Jun 4, 2019

  1. RNwithquestions

    RNwithquestions New Member

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    I am a registered nurse in the state of WI that takes care of a 14 year old girl with multiple diagnoses qualifying her for private duty nursing. Her family has a primary commercial insurance plan and Medicaid as a secondary. We have to submit documentation to the commercial insurance to be paid, as they are the primary, and we are paid from them. My question is, the mother is also a RN who was approved as a caregiver on the case. We bill a certain amount, and they pay us 50% reimbursement. It is determined based off of 140% of the Medicare rate, however there is no Medicare rate, so we are reimbursed 50% at any amount we bill. The mother submitted documentation to take care and bill for her child, and she bills for whenever nurses are not there (several hours weekly - including when he is asleep). He is approved for 24 hours of care per day through insurance. Based off of her documentation, she is making around $35,000 a month to care for her him. I know the obvious ethical issues, however should I be concerned as a caregiver working on this case? It does not seem right that a mother should be reimbursed to care for their own child, special needs or not, especially not to the tune of hundreds of dollars per hour to be in their own home. Thank you for any advice anyone may have. Feel free to ask any questions if they arise.