Friday, May 13, 2011

Did you ever accidentally report another social worker/agency?

Because this happened to me yesterday and I still feel kind of bad about it, even though it can happen to the best of us.

Anyways, this is the scenario:

Discharged a client from a nursing home last week.

They were given a one week supply of meds, and then a month's supply of scripts for refills.

I contacted the pharmacy to fill the meds, so they could then deliver to client. All of her scripts were able to be filled, except one---an extremely important psychiatric drug.

The pharmacist indicated that the nursing home had filled this at the end of April, so therefore, she would not be able to get a refill for a few more weeks.

I called the nursing home social worker who basically told me there was nothing that could be done. She had contacted their pharmacy who reported no record of the med being sent back. All of the other people who "may be able to help" were also out of the agency at the moment.

I spoke to the pharmacy I was working with again and they gave me a number to call to try to get a Medicaid over-ride, so the med could be filled. I ended up speaking with a man in THE NYS Medicaid office, who told me that if the pharmacy/nursing home did not produce the drug, or reverse their claim to Medicaid for a 30-day supply, they could be held responsible for Medicaid fraud.

He ended up calling both providers back threatening a report to the Office of Medicaid Inspector General (OMIG). Obviously, both providers were PISSED OFF at me for "reporting them" as was demonstrated in a bazillion calls back to me about this.

In any event, since this was all happening close to 5PM yesterday, I still ended up having to send the client to the psych ER for an emergency refill. This was something that also infuriated Medicaid man because of even more $$$$$ the system has to pay for, for something that is easily preventable. Note: I almost ended up having to call 911 over this too because the client's SSI money had not arrived yet, she already had used up all the carfare I gave her to get to her medical appointments last week, so therefore, had no way to even get to the ER. Fortunately, her aide loaned her money so she could go to the hospital.

I felt bad especially because the NH social worker told me she was the one who got reamed out for this happening.

I really don't think I could've done anything differently though. Have you ever been in a similar situation in your work? Did you ever have to report another social worker or helping provider (acidentally or not)?

1 comment:

  1. I wouldn't feel bad if I were you. The social worker told you there was "nothing she could do." When people say this it is rarely true. What they really mean is, "I don't feel like doing what I would have to do to try to take care if this problem; it would take a lot of time and would be a lot of work." Plus, you were looking out for the best interests of your client. If the client had ended up getting admitted to an inpatient psych ward because she couldn't get her medication and decompensated I'm sure the Medicaid man would have been REALLY pissed off, because that would cost even MORE money. You did what you had to do and you went above and beyond; your client is lucky to have a caseworker as dedicated as you are.