Robert Rodè, JD. Lores Vlaminck, MA, BSN, RN, CHPN. Surviving a Fraud and Abuse Investigation: On to Your Next Adventure?

Transcription

1 Srviving a Frad and Abse Investigation: On to Yor Next Adventre? 2 Robert Rodè, JD Provider advocate and consltant for Home Care, Hospice, Palliative Care, Assisted Living Focses on operations, srvey and complaint compliance and appeal, provider and individal licensre, dispte resoltion, client/family behaviors, employment, bsiness transactions, CHOWs, acconts receivable and contracts Active member of MHCA, LAMN, CPM, The Elder Jstice Center, American Health Lawyers Association, Training to Serve and Minnesota and Wisconsin State and Conty Bar Associations Named 50 for the Next 50 by LAMN 20 years experience, licensed in MN and WI Lores Vlaminck, MA, BSN, RN, CHPN Consltant for Home Care, Hospice, ELNEC and HPNA crriclm approved instrctor Home Care/Hospice Fonder and Director 41 years of nrsing experience Member; MHCA, MNHPC, LeadingAge MN, Palliative Care, Assisted Living 35 years hospice and palliative care Sigma Theta Ta, AAPHM, HPNA, NHPCO 1

2 Objectives Otline the state of affairs of frad and abse investigation in MN Understand how effective spervision benefits yo and yor client Develop strategies and best practices that reflect yor spervision Disclaimer 2 Things 1. This presentation is for edcational prposes only and is not intended to be legal advice. If yo have legal qestions please conslt a licensed attorney. 2. Any fact scenarios discssed in this session are hypothetical as we all are sensitive and proactive in preserving PHI. State of Affairs: Frad & Abse Focs Media Governor s Task Force Office of Legislative Aditor s OHFC Report Legislation 2

3 Star Tribne Series Part 1: Absed, Ignored Across Minnesota Part 2: Families Wait Years for Answers Part 3: When Roommates are the Absers Part 4: Speak Up, and Risk Eviction Part 5: A Model to Protect Seniors Governor s Task Force (Jan 2018) Comprised of AARP, Elder Jstice Center, MN Legal Aid, MN Alzheimer s Association and Elder Voice Notice that NO providers were inclded? Governor s Task Force (Jan 2018) Recommendations 1. Allow Older and Vlnerable Adlts to Go to Cort to Enforce Their Rights: Older and vlnerable adlts and their families and advocates need a stattory right to obtain redress and compensation for harms inflicted by the violation of consmer rights granted nder Minnesota law, inclding bt not limited to, rights contained in the Health Care Bill of Rights and the Home Care Bill of Rights. 2. Give Family Members and Others Advocates Athority to Enforce Rights Granted to Older and Vlnerable Adlts: Crrently, enforcement of the Health Care Bill of Rights is severely limited appearing to extend to only those persons with gardians or conservators. Nowhere else in law are family and advocates given stattory athority to enforce the rights of older and vlnerable adlts on their behalf. 3

4 Governor s Task Force (Jan 2018) 3. Allow Cort Actions Involving Abse to Proceed After Death of the Vlnerable Adlt Plaintiff: Families or an advocate shold be able to proceed to the conclsion of the case, withot limitations, on behalf of the deceased victim of abse. 4. Give Victims of Abse the Same Appeal Rights to Challenge a Maltreatment Finding: Victims of abse shold have the same rights as perpetrators of abse to jdicial appeal of an administrative determination of maltreatment. Office of the Legislative Aditor OHFC 2018 Evalation Report Key Facts and Findings: The Office of Health Facility Complaints (OHFC) within the Minnesota Department of Health (MDH) investigates allegations of maltreatment by MDH-licensed providers, sch as nrsing homes and home care providers. Between fiscal years 2012 and 2017, the nmber of allegation reports OHFC received increased by more than 50 percent, reaching 24,100 in Fiscal Year OHFC triaged for onsite investigation only 5 percent of the reports it received that year. Office of the Legislative Aditor OHFC 2018 Evalation Report OHFC does not have an effective case management system, which has contribted to lost files and poor decisions regarding resorce allocation. The majority of OHFC staff do not have confidence in OHFC leadership s ability to lead the office. OHFC has freqently failed to meet reqired triage and investigation deadlines. 4

