Healthcare fraud is a rising problem in Tennessee and across the United States. The government estimates health care fraud cost Medicare and Medicaid programs over $100 billion in 2017. Nearly $60 billion of which was attributed to fraud against Medicare and improper payments. Plus, the losses to these government programs are up by over 6% since 2008.

The continued rise in health care fraud and the sheer amount of losses sustained by the government, insurance companies, and taxpayers makes stopping health care fraud a priority in Tennessee.

For the nursing community in Tennessee, accusations of health care fraud are possible and should be a major concern. Both state and federal agencies are tasked with monitoring claims and payments for possible fraud, and administrative agencies are cracking down on offenders by revoking nursing licenses and impeding future careers.

How Nurses Commit Health Care Fraud?

You might be most familiar with health care fraud by doctors, surgeons, pharmacists, and executive decision-makers in hospitals or medical groups. But nurses in Tennessee can commit health care fraud, as well. A Tennessee nursing license defense lawyer will speak with several nurses each year that are facing complications or questions of health care fraud. What actions can land a nurse in trouble?

A common type of health care fraud is billing Medicare or Medicaid for services not actually provided. Improper billing is a major issue for medical practitioners. In this instance, a registered nurse or nurse practitioner may claim to administer a specific service or medication and submit a bill for that service. But the treatment was never given. Similarly, nurses are accused of aiding doctors to bill for ghost patients.

In particular, nurses that administer in-home care are at risk of accusations for falsifying treatment records and bills. The suspicion around home health care practices gained national attention when a registered nurse in Texas was convicted of participating in a $20 million scheme to defraud Medicare. Another case in 2017, uncovered by officials in Ohio found a home health care nurse guilty of Medicaid fraud that resulted in the death of a minor child. In this instance, the nurse was submitting bills for private nursing services that weren’t actually being administered. At some points, the nurse was absent from the home for long periods of time but submitting claims to Medicaid covering these time periods.

Repercussions of Fraud Accusations on a Nursing Career

Accusations of participation or orchestrating health care fraud can lead to the loss of a nursing job. Whether you work in a hospital, out-patient facility, or home health care, an employer or medical group is going to take accusations of fraud very seriously. The stigma of such fraud and investigation is likely to result in suspension of your duties and shifts. It is common for Tennessee nurses accused of health care fraud to be placed on administrative leave.

However, the immediate repercussions following charges of health care fraud are dependent upon the severity and extent of the accusations. In some instances, health care fraud leads to termination of a nurse’s employment.

The long-term impact on a nursing career is possible. A nurse convicted of health care fraud will find it difficult to build trust with an employer or gain upward mobility in a medical practice. Raises, new responsibilities, and promotions are unlikely, if employment is offered at all. For many nurses, conviction of health care fraud equals the end of a career in the industry.

Impact of Fraud Accusations on a Nursing License

Your future career could be even more at risk if the Board of Nursing wants to review your licensure after accusations of healthcare fraud. The Board of Nursing investigation, administrative hearing, and other procedures usually proceed tangentially, but separate, from the investigation and trial into health care fraud by the state of federal government.

Often, the lawyer hired to handle your defense to charges of health care fraud is specialized in that area of the law, but may not be familiar with the administrative proceedings for Tennessee licensure defense. This means a defense of your nursing license can, and in many cases should be handled separately from a criminal or civil trial for health care fraud. A Tennessee nursing license defense lawyer can be a huge asset when going before the Board of Nursing.

How likely is it that the Board of Nursing will revoke or suspend a nursing license because of healthcare fraud?

Each case is determined wholly by its own facts and circumstances. But just as the government, federal agencies, and government prosecutors are cracking down on the criminal aspect of health care fraud, administrative agencies are doing the same. Whether you license is revoked or suspended and for how long is often dependent on the severity of charges against you in court and the quality of your defense before the administrative board.

The time to develop a defense of your nursing license is before you go to trial or an administrative hearing, and the best course of action is contacting a  Tennessee licensure defense lawyer at Surber, Asher, Suber & Moushon, PLLC when you first hear of an investigation or suspicion of health care fraud.

If you are concerned with fraud charges, call Garrett Asher  at 615-997-1914.