cats were abundant. A confidence game or trick was to sell a cat in a sack instead of a pig in a sack. This confidence game was called a pig in a poke.

Fraud is a huge problem in business today. The typical organization loses 5% of its annual revenue to fraud, with a median loss of $160,000. Medicare fraud is estimated at $60 billion a year.

Businesses try to prevent fraud by various methods. For example, timecard fraud occurs when an employee has a co-worker or another person punch in/ punch out. Businesses try to prevent timecard fraud or “buddy punching” by using fingerprint based punch in/punch out machines or systems like Clockworks.

The Clockworks system uses a unique ID and password to record the number of hours worked. The employee must call from the parent’s phone, the phone in the house of the client. That guarantees that the employee is actually in the home, not calling from another location. Clockworks helps ensure that employees are paid for legitimate hours worked.

Clinical notes must be written every two hours and must match the time in/ time out recorded in Clockworks. Making up clinical notes for care not given is fraudulent. Cases of fraud are reported to the Illinois Department of Financial and Professional Regulation. The State of Illinois can revoke a nursing license if the person is found guilty of fraud.

The advent of computer technology has made it possible for individuals to create fake nursing licenses and CPR cards. These counterfeit documents are presented to potential or current employers. To combat this type of fraud, the employer must verify the licenses on the Web site of the Illinois Department of Financial and Professional Regulation. The State also requires that the personnel files contain both the front and back sides of CPR cards. The employer can verify the CPR card by contacting the school or organization sponsoring the CPR class. Verifying the licenses and CPR cards helps ensure that qualified nurses are caring for the clients.

Employers need to expect good behavior from their employees and monitor their activities. As Ronald Reagan said regarding the Soviet Union and nuclear arms, “Trust but verify.” If employees are committing fraud, employers must hold employees accountable for their actions.


Note: First published on American Home Health's news, March 2011.