This transcript is auto generated
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Meg Pekarske
Hello and welcome to Hospice Insights: The Law and Beyond where we connect you to what matters in the ever-changing world of hospice and palliative care. Part two, What's the Latest on UPICs? Highlights from Recent Audit Activity. Brian, thanks for joining me for this very important part two. We can't leave people hanging. It's like a cliffhanger, like
00;00;28;06 - 00;00;28;16
Brian Nowicki
I know.
00;00;28;16 - 00;00;55;27
Meg Pekarske
what’s going to happen next. What's the exciting stuff which that's come out with the bang? We're going to be talking about patient interviews because this gets everyone just talk about like hair on fire. When you start hearing that some government investigator is talking to your patients, people are really beside themselves. And this is not a new tactic, but one that just came up late last week again.
00;00;55;27 - 00;01;11;04
Meg Pekarske
And I expect, you know, maybe on the resurgence, but people might say like, do they have a right to talk to my patients? And the answer is yes, they do. They the federal government. Right.
00;01;11;04 - 00;01;35;14
Meg Pekarske
So, yeah, and there's a couple levels of layers of concern here. One is, you know, you have these vulnerable, dying patients, too. They get a knock on the door from the government. How does that affect their wellbeing? And that's really what our clients are coming to for coming to us and are alarmed about is that, you know, these vulnerable patients can be jostled in that way or their family members in these unannounced visits.
00;01;35;14 - 00;01;46;29
Brian Nowicki
And then secondly, what does that say about what the government is doing with regard to the hospice? Is there an audit afoot or what's being investigated and why? And trying to figure out what's at the bottom of that.
00;01;47;08 - 00;02;22;16
Meg Pekarske
Well, and Brian, and to the patient perspective, I think there are so many scammers out there. So part of it might be, are these people really legitimate because unannounced people we're showing you some business cards is scary. But and I think this is a very common occurrence occurrences people think their Medicare benefit is in jeopardy, like they're not going to get their health care services paid for, which is if someone is going to try to you know, say, I don't have health insurance anymore, like I would, you know, be.
00;02;22;24 - 00;02;23;03
Brian Nowicki
Very.
00;02;23;05 - 00;02;58;21
Meg Pekarske
Distraught. And so I think because their their business card will typically have, you know, Medicare on their CMS, whatever it says. And in terms of who uses this tactic, it's UPICs and also the OIG can use them. But that that's the other concern is people think there's their actual health coverage is in jeopardy. And I don't know that the people doing these interviews are always the best at like explaining that or putting in that.
00;02;58;21 - 00;03;19;07
Brian Nowicki
It is perhaps not a bedside manner, but it is these investigators whose card say they're a fraud investigator. And so, yeah, I mean, a lot of reasons that this can be alarming to patients, to families, to hospices, but it happens. And so, you know, the best thing to do is be prepared and stay on top of it, learn as much as you can about them.
00;03;19;20 - 00;03;47;18
Meg Pekarske
Yeah. So I think that oftentimes with patient interviews, nine times out of ten, you have not gotten a record of requests yet from the government. This is the first clue you have that you likely will now depending on if it's a UPIC or the OIG. I mean that what kind of record a class that that might be is it just a UPIC record request or is that something different?
00;03;48;00 - 00;04;20;25
Meg Pekarske
You know, I think it is actually really good information. If you find out that someone's talking to your patients like they called you or they mentioned it to the nurse on a visit, because the more you can understand what's going on, you can try to you're still behind the eight ball, so you're not ten steps ahead, but at least you're not like, hey, I didn't know anyone was talking to my two, my patients, but so it's legal for them to do that.
00;04;20;25 - 00;04;53;08
Meg Pekarske
Now, there are patients who have refused to talk to these people and obviously they don't force their way into your home or whatever. But. Right. So some people declined that visit and other people have the visit. And oftentimes these visitors, they're not clinicians themselves. Sometimes they do and have brought nurses, but oftentimes they're asking and maybe share, Brian, some of the kinds of questions that are oftentimes asked.
00;04;53;24 - 00;05;15;25
Brian Nowicki
Yeah, and it's changed over the years. I think what we're seeing more recently is they're kind of checking up on, it seems like is the hospice really doing what its medical records might suggest that it's doing. How frequent are you being visited? Do you know who the hospice folks are? Are you canceling visits or is the hospice canceling visits?
