CMS Compliances And Humana Case Study

HIPAA and HITECH Act help address several problems associated with inappropriate use of healthcare information by authorized users. HIPAA requires minimum necessary infor-mation to be released while HITECH goes into a little further detail but still to release minimum necessary information. Several different organizations need to define how they go about han-dling inappropriate use of information. A guideline must be set within the organization on who will have access to the information and how it is disbursed to other healthcare organizations re-questing records.

In one case study a hospital employee reportedly left a phone message with the daughter of a patient with specific details on her medical condition and treatment plans. It was also recorded that the private communication obligation was not obeyed when the employee left voice messages at the patient’s home phone number, an overlooking the directions from the patient to communicate her via her work phone number only.

On Tuesday July 7, 2015, at approximately 3:01 PM, Kiana Beekman, (MFCU Investigator) (Beekman) received a call on the state office telephone from HILL, Lucy (Service Facilitator of Lucy Hill Services (LHS). During the conversation, Beekman asked HILL to clarify her role and responsibilities as a service facilitator, in addition to the role and responsibilities of HARRIS, LaFrance as the Employer of Records (EOR) for Medicaid Recipient DANIEL, Rose and MCGHEE, Inocencia as DANIEL’s aide. She was also asked to provide any documentation of training on timesheet submission and approvals that she provided HARRIS and MCGHEE under the Department of Medicaid Services (DMAS) Consumer-Directed care aide program.

SC received a telephone call on 10/16/2015 stared 9:34 and end at 9:41 am from Tricia Crooks at Liberty Resources Home Choices (LRHC) Community Outreach and Enrollment Leader. Stating that she spoke Pa and he wants to resume his service order with LRHC for PAS service. SC informed SC that this information will first need to verify with Pa. SC expressed concerns about LRHC being able to fulfill service since they had the case unstaffed for over two weeks (09/25/15-10/15/2015). Tricia apologized on behalf of LRHC, and stated that they have someone assigned and is ready to go all is needed is the resumed service order ASAP. SC again explained to Tricia that Pa has to confirm this besides Pa was very adamant about switching provider because the

CCIB received a Corrective Plan of Action (CAP) detailing the visit to the home on 10/18/17 by Service Coordinator, Sally Cano. Ms. Cano arrived at the home, but no one was there. Ms. Cano proceeded to check Delta Home 3 (located next door) and found 2 of Delta Home Care IV residents along with residents from Delta Home Care 3 at the home. As Ms. Cano was leaving, she observed a bus arrive at the Delta Home Care 2. The bus driver reported that there was no staff at the home and that the residents were waiting outside. It was observed the Delta Home Care 2, 3, and IV to be lacking staff. On 10/19/17, RP and Quality Assurance specialist (QAS) Jesus Ozeda went to the facility to observe the staff to resident ratios and to collect the staff schedules

Service Coordinator (SC), Jennifer Stoker met personal staff, Aiesha Crayton at the home of consumer Jonathan .SC asked was Jonathan meet his outcome would like is medical expenses to cover. Aiesha noted he has Medicare and Medicaid which cover all his medical expenses. SC asked if money covering his want and needs. Aiesha noted yes. He wants and needs are being meet. Jonathan wants his cell to be paid every month. Aiesha noted he cell is being paid every month. SC asked is Jonathan maintain good health. Aiesha noted he when to his PCP on June the 1st. She noted he is health and there was no change in medication.

Violation of privacy, Take reasonable steps to ensure that health information is stored securely and that patients' data is not available to others who are not authorized to have access. Prevent inappropriate disclosure of individually identifiable information. Chis should not give anyone’s private information out no matter if it is just a name or not. Chris should have referred the food service to the hospital’s HIM’s

*The supervisor acknowledged customer’s concern. He tried calling CSA to check whether customer’s concern is a scam or not, however he failed to properly set the customer’s expectation. Customer was on hold for more than 7 minutes which could have been avoided if he check the customer back and forth.

SC received VM form Tanya, ERS provider via Active Aid Solution. Tanya reported that they received a monthly maintenance service order for ERS but did not get one for the installation and requested that SC put it in ASAP. SC created service order in Oracle and completed service order in SAMS. SC reviewed Pa care plan and everything else looks good. SC placed phone call the Penn Asian Senior Services enhanced day care provider. SC call was transferred to Soon Pack Pa’s social worker at the center. When Soon got on the phone SC introduce self and stated reason for calling (was to visit Pa at the day center) Soon stated that, that would be ok because SC must be there before Pa’s leaves at 1:45 PM. SC asked why Pa leaves so early and Soon reported that, that’s

The practice violates Health Information Portability and Accountability Act (HIPAA) privacy rule and the recent update to the HIPAA privacy rule or the HIPAA Omnibus Final Rule. The Health Information Portability and Accountability Act (HIPAA), a federal statute governing the protection of patient information, was enacted into law in 1996. The essential objective of the law is to make it easier for people, business to keep health insurance, protect the confidentiality and security of healthcare information and help the healthcare industry control administrative costs. The Privacy Rule addresses appropriate disclosure of PHI while the Security Rule addresses electronic disclosures.

I stated, “I am calling on behalf of a friend who is being auto enrolled in Fidelis Care. I heard that there might be a change with contraceptive coverage. Can you tell me more about this?” The agent informed me that termination of pregnancy services were not available and family planning services are available through their Unified IPA network at 1-800-342-2641. The agent also explained that if a patient needs birth control for a medical necessity such as alleviating symptoms of menstruation, the provider can send a request to Fidelis

I interviewed Trevor Olsen, Vice Principal at San Juan High (SJH). The current enrollment is about 415 students. The school is 52% Caucasian, 46% American Indian, and 2% Hispanic/African American and Pacific Islander. Fifty percent of student body qualifies for free lunch, and 55 students are considered Limited English Proficient.

Now in 2015, healthcare fraud and abuse was getting to an all time high and now more situations were being committed such as phantom billing,false patient billing, upcoding and upbiling. Now several federal agencies had come together to eliminate several occurrences pertaining to this matter. The outcome to really crack down on this matter is when the U.S. government created the Health Care Fraud Prevention

SC received phone from Pa’s dtr starting that she spoke with provider agency Accucare regarding changing Pa’s schedule from a split shift to one shift starting at 5:00 AM and ending at 9:00 AM. SC informed DCW that she is not authorized to make any change to Pa’s care plan or schedule. DCW was furious demanding to know why she is not authorize to make changes to Pa’s care plan since Pa’s she’s Director of Care. SC explained to DCW that she is not Pa’s director of care because Pa’s is directs own care and moreover she cannot be the direct care worker and the Director of Care because both role conflict with each other. DCW stated that she is only being paid for 4 hours but is constantly assisting Pa’s managing her health and navigating services/resources,

Shared governance is important to compliance in order to keep all staff accountable for compliance measures. Shared governance is an organizational model that gives all management and staff control over their actions and practices and extends the influence of administrative areas (Hess, 2004). Giving all managers a voice can help improve governance compliance and operations by promoting teamwork and accountability among staff throughout the entire organization.