Medicare Fraud, Waste, and Abuse

      Every year, millions of dollars are improperly spent because of fraud waste, and abuse.  This can be halted and prevented if the process of detect, correct, and prevent, is followed.  This process is required by The Social Security Act, as well as CMS regulations.  It is stated that those whom of which supply medicare and medicaid services, are required to have an effective compliance program of which includes measures to prevent, detect, and correct Medicare non-compliance.  There must also be implemented measures to prevent, detect, and correct fraud, waste, and abuse.  These steps and measures must be provided via effective training for employees, managers, and directors, as well as their first tier, downstream, and related entities.  (42 C.F.R. 422.503 and 42 C.F.R  423.504)
      An effective compliance program can be implemented via in-class settings, online courses, and "one on one" training.  If created correctly, an effective program would consist of steps as to how to detect, correct, and prevent.  It must also contain the 7 core compliance program requirements.
      The first step in stopping fraud waste and abuse, is prevention.  Being the most crucial step in halting fraud, is to go to the most vulnerable portion of information and ensure it's safety.  The most common types of fraud an abuse in the medicaid program include medical identity and theft, unnecessary billing, upcoding, unbundling, and beneficiary fraud.
      Medical identity theft, being the most common, involves the misuse of a person’s medical identity to wrongfully obtain health care goods, services, or funds. More specifically, medical identity theft has been defined as “the appropriation or misuse of a patient’s or [provider’s] unique medical identifying information to obtain or bill public or private payers for fraudulent medical goods or services.” Unique medical identifying information for physicians includes the National Provider Identifier, Tax Identification Number, U.S. Drug Enforcement Administration number, and State medical license number. Physician medical identifiers are used for such things as identifying the physician of record on claims and for tracking purposes. Stolen physician identifiers may be used to fill fraudulent prescriptions, refer patients for unnecessary additional services or supplies, or bill for services that were never provided.
      An excellent example of Medical Identity was seen when the ringleader of a criminal group in the Bronx stole prescription pads from doctors and hospitals in the New York City area. Between 2009 and 2011 she used the pads to forge more than 250 prescriptions for painkillers. By using stolen Medicaid cards, she was able to bill the prescriptions to the Medicaid program for a total of more than $200,000. She received two consecutive 4 to 8 year sentences in prison.  Thus, one tip for prevention is that health care professionals should keep their prescription pads in a secure location.
      The second most abused form of fraud is the billing for products or services that are not covered or medically needed.  The Federal Medicaid statute authorizes payment for items and services that are included in each State’s approved plan.  The included items and services vary from State to State. Only those items and services included in the relevant State’s plan are authorized. Even if an item or service is authorized, it is still not covered under Medicaid unless it is also medically necessary.  This can be easily prevented by constant review and analysis of your Medicaid approved plan, this will stop you and your organization from purchase of non-covered goods and or services.  If excessive purchases are made using medicaid that are not covered by the approved plan, the purchasing party can receive an extreme amount of jail time, as well as fines.  This was exemplified when an ambulance service owner in Texas was sentenced to 15 years for billing Medicare and Medicaid for transporting patients by ambulance to dialysis appointments even though the medical condition of the patients did not qualify for that level of transportation.
      Although it may sound like a complex network of underlying danger, Medicare fraud, waste, and abuse can be easily avoided as well as prevented.  If the measures for safety are taken, then it may be brought to a complete and utter stop.  All of the information presented here can be found in a more in-depth toolkit presented by Centers for medicare and medicaid services otherwise known as CMS.  MedTrainer offers extensive and captivating courses on the precautionary steps to take as to how to stop Medicare, Fraud, Waste, and Abuse.  Join us today in creating a more beneficial and productive medical field, free of theft and fraud.  Visit http://medtrainer.com/demo/ to learn more, as well as schedule your free demo.