00;05;16;09 - 00;05;47;04
Brian Nowicki
What's the quality of the care you are providing? Kind of an open ended general question, Meg. As you said, sometimes they get into questions or I guess they're investigating into what's the patient's overall condition. We know this because through freedom of information Act requests, which can be a real good friend of ours, we've been able to obtain some redacted memos of some of these visits and interviews where the investigators are making.
00;05;47;16 - 00;06;18;24
Brian Nowicki
They might not be asking questions explicitly about condition, but they're certainly making observations about patient bedbound patients appearance and so on. So they could be doing that kind of evaluation as well. So it's all geared toward, you know, developing their record for an audit. And so by the time they're doing investigations, it is probably the case that they've already identified some patients through whatever means a complaint or data analytics, and then they go out and interview them.
00;06;19;03 - 00;06;40;14
Brian Nowicki
And then typically after soon after that, you'll get a record request from the from the auditors that list those patients and make, as you said, you know, thankfully, I think it's a tribute to the kind of trust that patients have in hospices that we're often hospices are often receiving information from the patients themselves, where they're going to their case manager or nurse and saying, hey, I got visited.
00;06;40;14 - 00;07;03;04
Brian Nowicki
Is this is this right? Is this okay? And once once we get that information, it really is helpful as it allows the hospice to try to take measure of itself and try to figure out what's going on. And now there's ways you can kind of appropriately try to expand or do your own investigation to prepare for the audit that seems to be inevitably coming your way.
00;07;03;13 - 00;07;24;24
Meg Pekarske
Yeah, because I think the more you can find out, sort of the better. I think there is PR I have that in air quotes because I think if that say they go to visit one of your facility patients, right, that can make your facility partner a bit uneasy like, oh, I don't want to be involved with this, you know, hospice that are getting investigated or something.
00;07;24;24 - 00;07;53;21
Meg Pekarske
And so I think in terms of managing these issues, which we're going to talk about some different techniques, I mean, one of these things is, you know, how do you explain to, you know, other folks about what this is and what it isn't? With that said, I would say if you're in health care, most people know that just because you're getting audited doesn't mean you're doing something wrong.
00;07;53;21 - 00;08;20;17
Meg Pekarske
So I think most of the time, you know, a facility isn't going to be ringing alarm bells, but something I think you need to be aware of is people probably don't know the level at which auditing happens. Routine audits, even UPICs are almost routine at this point for hospices, including very good hospices and sort of how much do you want to message that?
00;08;20;17 - 00;08;45;17
Meg Pekarske
Right. You don't want to over respond to things. And then because you're it makes you sound defensive like we must have done something wrong. So I think you need to consider, you know, what is it that you want to do? You need to do any relationship building with that facility, partner with the patient or family or like sometimes they've actually talked to attending physicians as well.
00;08;45;17 - 00;08;55;08
Meg Pekarske
And so, you know, do you need to do anything in terms of managing, you know, providing some more context because it can be rattling.
00;08;55;26 - 00;09;20;28
Brian Nowicki
And the last thing you want is for people to be interviewed and you never hear about it. And what are those people now thinking about the hospice? So they interview a patient and, you know, the patient's family is alarmed, but they've never reported that. Now, what's that patient's family saying about the hospice? That's why you want to kind of try to be proactive in monitoring any kind of activity that that might suggest these visits are happening.
00;09;20;28 - 00;09;55;25
Meg Pekarske
It's sort of like when we do our investigation training, you don't have a good compliance program if you never get complaints like the fact that you find out about this stuff is a good thing because that means that people feel like they can share this and all of this other stuff. I mean that that great that you're getting audited but a good hospice hopefully finds out about this stuff because they're sort of open, honest transparency among patients, but also staff members know to bring something to compliance if you know that they hear a patient saying that.
00;09;55;26 - 00;10;00;26
Meg Pekarske
So I think hearing about it is actually sort of the best thing possible.
00;10;01;05 - 00;10;23;01
Brian Nowicki
Right. And we have a handout that we've developed to try to, you know, discern whether investigations or visits are happening and then what to do, which is essentially just documenting it. I mean, until you get a record requests, there's not a lot of proactive steps you can take. But, you know, you can you can certainly document any interactions that have happened.
