Does care given by a nurse with a suspended license who was provided by a staffing agency result in potentially submitting claims in violation of the False Claims Act related to substandard quality of care (F-727 Competent Nursing Staff and F728 Facility Hiring and Use of a Nurse)?
Compliance Perspective – Grand Larceny
Policies and Procedures:The Compliance and Ethics Officer, DON and Administrator will review Compliance Program policies and procedures and vendor contracts to ensure the facility is meeting the requirements for submitting appropriate claims for reimbursement. Nurse staffing agencies must periodically submit proof to the facility that the personnel provided are competent, appropriately licensed and have passed background checks. Training: All nurses supplied by a staffing agency will be trained regarding compliance with federal and state laws governing residents’ rights; freedom from abuse, neglect and exploitation; and providing quality of care. Audit: An audit will be conducted periodically to check whether nurse staffing personnel have had their licenses suspended or have unrenewed licenses. The results of the audits will be summarized and submitted to the QAA/QAPI Committee and the Compliance and Ethics Committee for review and recommendations.
Although her practical nursing license was suspended by the State of New York, a woman was hired to work as a licensed nurse by a nurse staffing agency and was assigned to work as a licensed nurse in a nursing home. She was arrested and charged with grand larceny and practicing without a valid nursing license after allegations were made that she fraudulently took over $20,000 in payment from the nurse staffing agency while practicing without a nursing license.
In October 2017, the woman had agreed in writing through an Application for Consent Order (ACO) to the suspension of her nursing license related to the settling of an undisclosed disciplinary matter by the New York State Office of Professional Discipline (OPD). Despite agreeing to the suspension, the woman immediately began working with the nurse staffing agency that provided nursing services to health care providers. From October 2017 to January 2018, she was assigned and worked for a nursing home as a licensed practical nurse.
If convicted on the two felony charges–Grand Larceny in the Third Degree and Unauthorized Practice of a Profession–the woman faces an indeterminate sentence with a minimum of 1 ½ to 3 years and a maximum of 3 ½ to 7 years in prison.