Fire Safety and Necessity

      OSHA has over seventy regulatory standards set into place for fire safety.  As a result, only about three percent of workplace fatalities are caused by a fire or explosion.  This is in direct correlation, to all the precautionary steps taken by employers to prepare their workers for potential danger.  Although three percent may seem low, the actual amount of fatalities should be zero.  It is understandable to be conflicted when keeping up with fire safety.  However, it is unacceptable to do so, for in order to keep your employees safe, as well as your facility, and business, you must understand the responsibilities that are required to be upheld.
      The first and foremost way to begin your path to compliance, is through the creation of a fire prevention plan.  This must be an updated and written form containing of all potential fire hazards, proper handling procedures for hazardous materials, the control of potential ignition sources, and the necessary equipment to control each major hazard.  This form must be written and stored in an area of which can be obtained by each and every employee.  If your facility has more than ten employees, an oral presentation of the fire prevention plan must be given.
      Alternate exit-routes are another crucial step in securing employee safety.  In the case of a fire, your typical facility exit may be blocked or inaccessible.  As a result, other ways to leave the building are required to ensure a safe escape without harm being caused to you or your employees.  These alternate exits should be included in you emergency action plan.  Aside from an evacuation process, the emergency action plan should contain procedures for reporting a fire or other emergency, procedures for rescue or medical duties, and procedures to account for all employees after an evacuation.  Included outside of the emergency action plan, training should be given to a selection of employees whom of which will assist in a safe and orderly evacuation of all other employees.
      Within a facility may reside potentially hazardous materials of which can cause a spontaneous combustion, explosion, fire, and meltdown.  These materials are required to be documented, each with their own proper disposal process, how to control the material in an emergency situation, and the proper equipment to take said control.  Under the category of hazardous materials falls: compressed gases, acetylene, hydrogen, oxygen, flammable liquids, spray finishing, explosives and blast agents, storing of gases, storing of anhydrous ammonia, safety management of highly hazardous chemicals, and lastly the hazardous waste operations and emergency response.
      Fire safety wouldn't be complete without an overview on fire protection.  Within the scope of fire protection, falls an entire list of application and definitions of which are applicable to items such as fire detection systems, extinguishers, and much more.  Plans must be physically available for all employees in a facility ranging in genre of proper extinguisher use all the way to fire brigades.  Although extinguishers are required, ones containing carbon tetra-chloride, or chlorobromomethane, are not permitted by OSHA.  It is also necessary to inspect and maintain fire extinguishers in a fully charged and operable condition, of which are easily located and accessible.
      With all forms of fire safety taken into full account, your facility and employees can confidently work with assurance that you are prepared for a fire.  The process of creating a fire safety plan, can be long, grueling, overwhelming, and tedious, all the while entirely necessary.  However, with the help of MedTrainer, fire safety planning has never been easier.  With many templates already created, MedTrainer can increase your facility's preparedness for an unexpected fire.  Schedule your free demo today at: http://medtrainer.com/demo/

Identifying Abuse/Neglect in Children and Elders

      The improper usage or treatment of an entity, otherwise known as abuse is sadly all to common in day to day human interaction.  It takes hundreds of shapes and forms, such as physical, verbal, maltreatment, injury, assault, violation, rape, and of course unjust practices.  although abuse can occur in many different ways, it is most commonly found in elders, as well as children due to their inability to defend or protect themselves.  This may be a horrible topic to cover, however, it is enormously crucial to understand the importance behind identification, prevention, and taking action in order to stop abuse.
      The first step that all of us are responsible for, is identifying when abuse occurs, what form it may be, and whom of which caused it.  Let's start with identification, specifically physical abuse.  Physical abuse is the most used of all, and as a result is the simplest to identify.  Common signs of physical abuse consist of bruises, sprains, difficulty in walking, bruises on neck that resemble fingerprints, and spiral fractures usually occurring in the wrists, arms, and legs.  Spiral fractures are common in both children and elders, due to their bone composition being more fragile and weak than that of a typical adult.  The most regular of which appears on the wrist which can simply be caused by a fast grabbing and rotating motion.  This is normally caused when the abuser attempts to gain immediate control of the victim with excessive force.
      Abuse prevention is above all, the most important step in this process, for if prevention is successful, then there is no need for the other two portions.  There are many different ways to prevent abuse, such as training, information awareness, and anger management courses.  quite possibly the most crucial portion of prevention, is learning the facts and understanding the risks.  This means that we must be entirely aware of the situation of potential victims, and have factual information that can prove potential abuse.
      It is up to us to report abuse, as it is reported that on average, only 1 out of 10 victims will report it themselves.  This is due to the fact that the victims fear what will occur if their abusers are exposed.  About 33% of abusers are family members, while 59% are people whom of which are judged by the family as trustworthy.  It can be difficult to identify the abuser, as there are little to no characteristics that "set them apart."  They look and act just like us and sometimes go out of their way to appear trustworthy.  Because of this, you will more than likely have to confront the potential victim directly.  This process can be dreadful and typically painful for the victim, as they likely fear what their abuser will do if they are exposed.  To start, ensure that you have a factual basis to form your reason for confronting the victim.  This can consist of but is not limited to: abrasions, flinching when being addressed, a look of fear when spoken to by a caretaker/guardian, and complaint of pain and difficulty walking.  Always have a valid reason for addressing the potential victim, and ensure them that everything they say to you is confidential and will not reach their abuser.  If the victim confesses to whom their abuser is, and the actions he or she has done, it becomes your responsibility to contact authorities, or a legal entity that can grant the victim permanent safety.
      With all of these steps followed correctly, and the actions taken properly, then we may one day live in a world with no abuse.  However, we currently live in a world riddled with abuse of which must be brought to an immediate end.  It is up to all of us to identify, prevent, and take action against all forms of abuse.  Take the first step, and make an impact in your healthcare facility with MedTrainer, offering multiple courses on everything discussed in this post.  Contact us today for your free demo, and begin the process in bringing abuse to a halt.
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Informed Consent

