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Recent OIG case highlights the importance of exclusion checks

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Employing qualified individuals is paramount in the healthcare industry as well as home and community based services.  In some cases though, we find individuals that appear to be great candidates but are excluded individuals and cannot perform services involving Medicaid and Medicare.  Agencies must perform their due diligence and check that prospective employees aren’t excluded before sending them to work.  You might think “well what’s the worst that could happen”?  Employing excluded individuals can put an agency at great risk during an audit.  If during an audit it is found that an excluded individual provided Medicaid or Medicare billed services, all services performed by that individual will be disallowed and the agency is then responsible to pay fines on top of the full amount of those billed services.  For example, a current published report by The Office of the Inspector General (OIG)  showed that OIG settled Civil Monetary Penalty (CMP) cases involving False and Fraudulent Claims.  In June, ePeople Healthcare, Inc, a health care staffing agency in PA, settled a case with OIG for $10K for employing an LPN who provided services and was federally excluded.  There were 3 other similar cases settled in June,  a hospice agency in FL settled for $429K, a Vermont Rescue Squad settled for $94K, and a hospital in CA settled for $155K.  Those are very hefty price tags for not checking exclusion lists. 

Tennessee plan foreshadows trends in DD services

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It's always interesting to see trends in DD Services from a macro or national level as states make their way through funding cuts and new models for DD services.  Recently, a plan in Tennessee was unveiled that I believe foreshadows the way DD services are pointing into the future.  To read the article, click here. 

MediSked News Roundup 7/23/14: CMS To Reform Medicaid Payments Model

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Here are the latest stories affecting DD providers across the country.  Have a look!

The Future is Now- PAR Tech Conference


5 Things to Expect When Implementing DD Provider Software

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If you have never been a part of a software implementation and you are currently look to purchase an agency management platform, it’s natural to be wondering ‘How are we getting this system actually up and running at our agency?’  That’s where implementation and training services come in and there are some key areas to expect when your agency is about to start an implementation with a vendor.  Disclaimer: Implementing software at your agency is a big task.  Having a cohesive team and keeping your eye at the end goal will get you through the process and the benefits of a successful implementation will be overwhelming. 

Thoughts on Person Centered Planning

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Earlier this year, CMS issued a new rule on home and community based services that requires agencies to administer person-centered care for its clients.   CMS and many DD advocates believe that a person receiving HCBS should be able to direct their care planning process, including defining their own goals and preferences on how to achieve them.  This planning process is also intended to include members of the client’s circle of care, whom the client chooses.  Guidance on how states operationalize this is yet to be released to states, but the intention is clear – provide more freedoms and rights to individuals being served in home and community based settings.  While you can’t argue that point, there are some questions and concerns about how far person centered planning goes; especially if decisions or goals go against the agency’s duty to protect the health and safety of the individuals they serve.

MediSked News Roundup 7/9/14: CMS & fraud protection on EHRs

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Here are some of the more popular stories trending in home and community based services from across the country.

MediSked News Roundup 7/2/14: MyCare Ohio

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Here are some of the more popular stories trending in home and community based services from across the country.  Enjoy and happy 4th! 

New MediSked Connect Feature Updates for Q2, 2014

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As the MediSked Connect Quarterly User Group sessions kick off this week, we wanted to highlight a few of the many feature updates for this quarter.  If you're a Connect user, be sure to attend a session to see live demos of these updates!


MediSked News Roundup 6/23/14: Autism & lifetime cost of care

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Here's the latest DD news from around the country. 

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