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Thread: Home Health Agency delicate issue...

  1. #1

    Home Health Agency delicate issue...

    Hey, I figured this forum was the best fit for my question even though its not exactly about caregiving, so let me know if I should post it somewheres else.

    Here is my situation. I just moved back out on my own (T6 complete - 8 months post) and I am on medicaid and all that good stuff, so I come to find out that the only way I can get NC medicaid to pay for my catheters and supplies is to be enrolled with a "home health" agency (I am still not sure exactly what that is, but I have one now). So I figure thats a good idea and I could use help with some stuff around the house, even though I do my own personal care, its hard for me to clean the bathroom/kitchen/etc so I will let them help me with that. (btw it all seems like a waste of some taxpayer money to me, because I would be perfectly happy to go pick up my catheters and supplies at the pharmacy, but medicaid doesnt like that, so here we are).

    So now its getting kinda sticky. The home health agency came out to my house and did an interview or whatever to assess my needs. They say "you need somebody 5 days a week for 2 hours a day"... I say "ummm, no... how bout once a week... how bout once a month, and you can just bring me my supplies." So they say okay, once a week. And then the next week the attendant (sorry if thats not the right term, but you know the person who helps ya out) comes by and says "yep, they've got you down for 5 days a week." Argh. "Well, i am not going to be here but one day a week" I tells them, and so they say thats fine just sign the paper that says they're coming 5 days a week.... therein lies the problem.

    I dont want to get in trouble for signing something that says they're doing things that they are not actually doing, but I also dont want them to drop me, or to piss off the person who is coming out to help me out around the house. Anybody got some advice about how to approach this with some tact (i've been known to lack that from time to time) and without pissing anyone off or anybody getting in trouble?

    thanks,

  2. #2
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    I would not sign anything that was not accurate. Sounds like there is some fraud going on with either the agency or the aide.

  3. #3
    Yeah, thats kinda a given, I am just looking for a smooth way to do it without pissing off people that I have to be around for the forseeable future.

  4. #4
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    I agree, don't sign anything that will implicate you in what is obviously fraud. Tell them you want one day per week, or month, or whatever it is YOU want, and that anything more than that would be intrusive and more than you can handle. You can make it sound like it is some eccentricity on your part if it makes you feel better and more secure with the agency. Sort of like..."wow,that's great, but I really need more time to myself so I can't have anyone here this much and I don't think it would be a good thing for me to lie about it."

  5. #5
    Give a call to your Senator's or member of congress's office. This is a situation they are in office to help you with. Besides this being an election year will get you a more speedy response. Let us know how this works out.
    T6 complete

  6. #6
    Since this is a state program (Medicaid) and a state funded program, it won't do much good to call a Congressperson or Senator. Check in your phone book to see if there is a hotline for Medicaid fraud reporting.

    I found this for North Carolina:
    http://www.ncdoj.com/law_enforcement/cle_miu.jsp

    Whistle blowing is protected according to this, but it applies specifically to employees, not clients, of agencies, so you should be prepared to ask them about protecting YOU if you file the report.

    Don't get pushed into signing a fraudulent claim. You risk loosing all your Medicaid benefits, not just your home health care.

    (KLD)
    Last edited by SCI-Nurse; 07-12-2008 at 02:57 AM.

  7. #7
    Member skicat1898's Avatar
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    Most home health agencies providing home services with a attendent recieve around $12.00 per hour which intern they pay the attendent around $8.00 per hour at the very most,,, the agency pockets the rest.

    Here in Texas the home health agency gets $100.00 per skilled nurse visit which is usually monthly or quarterly accessments by a RN...... My last accessment visit lasted all of 15 mins..... Not bad money if you can get it.

    My experince is that home health agencies and DME's rip the government off when ever they can......... Case in point, last year I got a new high profile ROHO cushion, you can buy them most anywhere for under $600.00,, by the time my home health agency went thru their DME Medicaid was charged $1500.00,,,,,, amazing.

    Just got a new Airpulse PK cushion,, same home health and same DME,,, cushion cost to Medicaid was same as manufactuer's price,,, strange.

  8. #8
    Senior Member Wesley's Avatar
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    I would try to find a new agency. Let's face it even if you stood up to the existing agency, would you really want aides coming to your house that were hired and managed by a bunch of crooks? as far as being a whistleblower, that would be the last thing I would be interested in eight months after a life altering injury. (maybe after your setup with the new agency, you can write a letter to Medicaid people). In the meantime before locating a new agency, I would let people come for five days a week or if you're really not going to be there, just cross out the hours that they didn't do and sign the sheet. Play dumb until you can get an ethical agency.

    also, you need to consider whether or not you might actually need additional help down the line. It's harder to get extra hours once you lived with less. I'm not saying you should have more help than you need, but if you're just getting set up make sure you get the help you need.
    Last edited by Wesley; 07-12-2008 at 01:06 PM.

  9. #9
    I don't understand why you have to be enrolled with home health, that does seem like a waste of money.

    In my state, hours for chores and cleaning etc can be done by virtually anyone if they pass a background test. You can use someone from the agency Health and Human Services contracts with or find your own person. I would ask your worker if that is a possibility??? Do not sign that the person is working for you more than they are. It makes sense that the person wants more hours when they are getting paid not much, but if you don't need them it is not your problem. That is why I suggested getting someone like a family member or friend authorized to do it for you.
    Aerodynamically, the bumble bee shouldn't be able to fly, but the bumble bee doesn't know that, so it goes on flying anyways--Mary Kay Ash

  10. #10
    Quote Originally Posted by november
    You can use someone from the agency Health and Human Services contracts with or find your own person. I would ask your worker if that is a possibility???
    I dont have a "worker" (i assume you mean social worker) and the thing is I need to be enrolled with a home health agency in order to get my supplies covered by medicaid, so getting someone outside of a home health agency is not an option (and i really dont need anyone to do anything for me, but its nice to have somebody wash the dishes and take out the trash somtimes.

    I think I have resolved it. They got really upset that I wont sign forms saying that they are coming 5 days a week, but I got them to schedule me in for two days a week (one on a weekend) which will work out okay for me. This is how bad it is though. One lady told me to just sign the paper saying that my worker comes 5 days a week and they would "break me off some CASH MONEY out of their check each week" Wow! thats one crooked crooked company, but I think I got things worked out.

    Medicaid is just begging to be taken advantage of like that though. I mean imagine if they covered catheters like prescription drugs. I'd never even have to be involved with these crooked companies at all. They were also trying to get me a power chair or scooter or something (I am T6) and pushing really really hard for it, but I dont need a power chair, and even if I wanted one, my apartment is like 300 sq feet (literally, I am not exagerating) where am I going to put a powerchair?

    Argh. this system is so broken....

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