Disclaimer: Names may have been changed to protect the agencies surveyed
Health care policy consultants have a peculiar job in that they must protect the licenses of the providers who hire them. They must also educate providers that the community has a right to quality care delivered by licensed, experienced nurses. Unfortunately, the two ideas don’t always successfully marry in some practices. Identity fraud in health care is not new. Some states such as Florida and Texas are hot spots for fraud with identity theft being just one issue of many. Maryland has recently joined the big leagues in a bad way. Health care fraud is on the rise. In Baltimore, one of Maryland’s largest health care markets, this examiner has seen a new pattern of fraud. The identity of health care workers is being stolen not just by other individuals, but by the agencies from which they seek work. Credential theft is the new issue and its side affects are costly.
A Baltimore provider certified by Maryland Medicaid to provide in home care to pediatric patients received a request from The Maryland Division of Nursing for the treatment records and nurse credentials for the agency’s REM clients. When the agency failed to produce the requested information, the DONS paid them a visit. During the visit, the agency was cited for failing to keep accurate hiring records as required by Maryland COMAR. The agency was given ten days to submit the required credentials to the state. The agency had provided the care but there was one problem and it was a big one; of the workers contracted to provide the care, some had negative or no background checks. Others had expired credentials or missing health care records. Worse, some workers had been excluded from Medicaid & Medicare programs by OIG for past fraud convictions. When faced with the possibility of paying back hundred of thousands of dollars in recovery and facing possible criminal prosecution the agency crossed a line. Instead of disclosing the information to MD Medicaid, the agency removed the names of ineligible workers and included the names of nurses who had never worked for the patients. The agency’s deception increased when the state enforced a recent rule which requires each licensed agency to submit the names and qualifications of nurses and aides providing care to recipients by the first of every month in order to receive payment for services rendered to waiver participents. The agency continued to use the names and credentials of phantom nurses to ensure payments were received. When the deceptive practice was uncovered the agency believed no one was hurt because care was being given.
This is a cautionary tale. Some Baltimore area providers have developed an “the end justifies the means” mentality regarding the delivery of care. When providers steal the identity of nurses and aides to secure payments fom the state or federal government, they are committing fraud. Nurses and aides are unaware that the information provided while filling out applications for employment may be used without their knowledge. What’s more, the revenue gained by the provider is forever attached to the worker’s social security number. Also, if the patient suffers due to care received or dies as a result of neglect, the state is required to investigate the care given. The nurse or aide, totally unaware that their credentials have been attached to the care of the patient, will be subject to a federal investigation and face possible prosecution. This is the hurt of which the agency believes does not exist.
How common is this type of identity theft? It depends on who you ask. According to The Telegraph (2009), this type of ID theft is usually committed by individuals and not by the agencies who hire them. However, of the twenty-five agencies surveyed for this report, more than half reported they know of the practice or have heard of providers who have engaged in the practice without being caught. How can nurses and aides protect themselves from unauthorized use of their credentials by providers? The following tips may not completely alleviate the practice but could deter the fraud from happening to you:
- When filling out applications, ask the provider for their policy regarding the use of credentials.
- Ask providers how long information from your application is kept on file and how it is stored/destroyed.
- Don’t sign any policy which requires you to waive your right to confidentiality.
- If you are not hired by an agency, ask that your information be destroyed, not saved. If work becomes available, you can always re-apply.
- Make your own copies. Employment forms such as the I-9 are available on-line. Copy both sides of your credentials and take them with you to your interview. The interviewer can inspect the documents and give originals right back to you.