      Informed consent is only given when the receiver-to-be has a clear appreciation and understanding of the facts, potential outcomes, as well as potential consequences.  Although this concept appears simple, it contains an entire list of potential prevention factors.  Certain impairments such as mental illness, Alzheimer's disease, intoxication, and even basic intellectual immaturity can restrict a person from granting permission to healthcare providers.  In certain cases where the individual of concern is incapable of giving his or her own consent, another person is generally authorized to give consent for said individual.  This can be seen with guardians of children, as well as conservators for the mentally ill whom of which may be rendered incapable of providing conscientious and informed consent.

      In the medical world, millions of people receive care for injuries and sickness.  All of which give consent so that medical professionals can do their job.  The process in which permission is gained before healthcare intervention on a person is granted, is called Informed Consent.  It is granted via patient permission and follows guidelines from the fields of medical ethics as well as research ethics.
      There are multiple different forms and sheets of which a person is required to sign so that the informed consent has physical and legal documentation that is created by legal standards.  Templates of these consent forms can be easily accessed on the World Health organization Website for common and practical use.  Not only are these forms required, but they are extremely useful when it comes to assessment of consent.  Assessment of consent is the process in which the determination between comprehension and confusion of the agreement is made.  This can be complex to evaluate due to the fact that neither expressions of consent, nor expressions of understanding of implications, mean that full consent was given, nor that full comprehension was successfully digested.  With the assistance of informed consent documents, the assumption that the individual comprehends the matter, is implied due to their signature of agreement.  However, without documentation, it can be stated that a person may verbally agree to something from fear, perceived social pressure, and or psychological difficulty in asserting true feelings.  The occurrence of incomprehension may also happen if the person fails to understand the potential consequences.
      Alternate circumstances may change the necessity of informed consent.  Multiple situations can consist of emergencies where the individual is incapacitated or otherwise unable to give consent.  In this instant, it is necessary to give medical treatment to the injured or otherwise incapacitated individual in order to sustain their life, therefor informed consent is not needed.  However, if the individual is not in need of medical treatment, and instead desires treatment, then consent must be implemented.
      The use of Informed consent forms is a widely spread practice to ensure the comfort of both the healthcare provider as well as the patient.  Although at times it may seem rather excessive, it is another necessary precaution of which me must uphold in the medical field.  Enforce this requirement, and make sure that your healthcare facility is practicing safely, soundly, and of course with compliance to local, state, and federal regulations.  Ensure this and much more with the help of MedTrainer.  Contact us today and reserve an appointment for your free online demo at: http://medtrainer.com/

