Be A Thorough Housekeeper

Recently an industry list serve had much discussion of an agency having to pay unemployment insurance benefits to an RN employee who was fired for falsifying the clinical notes. They reported that fact to their state employment office but were still charged for the unemployment claim.

We had a client who fired their contracted PT because she was having some of her visits done by her cousin who was a PT assistant and licensed in another state. The client did not bill Medicare for any of her visits.

In both of the above cases the agency properly fired the caregiver and did not bill for services the caregiver had provided.

The agency should also check out the employee and the independent contractor on the Office of Inspector General exclusions list http://exclusions.oig.hhs.gov/.

“No program payment will be made for anything that an excluded person furnishes, orders, or prescribes. This payment prohibition applies to the excluded person, anyone who employs or contracts with the excluded person, any hospital or other provider for which the excluded person provides services, and anyone else.” (OIG)

The list is updated monthly and every provider should be checking all their employees and contractors upon hiring and on a regular basis thereafter. (See http://oig.hhs.gov/newsroom/video/2011/heat_modules.asp for 4 1/2 minute video if wanting more information.)

Why stop there? I suggest that both parties should also;

1. Report the matter to the caregiver’s license board.
2. Report matter to CMS.
3. Report the matter to Medicaid.
4. Report the matter to the local authorities as criminal acts.

The caregivers who were terminated will go to work for other health care providers. They likely will contiue their illegal practices. Their practices may cause health problems or complications and even death for the patients they treat.

And if I was a successor employer and found myself sued for malpractice or investigated I would look back at the history of the caregiver and involve former employers to share the responsibility, the blame and the costs.

When engaged in house cleaning you don’t sweep the dirt under the rug (so my wife tells me).

Growth of Medicare Advantage (MA) Plans Enrollment

Comments by Tom Boyd

I have read a couple of articles that estimate the growth in the MA enrollment for 2011 to be from 580,000 to 650,000. They imply or state that isn’t this amazing or great growth.

The US census bureau states that approximately 10,000 A DAY became Medicare eligible in 2011, about 3.6 million. This would suggest that the “growth” in MA enrollment is less than 20% of the growth in the total Medicare enrollment. This must mean that the rest, more than 80%, have opted for traditional Medicare or something other than MA.

MA plans have about 25% of the national Medicare enrollment. Does anyone see that increasing?

My Bucket List

In 2007 there was a movie starring Jack Nicholson and Morgan Freeman. The main plot follows two terminally ill men on their road trip with a wish list of things to do before they “kick the bucket.”

At this time in my life I decided on my own bucket list. It does not include skydiving, a lion safari, or seeing the Great Pyramid as they did in the movie.

1. World War One memorial. More than 116,000 Americans died in WWI, twice the number that did in Vietnam. We have memorials for WWII, Vietnam, the Korean War. Why not WWI? I suspect because no WWI veteran is alive and we don’t have Tom Hank’s advocacy. I would like to start or join a campaign to establish a WWI memorial. It would be great to have the memorial dedicated on 11/11/18, the hundred year anniversary of the end of WWI. While I am better looking than Tom Hanks I know that this “cause” will need to find a known and reputable national spokesperson.

2. National chess tournaments on aircraft carrier museums. The cities of Oakland, New York, Corpus Christi, San Diego, Los Angeles, and Charleston have aircraft carrier museums, some of which are having financial problems. Dances, weddings, and memorial services have been held on these ships. Can you imagine a chess tournament for hundreds of people, mostly kids, being held on all the carriers on the same 4th of July? What a way to honor the ships and promote them and chess.

Clearly the above ideas will require a great number of volunteers.

3. I have three grandchildren. I would like to see them go to college, or arrange for them and any more that may come, go to college. Olympic swimmer and fashion model are also options for the two girls. As is being the offensive line for the 49ers for the two year old boy, C. Thomas Boyd.

4. I would like to take my wife to Ireland, New England, Scotland, Germany, New Mexico (ugh) and some other places as time, health and money permits.

5. I would like to get a small, four person, sail boat. The San Francisco bay is often lovely for sailing. Some technical problems, aside from cost, is that my wife wouldn’t let me take the grandchildren or her along until I take and pass an approved course for both sailing and swimming (not having done either).

You should have your own bucket list started and try to do some of them before time runs out on you. My best wishes for your success.

Another reason Why I like Warren Buffett

Mr. Buffett is viewed as a great and wise man for his comments and what he has done with Berkshire Hathaway (BRK). And rightly so. Recently BRK bought the Santa Fe railroad for $26.5 billion and Lubrizol for close to $9 billion, largely using cash on hand for both. It has been said that any possible acquisition would have to be in excess of $5 billion to catch the attention of Mr. Buffett.

Mr. Buffett has also been quoted as saying the business model for newspapers in this country is flawed. “Imagine that someone came along saying, ‘I have a great idea: Let’s chop trees down, buy expensive printing presses, and buy a fleet of delivery trucks, all to get pieces of paper to people to read about what happened yesterday.’”

On 11/30/11 BRK bought his hometown ( Omaha Nebraska) paper for $200 million. This acquisition both in price and any possible profit will hardy matter to BRK which had $136 billion in revenue and $13 billion in profit in 2010. Whatever “spin” BRK needs to put on the acquisition because they are a publicly traded corporation is fine by me.

The truth is he bought the hometown paper to save it from going under. And I like him for that. We have all seen business in our community fail and we may have bought them to prevent that were we rich ( at least I would have).

Happy New Year Mr. Buffett and everyone, and Mr. Buffett, please consider moving to Petaluma, California.