Training

How to report

For Medicare:

 US Department of Health and Human Services (HHS)

 Call 1-800-Medicare (1-800-663-4227)

 TTY users call 1-877-486-2048

 Online at https://oig.hhs.gov

For Medicaid:

 Michigan Department of Community Health (MDHHS)

 Phone (toll free): 1-855-MI-FRAUD (1-855-643-7283)

 Online: www.michigan.gov/fraud

 Write: Office of Inspector General (OIG), PO Box

30479 Lansing, MI 4890

Critical Incidents that must be reported

Exploitation – Required to report to APS

 Neglect – Required to report to APS

 Verbal abuse – Required to report to APS

 Physical abuse – Required to report to APS

 Sexual abuse – Required to report to APS

 Illegal activity in the home with potential to cause a serious or major negative event - local authorities/police

Suspicious or Unexpected Death Death should be reported to law enforcement if it is a suspicious death possibly linked to abuse or neglect. (TSA)

Training tools

Direct Support Caregivers

You are important to the person centered process because you…

 Know the person You understand what is important to the person

you understand the person’s communication style/non verbal

communication Have a trusting relationship with the person

 Support the person in different environments You

 Are the individual the person turns to for assistance and support.

 Your job is to encourage and support the individual while providing necessary daily care to keep them safe in their homes.

You are clearly an important part of each person’s life. (TSA)

Fraud

Fraud is knowingly and willfully executing, or attempting to execute, a scheme or artifice to defraud any health care

benefit program, or to obtain, by means of false or fraudulent pretenses, representations, or promises, any of the

money or property owned by, or under the custody or control of, any health care benefit program. The Health Care Fraud

Statute makes it a criminal offense to knowingly and willfully execute a scheme to defraud a health care benefit program. This applies to the fraudulent completion and submission of

timesheets/cards in order to collect payment for hours not worked.

Waste & Abuse

Waste includes overusing services, or other practices

that, directly or indirectly, result in unnecessary costs

to the Medicare Program. Waste is generally not considered to be caused by criminally negligent but rather by the misuse of resources. (CMS)

Abuse includes actions that may, directly or indirectly,

result in unnecessary costs to the Medicare Program.

Abuse involves payment for items or services when there is not legal entitlement to that payment and the

provider has not knowingly and/or intentionally misrepresented facts to obtain payment. (CMS)

Culturally and Linguistically Appropriate Resources / Disability Resources (Molina Healthcare of Michigan)

Introduction to Cultural Competency

Culture competence is the capability of effectively

dealing with people from different cultures.

Health Disparities

Seniors and Persons with Disabilities

People with disabilities are individuals with families, jobs, hobbies, likes and dislikes, and problems and joys. While the disability is an integral part of who they are, it alone does not define them. Don't make them into heroes or victims. Treat them as individuals.

Becoming Culturally Competent

Personal Centered Planning

A set of approaches designed to assist someone to plan life and supports. It is used most often as a life planning model to enable individuals with disabilities, or otherwise, requiring support to increase their personal

self-determination and improve their own independence It shifts power back to the participant People are the expert of their own lives. Getting to know the person is the core of person centeredness. We learn:

 How the person wants to live

 Builds upon their capabilities

 Honors their preferences, choices, desires, and needs.

RELS Homecare Corp