Infection Control

    Every year, lives are lost because of the spread of infections in hospitals. Health care workers can take steps to prevent the spread of infectious diseases. These steps are part of infection control.  Of the many ways to prevent infection, the most commonly stressed is hand washing.  This is also the most practiced form of infection control  as it is a vigorously set standard by the CDC.  There are multiple ways to practice hand sanitation, one for example is the use of an alcohol based hand rub as a disinfectant.  The proper process is to apply to one hand and vigorously rub both hands together until dry.  The second of course, is washing your hands using soap and water.  This process is properly executed by wetting your hands with cold water, applying soap, and vigorously scrubbing hands with the antibacterial soap for fifteen seconds.  Next, rinse your hands and dry them with a paper towel, you will then use the paper towel to turn off the faucet.  Hand sanitation is always necessary before touching a patient, exiting the care area after touching the patient or potentially contaminated materials, after touching any form of bodily fluid, before performing an aseptic task (ie. injection), and after glove removal.      A second form of infection control is through the use of Personal Protection Equipment, otherwise known as PPE.  PPE takes many shapes and forms, consisting of gloves, gowns, goggles, surgical masks, face masks, gas masks, hazmat suits, face shields, and respirators.  All PPE have at least one similarity, and that is the standards set by the CDC.  All PPE must be fit to the user, and the proper PPE must be used for certain procedures.  Personal Protection Equipment requires a specialized procedure to both put on and remove.  To equip PPE, the equipment must be new, or disinfected if it is a reusable material.  Hand hygiene as previously discussed must occur before donning PPE, then the user may equip his or her gown, next face protection device, and lastly gloves.  For PPE removal, simply reverse the process, removing the gloves first without touching the potentially infected outside portion.
    Another and more than likely most important infection control precaution, is the identification process of those with potential respiratory infections.  A very common form of disease outbreak, is through respiratory excretion of an infection (ie. coughing, sneezing, etc.)  Through pathogenesis (entering through the distal airway via inhalation), common infections such as Influenza, Bronchitis, Bronchiolitis, and Pneumonia can be very easily spread without taking proper infection control measures.  With proper safety measures, infection can easily be subsided to a minimal amount.  One of the most common procedures taken, is the use of respiratory hygiene (ie. cough and sneeze etiquette.)  Another important form of infection control is training staff as to how to remain alert with identifying people with potential respiratory infections (irregular breathing, coughing, sneezing, and hacking.)  Finally, respiratory infection spreading can be slowed simply by using the supplies available in practically every medical facility.  These consist of face masks, tissues, alcohol based hand rubs, and no-touch waste receptacles for disposal of potentially contaminated materials.
    Through necessary and implemented protocol, infection control can be efficiently and successfully used to keep medical facilities, staff, and patients safe.  MedTrainer offers many courses pertaining to Infection control ranging from Airborne and Droplet disease Transmission to Hand Hygiene.  Keep your medical facility and staff safe, and ensure that your patients are taken care of with the use of MedTrainer, an online compliance system that is effective, inexpensive, and used worldwide as a way to keep the medical field safe and reliable.
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Ergonomics and Injury

A Musculoskeletal Disorder otherwise known as an MSD, is a condition in which muscles, nerves, and tendons are affected negatively.  MSD's of the neck, upper extremities, and lower back, are the number one causes of a lost workday injury and illness.  There are over one-hundred different Musculoskeletal Disorders affecting anywhere from tendons, to ligaments, to muscles all throughout the body.  An MSD can easily be caused by lifting too heavy of items, pushing/ pulling heavy loads, bending, and reaching overhead.  These are known as risk factors, all of which cause disorders.  However, an MSD doesn't have to happen in an instant, in fact they most commonly occur over a large period of time in which the body is operating in an awkward posture.  Ultimately, analysis shows that the main cause of MSD's in the workplace, is the repetition of processes in which the body is improperly fitted.

    The study of fitting the workplace to the employee, is known as ergonomics.  Ergonomics assists in finding ways to properly and safely function in the workplace, while lowering the susceptibility to MSD's.  When practiced correctly, studies have shown that ergonomics will increase productivity, lessen muscle fatigue, and, lower the number as well as the severity of work related MSD's.  The industries with the highest rates of Musculoskeletal Disorders, are health care, transportation, and warehousing. MSD's can lead to a permanent annoyance in an employees life causing displeasure, discomfort, and a decrease in productivity.  Common MSD's consist of Carpal Tunnel syndrome (CTS), Osteoarthritis, Fibromyalgia, and Rheumatoid Arthritis (RA).  These are commonly caused by immense physical overexertion such as lifting too heavy of an object, or an object that may not be too heavy, but is lifted too many times.  RA is a rather aggressive degenerative MSD due to the fact that 40% of people with RA retract from the workforce within 5 years of their diagnosis because of their condition  It is the duty of the employees to be aware of when they are damaging themselves, and when to take a break to alleviate any encumbrance they may have attained.  With proper practice of ergonomics, the number of people affected by MSD's can be greatly reduced, productivity will increase, and employees will be able to confidently work without worry of injury.