5 Office of the Legislative Aditor OHFC 2018 Evalation Report OHFC s intake, triage, and investigation processes lack sfficient qality control measres. OHFC does not inform vlnerable adlts or their family members whether providers have reported sspected maltreatment. OHFC posts investigation reports on its website, bt the website is incomplete and difficlt to navigate. Office of the Legislative Aditor OHFC 2018 Evalation Report OHFC does a poor job managing its data, and MDH does not se available allegation and investigation data to identify trends and inform prevention efforts. Hosing with services establishments which inclde assisted living facilities are not licensed by the state and do not have the same level of oversight as nrsing homes or other licensed service providers. MDH Response to OLA OHFC Report In a letter dated March 1, 2018, Minnesota Department of Health Commissioner Jan Malcolm commented: the evalation raises a nmber of serios and important isses. In recent years, OHFC has not met Minnesotans reasonable expectations for investigating maltreatment complaints in a timely way. Improving the performance of this office is a top priority and we are committed to rebilding trst with victims, families and the people of Minnesota. MDH s Interagency Partnership with DHS has started making the changes necessary for OHFC to help prevent vlnerable adlt abse and neglect, respond to abse complaints in a timely manner, and ltimately, hold accontable those responsible for their failres in care and protection. 5

6 State of Affairs: Frad & Abse Focs MHCA - the impact on services being offered in private homes and other settings: 1. We spport zero tolerance for elder abse (or of any home care client). 2. We believe there are opportnities for improving reglation reglatory enforcement withot significantly driving p the cost or redcing access to health care. 3. We spport the process enhancement that is being implemented within OHFC inclding coordination and consistency with the MAARC system. 4. We believe it wold be wise to start with focs on ensring existing laws designed to protect home care clients, their families and providers are being enforced (e.g. timely srveys). 5. It is important to engage providers in the discssions related to program integrity and enforcement and, in doing so, remembering home care providers already embody and provide the dignified cares so necessary to those so vlnerable in Minnesota. Pending Legislation... At the time of this sbmission, competing bills in the Hose (Kiel); Senate (Hosley) and by the Governor (Lorey (S) and Olson (H)) Regardless: what s the pblic perception and expectation? How do we prove: 1. Zero tolerance for abse of any home care client; 2. Promoting and improving reglatory enforcement withot significantly driving p the cost or redcing access to health care; 3. Spporting the process enhancement being implemented within OHFC inclding coordination and consistency with the MAARC system. 4. We ensring existing laws designed to protect home care clients, their families and providers are being enforced (e.g. timely srveys); and 5. Home care providers already embody and provide the dignified cares so necessary to those so vlnerable in Minnesota. Clinical Spervision and Docmentation 6

7 Tools what do we already have? Nrse Practice Act (Minn. Stat ) Important definitions: Assignment Delegation Intervention Monitoring Spervision Scope of practice: LPN vs. RN vs. nlicensed assistive personnel Delegation National Concil of State Boards of Nrsing Pblic Protection Delegation verss Assignment Assignment: The rotine care, activities, and procedres that are within the athorized scope of practice of the RN or LPN/VN or part of the rotine fnctions of the UAP 7

8 Spervision Develop a cltre of excellence that develops the confidence and competence of all team members JUST Cltre Shold improve the qality of practice Spport the development of integrated team work Ensre contining professional development Spervision What leading open-ended qestions are yor spervisors engaging in with yor clients? Do yo spervise the licensed staff? Is there an opportnity to edcate or clients to empower them to be alert to scams, financial exploitation, maltreatment What do yo provide in yor admission packets regarding maltreatment Is yor grievance and complaint procedre easy to access? Docmentation of Spervision Concise Timely Compliance officer review Progressive discipline if applicable 8

