questionable documentation

Irie

What can an employer do if they think the doctor's certification for FMLA is fraudulent? In otherwords, it looks like the employee filled out the form themself.

Also, this same employee brings in documentation from his doctor and word has it that he is using copies and filling in his own information.

What can an employer do about this? Thanks.

ritaanz

I had a doctor's cert that looked altered. I called the office and asked them. The nurse I spoke with was very helpful and even had a copy of the cert on file. She faxed it to me and sure enough, the employee, now ex-employee, had changed it.

If you approach it in such manner, I think they will help.

marc

Good advice Rita - I, thankfully, have not had to do this, but it is good to know that this sort of thing can work.

HRQ

An employee submitted a doc's note excusing her from a mandatory meeting. The doc's handwriting and signature was suspiciously similar to the employee's own. We chose to leave it alone.

Two months later the employee applied for two weeks FML. Same doc completed the FMLA certification and STD claim form. The doc's section on the claim form was TYPED. Who even has a typewriter any more? Plus the language they used just struck me as odd.

So, I called the doc's office (Cigna) and told them about my concerns. Faxed them all the notes, and they faxed right back to me that everything was legit.

They were happy to help, and I was relieved that this employee was not attempting to fraud our STD plan.

joannie

You can ask the ee to go to a doctor of your choosing for a second opinion on the FMLA certification. Below was copied from the DOL/elaws web site under FAQ's.

"if the employer wishes to obtain another opinion, you may be required to obtain additional medical certification at the employer’s expense, or rectification during a period of FMLA leave. The employer may have a health care provider representing the employer contact your health care provider, with your permission, to clarify information in the medical certification or to confirm that it was provided by the health care provider."

ritaanz

It is amazing what some lengths employees will go. One employee always had a doctor's note to cover their absences. The name on the top of the note was something like Maricopa County Doctor's group.

One day I had a question about the light lifting that was on the note so I called and asked to speak to Dr. Brown. There was no Dr. Brown. I then went to the file and got the other notes. There were no doctors working there by those names either. Guess what. The employee's mother worked for a cleaning company at night and she stole the note pad for him.

Another day older and now wiser.

HR Jones

Employers are not allowed to contact health care providers under the FMLA. The regulations specifically address it. I also have documentation here from the Department of Labor that says

"A health care provider representing the employer may contact the employee's health care provider, with the employee's permission, for purposes of clarification and authenticiy of the medical certification."

At seminars and conferences I have been to, the lawyers always say that employers are not allowed to contact health care providers for any reason - even with the employee's permission. I would err on the side of caution on this one.

If you choose not to do that, you can send the employee for a second opinion. But I do not recommend that you contact the health care provider yourself.

ritaanz

Jonesy, I contacted the provider to verify the documentation not the diagnosis or the health care provider's choice in putting the patient on FMLA.

HR Jones

Right, you contacted them to make sure they had filled out the form. I take that to mean verifying the authenticity of the form, which the DOL has said (see quote above) is only to be done through a health care provider, not an employer.

allsteaks

We are fortunate to have a local physician as our medical gatekeeper. He can do any follow ups we may need and does not review any medical info to us, only authenticity.

ACU Frank

[font size="1" color="#FF0000"]LAST EDITED ON 06-07-07 AT 04:18PM (CST)[/font][br][br]Maybe the best way around this (going forward) is to require that all doctor's notes be faxed to you. That way, you can see that it was sent from the doctor's fax machine, at least.

That's the way I do it.

HRQ

Just seems crazy to me that an employer can't verify that a doc's office did indeed complete a form, and what's on the form. I emailed our local HR consultants for their opinion. Will let you know what I find out.

HRQ

I was wrong, HR Jones was right. The emailed response is below;
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"Yes, it is absolutely crazy, but the information in the blog (That's you, HR Jones) is CORRECT. FMLA is horrible for the employer to administer, and this is one of the main reasons.

There is a fairly "new" practice that the employer can use if the circumstances in the original medical certification form have changed (i.e., employee authorized to use intermittment leave once a month, for example, and begins using leave once a week). You can copy the employee's attendance records that are related to the FMLA leave, and attach those to a medical certification which the employee takes to the health care provider to get recertified. We suggest that you include a cover letter to the employee stating that this is required because they are missing X number of days due to FMLA leave, when the certification only indicated X, then send a copy of the whole thing to the health care provider's office, giving the original to the employee to take."

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They are offering a class on navigating FMLA. I haven't had formal training in this area in ages, and I guess it's about time I go.