    The first step in solving MSD's, is addressing what is causing the problem.  This can be tackled simply by creating a strong commitment by management, to enforce and uphold proper ergonomic processes.  Another way to manage MSD influence on the workplace, is to provide training.  Providing an educational format to understand the danger of ergonomic malpractice, can inform employees as to how to identify potential causes to MSD's, and stress the importance of reporting any early signs of a disorder.  A good ergonomics training program will teach employees how to properly use equipment, tools, and machine controls as well as the correct way to perform job tasks.  Such as work methods that allow workers to keep their joints in a neutral position while using tools requiring manual force to prevent excessive force on joints and tendons.  Employers should also encourage employees to avoid forms of side-to-side twisting, and to refrain from making any quick motions with their wrists.  MSD management is another important element of an effective ergonomics program. Proper MSD management focuses on early identification and evaluation of signs and symptoms of MSD's and helps eliminate or reduce the risk of developing MSD's.  With compliance from both the employers, employees, and trainers,  MSD's can be removed from the workplace all together.  Ensure that you meet the compliance standard, and help increase the longevity of your role in the workforce with MedTrainer.  MedTrainer offers an in depth analysis and lesson as to how to remain safe and compliant in the workplace.  http://medtrainer.com/

Hazardous communication and Safety Data Sheets

    Since December 1st, 2013, all employees have been required to be trained on Safety Data Sheets in the workplace by their employer. An SDS is a precautionary standard in order to avoid injury, and to educate employees on potentially harmful chemicals in the workplace.  It is also an important component of product stewardship as well as occupational safety and health.  SDS's are a commonly used system for cataloging chemicals, chemical compounds, and chemical mixtures.  More often than not, these forms will include physical data of the substance (ie. Melting point, boiling point, etc.). The SDS is widely used to describe toxicity, health effects, how to store said substance, and spill handling procedures.  As a safety measure for employees, each and every SDS contains first aid information, as to how to clean and or disinfect an employee contaminated with said substance.  Certain chemicals have different levels of reactivity, meaning that they require specific types of handling.  SDS's have been implemented to prevent chemical activation of which can injure employees, and cause a business to shut down due to lack of safety protocol being followed.  All of this is to ensure that the handling and working with that substance is in a safe and condoned manner that abides to all governmental regulations and requirements.    

      The new HazCom standards implemented by OSHA, require an in depth hazard classification, descriptive clear labels, a sixteen section format for all SDS's, and of course the informing and training of all employees.  All classifications now consist of specific criteria for classification of health and physical hazards, as well as classification of mixtures.  All chemical manufacturers and importers will be required to provide a label that includes a harmonized signal word, pictograph, as well as a hazard statement for each hazard class and category.  Violation will ensue if these labels are damaged in the slightest, for they are required to be easy to read and understand.  Precautionary statements must also be provided about any and all hazardous ingredients contained in a substance.  If any new hazards are identified by the employer after the date of December 1st 2015, it is the job of the employer to inform and educate all employees within six months of said discovery.  The latest legal date to inform all employees by is June 1st, 2016.  However, if the employer is making a reasonable effort to comply, but has yet to received the new SDS's, then said legal end date may be extended.

    When it comes to accessing SDS's, it is within the standard of compliance to keep all files in an "online binder."  However, all files must be obtainable in a backup location in the event of a power outage or in the case of inaccessibility, as well as offsite locations.  In order to be fully and legally compliant, employers must learn the standards as well as the ability to identify responsible staff members that properly follow guidelines.  The employer must also provide and implement a written Hazard Communication Program (HazCom) which informs all employees about a potential hazard.  Other employer duties consist of updating his/her employees with important information regarding SDS Maintenance.  Lastly the employer must constantly undergo re-evaluation and reassessment of his or her program.  This will guarantee compliance with national requirements, and keep your workplace a safe and functioning area of employment as well as care.  Ensure that you follow all protocols with the many online certification courses offered by MedTrainer. http://medtrainer.com​