How to report
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
Michigan Department of Community Health (MDHHS)
Phone (toll free): 1-855-MI-FRAUD (1-855-643-7283)
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)
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 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)
Introduction to Cultural Competency
Culture competence is the capability of effectively
dealing with people from different cultures.
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.