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Nurse practitioners, and at times, registered nurses, may be asked by their patients or required by legislation to complete forms to be submitted to a third party. This typically includes filling out a form or writing a letter on behalf of the patient for the purposes of gaining access to a benefit, or confirming certain health information. Common examples of such requests include filling out forms to submit to government programs or agencies, completing disability claims, or providing letters to employers regarding fitness to work.
Clinical information and opinions communicated to third parties are likely to be relied upon to make decisions and, in many circumstances, determine entitlement to benefits. It is important that third party forms not be completed solely for reasons of convenience to the patient, even if at times, fulfilling the patient’s request may appear to help ease a patient’s burden. Nurses should endeavour to present information that truthfully and accurately reflects the clinical status and history of the patient, based on a reasonable clinical assessment. In doing so, they can rely on the signs observed during the assessment and the symptoms and history reported by the patient. They can also rely on the information contained in the patient’s clinical records or the results of the relevant diagnostic tests that have been ordered in the context of the clinical assessment. It is a good practice to ascertain that the information relied upon is documented or readily available in the records so that the content of the report can be further explained and supported, if necessary.
If the clinical information or opinion appears doubtful, the author of the report or the form may be asked to substantiate the information. If the information or opinion cannot be substantiated, questions may be raised as to whether the nurse met the applicable standard of care or even whether there were improper motives for completing the form, potentially leading to complaints to the regulator. Nurses could face very serious legal consequences if they deliberately provided information that they knew to be false for the purpose of securing for themselves or for their patient an advantage to which they would otherwise not be entitled. For example, a nurse in Illinois was charged criminally with health-care fraud after allegedly signing nursing assessments that contained false information.1 It was alleged that the nurse had paid fees to a marketing company to refer patients to the agency where he worked as manager and then falsely reported the patients as homebound and requiring assistance with the daily activities of life such that he could then bill Medicare for services that were not rendered. The nurse subsequently pleaded guilty to a number of criminal charges based on the allegations against him.2
CNPS beneficiaries can contact CNPS at 1-800-267-3390 to speak with a member of CNPS legal counsel. All calls are confidential.
1.“Nurse Charged with Health-Care Fraud Scheme For Billing Medicare For Unnecessary Services,” The United Stated Attorney’s Office Northern District of Illinois: March 10, 2015 (https://www.justice.gov/usao-ndil/pr/nurse-charged-health-care-fraud-scheme-billing-medicare-unnecessary-services).
2. “Owner of Homewood Telemarketing Company Convicted of Taking Illegal Kickbacks for Referring Patients to Home Health Agencies,” The United States Attorney’s Office Northern District of Illinois: August 31, 2016 (https://www.justice.gov/usao-ndil/pr/owner-homewood-telemarketing-company-convicted-taking-illegal-kickbacks-referring).
Published May 2018
THIS PUBLICATION IS FOR INFORMATION PURPOSES ONLY. NOTHING IN THIS PUBLICATION SHOULD BE CONSTRUED AS LEGAL ADVICE FROM ANY LAWYER, CONTRIBUTOR OR THE CNPS. READERS SHOULD CONSULT LEGAL COUNSEL FOR SPECIFIC ADVICE.