Abington Memorial Hospital: Physician Signatures Cut and Pasted Into Records

Abington Memorial Hospital agreed to pay $491,672 in a home health signatures settlement resolving allegations that an employee copied physician signatures onto forms submitted to Medicare for home care services. For someone in records, compliance or billing, the alleged shortcut is painfully recognizable: a form can look signed even though the physician never authorized it.

The U.S. Attorney’s Office for the Eastern District of Pennsylvania announced the settlement on May 26, 2017. Abington Memorial Hospital did business as Abington Hospital – Jefferson Health. The Justice Department’s announcement described allegations involving its affiliated agency, Jefferson Abington Health Home Care and Hospice. The government said a hospital employee cut and pasted the signatures onto the agency’s submitted forms, leaving them without legitimate physician authorization.

Copied Physician Signatures on Medicare Forms

The government described a period beginning in May 2014 in which the affiliated home care agency submitted claim forms carrying the copied signatures. Medicare required genuine physician signatures on those forms before reimbursing the claims. The alleged substitution therefore reached the payment request: a physician’s apparent approval stood where actual authorization was required.

We see the absurdity in treating a copied signature as a completed clinical task. The image can be moved onto the form. The physician’s judgment cannot.

That distinction matters to staff responsible for getting records ready for billing. A signed-looking document may tell the next person in the process that authorization is complete. The person who saw how the signature got there can explain something the finished form conceals.

Abington’s Disclosure and Electronic-Signature Changes

According to the Justice Department, Abington disclosed its discovery of the copied signatures to the government in June 2016. The hospital promptly reversed Medicare claims that were within one year of billing and repaid the reimbursements it had received for those claims.

The announcement also said the hospital terminated the employee involved and installed a computer program requiring physicians’ electronic signatures. That change eliminated the need for Abington to obtain physical signatures.

We examine the response alongside the original forms. Repayment entries and changes to the signature process help us understand how an agency responded to an alleged practice. Someone who worked through those changes may know which forms prompted them and how staff handled the affected claims.

Physician Authorization Has a Clinical Job

The home health certification chain connects the patient’s condition, the encounter, the care plan and the Medicare claim. Records pass between the referring provider, the certifying practitioner and the home health agency. Each holds a different part of the explanation for why Medicare should pay.

The certifier’s or discharging facility’s records must support eligibility under today’s rules. Agency documentation needs corroboration from those records and the certifier’s signed, dated acknowledgment that it was considered. The signature has a job: connecting the certifier to the clinical support for payment.

When the concern is care the patient did not need, the clinical findings and visit orders carry the issue. When the concern is a copied signature, who actually authorized the form becomes central. We start with the approval you saw copied and work through what it represented to the next person handling the claim.

What Is an OASIS Form for Home Health?

OASIS assessment data describe the patient as part of the agency’s comprehensive assessment and help determine payment and measure care quality. The assessment, physician authorization and claim serve different purposes. A completed assessment cannot supply the physician’s missing approval on a form that requires it. For health care billing staff, the allegation against Abington sits at the authorization step: who approved the form that supported the claim.

A Separate Case Where the Original Certification Disappeared

In a separate government complaint concerning Great Lakes Home Healthcare Specialists, the government alleged that management directed an employee to use white out to change the date a physician had signed a certification. The allegation went beyond changing the date. The complaint described what happened to the original:

That alleged deletion explains why the final patient file may be the wrong place to stop looking. According to the complaint, it contained the replacement while the original showing the actual signature date had been removed. The instruction, the alteration and the replacement together tell a story that the final document alone would hide.

The parallel is the manufactured appearance of physician approval. In Abington, the government alleged copied signatures. In the Great Lakes complaint, it alleged altered signature dates and deleted originals. An insider who knows how a document changed can make that difference visible.

What Evidence Is Needed to Prove Fraud?

For copied-signature allegations, we connect the original authorization to the submitted version and the resulting Medicare claim. The insider brings the part a finished form may conceal: how the signature got there. We develop that account alongside the clinical support, document history and payment records.

We work through those connections with the people who know the records. A records employee may have seen the original and replacement. A clinician may know what was actually approved. A billing or compliance employee may know which claims used the forms and what happened when the problem came to light.

The payment side deserves the same attention as the signature. The Medicare claims-processing manual describes the claim and remittance process. The remittance shows what Medicare actually paid after adjustments. Matching it to the affected claim lets us examine the money alongside the document that supported reimbursement. A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

You Know How the Signature Got There

If you saw physician approvals copied into home-care records, speak with our whistleblower experts about how those forms reached Medicare. We develop the case with you around the records and decisions you know, and bring in home health fraud whistleblower lawyers who understand physician authorization and healthcare billing. You have our expertise and partnership from that first conversation through the case.