In the simplest terms, fraud occurs when someone knowingly lies to obtain benefit or advantage or to cause some benefit that is due to be denied.

If you know you did not arrive at a client's home until 8:15 am but you sign in for 8:00 am, that is Fraud! Not only are you being paid for time you did not work, you are denying the client time they are entitled to receive.

If you did not give a treatment or medication but chart that you did, that is Fraud!

If you leave before your shift is over but still sign out for your normal shift, that is Fraud!

If a health professional submits a false or fraudulent claim, such as documentation of services not rendered, or makes a false statement, including concealing material facts as well as providing fictitious or fraudulent representation, he or she has committed a crime that carries a five year prison sentence as well as fines. The U.S. can also pursue a false claims civil action against the defrauder and recover $5,000 to $10,000 for each false claim plus three times the amount of damages that the government sustained because of the fraudulent act.

A healthcare fraud perpetrator who works along with another person to affect a scheme may be guilty of conspiracy. That is also punishable by fines and/or imprisonment.

This is a very serious issue. Every day, there are people associated with healthcare that are being investigated for fraud. Over the past year, we have seen several investigations involving nurses working in homecare. Some of the fraudulent activities were:

  • A nurse who was working for two agencies had documented that she left one client's home at 4 pm and arrived at another client's home at 4 pm on the same day. We know that this would not be possible.
  • A nurse, who was being paid by one employer for Monday through Friday from 8 am to 4 pm, was also turning in paperwork to another employer for intermittent visits she made during the same hours.
  • On several occasions, a nurse was not at the client's home when the agency tried to contact the nurse. The state sent an investigator and found that the nurse was turning in documentation for shifts that were not worked at the client's home.

Not only are you liable for your actions criminally but professionally as well.If found guilty of fraud, you may find yourself without a nursing license (perhaps forever). In addition, fraud is a felony. Anyone with knowledge of a commission of a felony can be held responsible in part for the crime. Do not allow this type of behavior to happen in the homes of our clients. If you suspect others of fraud, it may be reported to management personnel at the office. We will investigate without divulging your name if possible.

Note: If this agency has ANY indication or suspicion of fraud, we will report it to the Illinois Department of Professional Regulation. They will proceed with an investigation of that suspicion at which time we will cooperate totally with the state board to prosecute to the fullest anyone who is defrauding our government, our agency, our profession and MOST importantly our Clients.