Post By: J. Veronica Xu, Esq., CHC, CHPC, CCEP, Chief Compliance Officer for Saber Healthcare Group, LLC
It is not an exaggeration to say the event was quite well-known by generations of people around the world that Little Red Riding Hood and her elderly grandma (“Grandma”) were eaten by the wolf (“Wolf”), but were eventually rescued by the heroic hunter (“Hunter”) who happened to be nearby and heard the commotion. Hunter thought the sound was suspicious, so he investigated and took actions. Thank goodness he did, because we all know what would have happened if he hadn’t done a thing. For sure, it certainly would not have been a happy ending for Little Red Riding Hood and Grandma.
After this horrific experience, Grandma decided to leave her lonely little cabin in the forest and she came to live in this magical place where Hunter works. It’s a place referred to as a “nursing facility” where patients and residents are cared for by a group of dedicated people called healthcare workers. However, once bitten, twice shy. Grandma has become increasingly incredulous and extremely concerned about anyone who enters her room. She is afraid that someone may disguise him/herself as a care provider, but is actually going after her valuables and her flesh and bone (literally, as Wolf did).
Just like most healthcare workers, Hunter is a caring and kind individual. He understands Grandma’s worry due to the traumatic incident. He took the time to explain to Grandma that this nursing facility has a rigorous pre-hiring screening process in place where teams strictly follow the procedures and Compliance conducts periodic reviews, so people like the big bad Wolf would not have a chance. In addition, companies that violated laws and regulations have faced stiff penalties and dire consequences, including fines like $121,783.31[i], $67,359.21[ii], $38,384.96[iii], $274,752.87[iv], and $179,725.61[v] paid by entities across the country. Plus, Grandma can always talk to the staff and/or the compliance team about her fears and concerns. Those comforting words and sound measures genuinely put Grandma at ease. Assured and satisfied, Grandma was finally feeling better and has started to enjoy the next chapter of her life in this safe and sweet place that residents call HOME. At last, Grandma has found her happily-ever-after.
* Although the characters are fictitious, the cases and settlement amounts are real.
Key takeaways:
- Regardless of our roles in an organization, we all have an obligation to report anything suspicious, unlawful or unethical. Our actions make an impact and our vigilance can save lives.
- Laws and regulations mandate that health care providers conduct certain pre-employment screening, including but not limited to criminal background checks, exclusion screening, verification of licenses and certifications, etc. All required checks shall be completed and properly documented in accordance with rules and the company’s policies.
- Compliance is just one call/email away. We are here to protect, help, support and guide.
Questions to ponder:
- Do your HR personnel know the hiring process?
- Is your team familiar with the mandatory screening and checks?
- Are your pre-employment checks documented anywhere?
- Does your team know where to seek assistance when they have a question?
The story behind the story:
Nursing homes are a place where our society’s most vulnerable population resides. Criminals often disguise themselves, take advantage of any loose systems to get themselves in the door, and manipulate the weak and the elderly for their own personal gain. For healthcare providers, it is imperative that comprehensive policies and procedures be developed and implemented to ensure rules are followed and residents are protected. Healthcare organizations’ adherence to policies and their active participation in their compliance programs help build a safe home for their residents. It is not only a regulatory requirement, but also a moral commitment, because residents rely on healthcare workers and their safety depend on all of us.
On a personal note, I have always loved reading and writing since I was 3 years old. With time, such passion only grew, which has helped me tremendously throughout my legal education and career. As an enthusiastic compliance professional, I am constantly thinking and reflecting (even when I am in the bathroom) – How can I make compliance messages stick? How can I make compliance more interesting, fun, engaging and memorable?
Since my first “Once Upon A Time” story published almost a year ago, I have received appreciable amounts of positive feedback from colleagues and fellow compliance professionals. Their encouragement truly motivates me to do it again. Thus, combining my compliance messages with my imagination inspired by fairy tales/fantasy, I am presenting to you this new original story from my “Once Upon A Time” series. As much as I loved writing it for you, I hope you will enjoy reading it while learning the regulatory requirements.
Sources:
[i] https://oig.hhs.gov/fraud/enforcement/longwood-management-corp-and-intercommunity-healthcare-and-rehabilitation-center-agreed-to-pay-121000-for-allegedly-violating-the-civil-monetary-penalties-law-by-employing-an-excluded-individual/
[ii] https://oig.hhs.gov/fraud/enforcement/swedish-medical-center-agreed-to-pay-67000-for-allegedly-violating-the-civil-monetary-penalties-law-by-employing-an-excluded-individual/
[iii] https://oig.hhs.gov/fraud/enforcement/longwood-management-corp-and-longwood-manor-convalescent-hospital-agreed-to-pay-38000-for-allegedly-violating-the-civil-monetary-penalties-law-by-employing-an-excluded-individual/
[iv] https://oig.hhs.gov/fraud/enforcement/pediatric-services-of-america-agreed-to-pay-274000-for-allegedly-violating-the-civil-monetary-penalties-law-by-employing-an-excluded-individual-and-submitting-claims-for-services-provided-by-an-individual-without-a-valid-provider-agreement/
[v] https://oig.hhs.gov/fraud/enforcement/tidalhealth-nanticoke-agreed-to-pay-179000-for-allegedly-violating-the-civil-monetary-penalties-law-by-submitting-claims-for-services-by-unlicensed-nurse/