9 Scenario 1 Scenario 2 9

10 Resorces Pocket_Gide_National.pdf tecting-residents-from-financial-exploitation.pdf ochre_national.pdf Smmary Otline the state of affairs of frad and abse investigation in MN Understand how effective spervision benefits yo and yor client Develop strategies and best practices that reflect yor spervision 10

11 Qestions Robert Rodè VOIGT, RODÈ & BOXETH,LLC 1000 University Avene West Site 250 St. Pal, MN Phone: (651)

12 Lores Vlaminck, MA, BSN, RN, CHPN Lores Conslting, LLC 3063 Darcy Drive NE Rochester, MN Office Cell FAX

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14 Pocket Gide on Elder Investment Frad and Financial Exploitation Shold I be concerned? Red Flags in patient/client history: Social Isolation Bereavement Dependence on another to provide care Financially responsible for adlt child or spose Alcohol or drg abse Depression or mental illness Red Flags from clinical observations: Cognitive problems Fearfl, emotionally labile, or distressed Sspicios, delsional Change in appearance, poor hygiene Accompanied by caregiver who is overly protective; dominates patient/client Change in ability to perform activities of daily living, inclding self-care, daily finances, medication management

15 How do I ask abot financial capacity? Introdctory qestion: We find that some older adlts worry abot money; may I ask yo a few qestions abot this? Qestions yo can ask: 1. Who manages yor money day to day? How is that going? 2. Do yo rn ot of money at the end of the month? 3. Do yo regret or worry abot financial decisions yo ve recently made? 4. Have yo given power of attorney to another person? 5. Do yo have a will? Has anyone asked yo to change it? If answers raise sspicion, see the following for referral sections or probe for frther details by sing the Financial Concerns Checklist. This checklist may also be added to the patient/client information packet and completed dring intake. What types of referral may be needed? 1. Frther social assessment, help with managing money, or other care. Poor resorce management or limited resorces available needs assistance with finances, meals, transportation, ADL s. 2. Legal advice or protection. Needs assistance with financial planning or legal docmentation. 3. Frad and exploitation may have occrred. In most states, reporting to APS is reqired by law. It can be reported orally and confidentially withot civil or criminal liability. 4. Frther medical evalation. Needs assessment for cognitive, nerological, or other conditions.

16 Resorces for social services and investor protection: National Center on Elder Abse United Way National Association of Professional Geriatric Care Managers Case Management Society of America North American Secrities Administrators Association Investor Protection Trst Resorces for legal advice or protection: National Academy of Elder Law Attorneys (NAELA) Resorces for potential frad or exploitation: Adlt Protective Services (APS) Resorces for frther medical evalation: Specialists sch as a geriatrician, nerologist, psychiatrist, or psychologist may be warranted. The MiniCog ( geriatrics. thscsa.ed/tools/minicog.pdf) and Financial Capacity Instrments ( abstract/73/12/928) may be sefl tools for se to screen for vlnerability to EIFEE.

17 Financial Concerns Checklist Are yo having any of the following common concerns? I have troble paying bills becase the bills are confsing to me. I don t feel confident making big financial decisions alone. I don t nderstand financial decisions that someone else is making for me. I give loans or gifts more than I can afford. My children or others are pressring me to give them money. People are calling me or mailing me asking for money, lotteries. Someone is accessing my acconts or money seems to be disappearing. The Clinician s Pocket Gide was created by Baylor College of Medicine s Texas Consortim Geriatric Edcation Center as part of the Elder Investment Frad and Financial Exploitation program throgh a grant from the Investor Protection Trst ( with the spport and involvement of the Texas State Secrities Board.