Remember: CMs advocate; they don't spy
Avoid getting caught in ethical dilemmas
Insurance companies often use surveillance techniques to disclose fraud in workers' comp and disability cases. While surveillance may be appropriate in some cases, it is not the role of the case manager, says one nurse attorney.
"There are plenty of people out there who can do surveillance. It's simply not your job," says Lynn S. Muller, RN, JD, CDMS, CCM, a partner with the health care law firm of Muller and Muller in Bergenfield, NJ. If you are asked to take pictures, tape record, or videotape your own client, say "no," she advises. "Tell the insurance company that you will go to the house and do an assessment, but that's all."
The case manager's role should be limited to advocating for the patient, notes Muller. "If you are approached by an investigator in a medical center parking lot and asked,'Is that your client?' Answer yes. It's the truth, and it's not the same thing as participating in the surveillance."
The question later in court would be whether you went to the doctor's office with your client on that day, and your answer would be, "yes," says Muller. "What did you do wrong? Nothing."
However, it is essential that case managers represent themselves honestly to clients, she adds. "You must tell your clients that you work for the people that provide their services. If your client has limited understanding, repeat yourself often," she says. Don't put yourself in a position where you must testify against your own client by allowing the client to reveal something that places his or her claim in question, Muller cautions.