How does the role of an MDS Coordinator relate to patient care and Medicare or Medicaid fraud?

A nursing home MDS Coordinator assesses the capabilities of a patient and creates individual care plans—including the level of treatment that must be delivered. A person in this position may be doing their job right but then fall under the pressure from the nursing home to up the ante for more billings or risk losing a well-paying job. It starts out with a fudged physical therapy session here or there. Then the message flows downhill to CNAs and other healthcare staff resulting in more falsified records. This escalates with more and more demands from above to get additional services—and higher value services—added to the bills. In the end, the Government is defrauded.

Rather than going that route, the MDS Coordinator should report the nursing home under the False Claims Act (FCA) and whistleblower protection. The nursing home is NOT allowed to terminate you for reporting their illicit actions. They may try, but there are terrible consequences for doing so, including double damages and double back pay.

We prosecute hundreds of cases: we settle some, take some to court, and also attain judgments. Nursing homes often want to convince the litigant to sign a non-disparagement agreement which prevents saying anything negative about the nursing home. This makes it hard for other people to find out about the standards of care when they are comparing nursing home choices. It also keeps bad care and fraud under a veil of secrecy—this is why we recommend against signing these documents.

The MDS Coordinator, as a person of conscious, needs to ensure the patients are receiving the care they are supposed to receive—not too much and not too little. They must also make sure the nursing home is paid adequately—not overpaid—so that they can hire enough staff to do the work. If that’s not happening, documents are being falsified, and false billings are going out, the MDS Coordinator should reach out to an attorney to bring the appropriate actions so the federal government can come in and stop the fraud. In this position it’s important to realize you have rights, you have protection, and you can help make a change in that facility.