1. GSIL Long Term Support Medicaid Fraud Update Debbie Krider, GSIL COO and Compliance Officer January 17,2017
I wish I did not have to talk to you about this, for it’s not in our values to have this, but because of the type of program it is, it is very vulnerable to Medicaid Fraud.
Our personal care services are valuable and needed services:
Tell me how you see them as so?

2. 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.

3. 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
The mission of the Office of Inspector General (OIG), is to protect the integrity of the Department of Health and Human Services (HHS) programs, as well as the health and welfare of beneficiaries served by those programs. Through a nationwide network of audits, investigations, and inspections
The Office of Inspector General’s (OIG) body of work examining Medicaid personal care services (PCS) has found significant and persistent compliance, payment, and fraud vulnerabilities that demonstrate the need for Centers for Medicare & Medicaid Services (CMS) to take a more active role with States to combat these issues.
Since 2009, seven of the eight completed audits have identified over $582 million in questioned costs.
In Oct the OIG really came down on CMS saying you are not doing enough to discourage and prevent Medicaid fraud. We are asking CMS to step up the regulations to prevent this waste.

4. 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

5. 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

6. 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

7. 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

8. 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

9. How this Effects GSIL 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!
We will hear and see more about this.
For one for every dollar the Feds put into investigation their return is 6 in pentlies and paybacks.

10. 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 Thank you!