00;10;23;18 - 00;10;49;09
Brian Nowicki
Maybe take a look at the medical records for those patients, start to see if there are any common threads. But I think it can start and I think a way to keep this as kind of seemingly as harmless as possible. And what I mean is you don't want to learn of a visit and then for the first time, you're call in an all hands on deck meeting and hey, we've got visitors to go tell our visit, make it more routine.
00;10;49;09 - 00;11;17;07
Brian Nowicki
Like when you're onboarding new staff or when a new patient is being admitted, just let them know, you know, there are scammers out there, but there's also legitimate government oversight. And so, you know, we want to make sure you're not being taken advantage of. Just let us know if you're concerned about anybody visiting you. We think it's a good idea to get credentials before you talk to them and hopefully begin to develop that trust so that they will come back and report to you.
00;11;17;07 - 00;11;41;05
Brian Nowicki
Yeah, somebody stopped by the other day and ask these questions and then it gives you something to follow up on. If that doesn't kind of turn up any visits and you do get kind of a call from a from a person saying, hey, I was just visited, you know, maybe that's a time for a refresher so that at a next ID meeting, you kind of remind staff, hey, there's no scammers out there, there's government oversight, might be a good time for a check in.
00;11;41;24 - 00;12;00;04
Brian Nowicki
And we've done that there advise clients to do that and they have found additional people who have been interviewed. And then it allows us to to build the data we have to try to figure out what's going on, what kind of action we need to take and documenting the details when did it take place? Who who was involved, what was said?
00;12;00;25 - 00;12;08;23
Brian Nowicki
That's how we've gotten the information we have. And again, all very helpful as we strategize a response to the the audit that's coming around.
00;12;09;00 - 00;12;36;11
Meg Pekarske
And there's a bunch of different handouts that are in the podcast notes that people can pull. And this is one of them about talking points for staff. And then sometimes these patient interviews end up extending to staff interviews like oftentimes they could come on site and hand-deliver this record requests and then they might ask to speak to certain individuals, staff members.
00;12;36;11 - 00;13;06;19
Meg Pekarske
And so how do you deal with keeping staff prepared and for onsite auditor visits and what it can happen there? Because, again, just because they're doing that, it doesn't mean that you did anything wrong. It's just I frankly can't for all of the work we do in this area, I haven't been able to figure out a pattern of when they do that and when they don't do that.
00;13;06;19 - 00;13;30;28
Meg Pekarske
It's sort of like business records and record requests. Sometimes they ask for all these business records, but you never really see how that's evaluated or used in the investigation. Same with, I think, these visits. It's always sort of hard to to know why they go on site, sometimes not others, why they visit patients, sometimes not others like.
00;13;31;15 - 00;13;57;29
Brian Nowicki
Yeah, you know, in the ones that we've been working on, you know, we've been very proactive. We think that's critical to success is once you think something is happening with the patient visit or you know, they're going to come on site and they're going to talk to people, you got to get prepared. And and I think we've been fortunate enough that Meg, I don't I don't recall any of these things, these items that we've worked on have then gone on to anything other than an audit.
00;13;57;29 - 00;14;21;27
Brian Nowicki
And an audit is bad enough, but it's not like then there's a false claims act or then there's allegations of actual fraud. And I think an important part of that is you're being prepared. So you're not having if your staff are going to be interviewed on site, know they're not tripping over themselves or speaking out of turn about what their responsibilities are, and we're able to to help manage the information.
00;14;21;27 - 00;14;40;25
Brian Nowicki
And again, we have handouts that will attach to the to the episode in the episode notes that give you some guidance about, you know, if you're going to be interviewed by an auditor, here's the mind frame. That's the state of mind you should be in because it's not a conversation they're looking for information to use against you.
00;14;41;03 - 00;15;10;11
Meg Pekarske
Yeah. And I guess that's sort of a big pet peeve of mine is that people and it starts with language, which is people will say auditors are surveyors and psych. They are absolutely not like these are fraud investigators, not people surveying for compliance with the cops. Right. They're looking for potential fraud. I mean, we could do, you know, a whole series on survey management and survey prep.
