GSIL Long Term Support Medicaid Fraud Update Debbie
GSIL Long Term Support Medicaid Fraud Update Debbie Krider, GSIL COO and Compliance Officer January 17, 2017 Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org
What is Medicaid Fraud? • Being paid for services that have not been provided or have not been provided in a reasonable standard of quality care. • It brings serious consequences to the organization providing the service and to the Consumer or Personal Care Employee if they are involved. Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org
Office of Inspector General Sounding an Alert to Medicaid Oct 3, 2016 Letter regarding Personal Care Services • Found significant and persistent noncompliance • With homecare growth this is heightened urgency • Encouraging CMS(Medicaid & Medicare) to have more oversight, monitoring and regulations to reduce this occurances • OIG found improper payments, questionable quality of care and high amounts of fraud Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org
Types of Fraud Found • Care unnecessary • Care not provided – false documentation of activities were submitted • Caregivers persuaded the Consumer to sign blank time sheets and submit them without the Consumer receiving services Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org
Examples of the Problem • Owner of a agency knowingly authorized employees to submit false time sheets • An employee that was excluded from all Federal health care programs submitted timesheets • Caregiver was in Caribbean submitted timesheets for the dates while there • Caregiver had a full-time job with another employer and submitted timesheets during the time she was working at her other job Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org
Consumer Harm • IOG revealed incidents of abuse and neglect • Some have resulted in deaths and hospitalizations • Found Caregivers impaired while providing care • Money, items and medications stolen Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org
OIG’s Conclusion • There are not sufficient controls • Want CMS to send guidance to States on steps they can take to improve internal controls • Establish minimum Federal qualifications and screening standard for PCS workers, including background checks • Require States to enroll or register all workers and assign them unique numbers Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org
Possible Consequences for Committing Medicaid Fraud • GSIL: tarnish reputation, loose consumers, fined and/or program closed • GSIL Consumers: jail, fine, no longer GSIL Consumer and/or loose Medicaid as a benefit • GSIL Employee: jail, fine, no longer can work in the healthcare field as well as if Felony will severely limit future employment in other fields Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org
How this Effects GSIL will: • Change policies to support new regulations • Continue audits: HR, timesheet, payment and consumer record audits • Continue checks in real time if PCA are working • Implement new time and attendance • Continue to train and education everyone! Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org
Compliance… …it’s EVERYBODY’s Responsibility! We are all responsible to do the right thing and to report any situation that could potentially be a problem. Contact Supervisor, HR or Compliance Officer at 800 -826 -3700. Thank you! Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org
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