00;15;10;11 - 00;15;37;01
Meg Pekarske
And I mean, I'm not saying you should ever, you know, be completely free in your exchanges with any government individual. But these in particular, like, you know, answer the question asked, don't overshare, don't guess that answer answers. Like all of these things are really important and it you should be professional and courteous and, you know, develop rapport with people.
00;15;37;01 - 00;16;02;19
Meg Pekarske
But that's not by getting real chummy and like, yeah, so it's like how to develop rapport through actions and not oversharing and things like that. And so people really need to understand the difference between surveyors and auditors. And being precise in your language is important because if you don't understand the difference, then your staff isn't going to get that.
00;16;02;19 - 00;16;14;19
Meg Pekarske
And it's like we treat everyone sort of the same. And this is a much more elevated discussion when you're talking to a fraud investigator over just, you know, a chap surveyor, right.
00;16;14;21 - 00;16;32;19
Brian Nowicki
So yeah, yeah. It's kind of between, you know, the way I mean, they're not going to read you your rights, you know, right. To remain so I mean, you don't have to deal with that level of it. But but it's good to know. Like I said, it's not a conversation. Be direct in the responses, be honest and accurate.
00;16;32;19 - 00;16;59;28
Brian Nowicki
I mean, that's rule number one, of course. And all of this don't don't guess at stuff because that inevitably leads down a bad path. And now among the handouts we have is ten questions that we think every hospice employee should know just about the fundamentals. So you don't have a a chaplain. When asked who who certifies the patients, the chaplain saying, well, I think the nurse does that, which is a situation we encountered.
00;16;59;28 - 00;17;19;21
Brian Nowicki
And had to do some do some remedial work on. But just the fundamentals so that these investigators know you're a sophisticated hospice, you know what you're doing and then the other hand out is kind of actual questions that have been posed about a number of topics during these onsite interviews. Now, it's not the case that they're always going to have in-depth interviews.
00;17;19;21 - 00;17;36;21
Brian Nowicki
Sometimes they show up at a hospice just to drop off the record requests, and they drop it off in and say goodbye. And that's great. Other times they're very targeted. They want to talk to this person or that person, and other times it's like, Well, we want to talk to the medical director, we want to talk to your clinical manager.
00;17;36;21 - 00;17;59;16
Brian Nowicki
And they don't have names, they have titles, but we've been everywhere from just the drop in. We've been involved in cases that have just been the drop off the letter kind. And we've been involved in cases where it's a multi-day onsite audit with interviews all day long. Those the latter has not happened recently. So I think thank goodness for that.
00;17;59;16 - 00;18;04;29
Brian Nowicki
But but the on site visits, the more targeted ones, those those have continued to happen through the years.
00;18;05;27 - 00;18;34;01
Meg Pekarske
Lots there, Brian. But so these handouts I think are really good and they're fairly timeless. So, you know, print them out once, have them forever, you know, I know people don't like to print anything but me anymore, but I think they're still really great to have in your back pocket. So literally in the back pocket, I’m not saying the right hand drawer I’m saying back pocket on your person.
00;18;34;24 - 00;18;35;13
Brian Nowicki
Right.
00;18;35;13 - 00;18;39;05
Meg Pekarske
So you need to have these on your person with your comb in your back pocket.
00;18;39;05 - 00;18;45;00
Brian Nowicki
Yes, that might be a bit of an inside joke, but yeah. Back back pocket or left hand drawer or maybe so.
00;18;45;20 - 00;18;56;29
Meg Pekarske
That's so awesome. Wow. I'm sure, you know, part 100 will be released in five years, so.
00;18;57;17 - 00;18;58;00
Brian Nowicki
We'll be back.
00;18;58;17 - 00;19;00;06
Meg Pekarske
So anyway. Great.
00;19;00;22 - 00;19;06;08
Brian Nowicki
Yeah. Thanks, Meg.
00;19;06;08 - 00;19;07;02
Meg Pekarske
Well, that's it for
00;19;07;02 - 00;19;22;08
Meg Pekarske
today's episode of Hospice Insights: The Law and Beyond. Thank you for joining the conversation. To subscribe to our podcast, visit our website at huschblackwell.com or sign up wherever you get your podcasts. Until next time, may the wind be at your back.