pa r tner s hips / a ffil ia tio ns - leadingageny.org facility hiring best practices... · ny s e...

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Best Practices in

Health Facility Hiring: Don’t become a victim of Medical

Fraud

March 8, 2018

The content of this presentation is proprietary of Alliance. It is not intended ot b

Partnerships/Affiliations

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Mario Pecoraro is an Industry Thought Leader Sought by National Media!

Alliance is the gold standard for those who want to screen out the fakes!

-Deborah Roberts/ABC’s 20/20

Overview of What Will Be Covered:

Don’t Become a Victim of Medical Fraud!!!

1. Statistics that are important to know2. Review of audit released by DiNapoli3. How this will impact your organization4. 4 Reasons WHY YOU should be conducting

more comprehensive investigations5. Case Studies of failures in the process6. Best Hiring Practices7. Post-Hiring 8. What is the infamous “FBI” Check?9. Q & A

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Fraud & HR

A Study on Resume Fraud Concluded:53% of resumes and job applications contain falsifications

Job Titles, Degrees, Dates, Salary“Background verification services are essential…” - Society for Human Resource ManagementBusiness Failure:

1/3 of all business failures are the result of employee theft or other employee crime. – US Department of CommerceEmployee Theft:

$50 Billion is stolen annually in U.S. businesses by employees. –Statistic BrainWork place Fraud:

Fraud costs organizations 5% of revenues each year: In 2014 work place fraud resulted in 3.7 trillion of loss profits globally?

- ACFE 2016 Report to the Nations

NYS Comptroller Thomas DiNapoli Audit Released September 2017

“State Education Department SHOULD improve its process to investigate serious complaints against nurses and more actively monitor professional misconduct”

Priority 1 (SERIOUS) complaints against nurses Taking 228 days to investigative vs. 42 1 case open for 866 days SED was failing to follow-up on many lower level offense

complaints; 8202 investigations, 215 of which were priority 1 between 2014-2017

NYS ED has clear policies for vetting potential nurses and monitoring/investigating but failing to meet those

Interesting Facts: NYS ED also oversees licensure and practice of 54 professions, including nursing. On average SED receives 6000 complaints annually against all licensed professionals

www.allianceinvestigative.com

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Audit outcome continued… Between 4/1/16 – 10/31/16 there were 450,000 active nursing licenses

To qualify, applicants must meet certain standards under state law including EDUCATION, EXAMINATION & MORAL CHARACTER REQUIREMENTS

SED independently verifies education, credentials, and exam results and out of state licenses, but NOT able to confirm a nurse meets the moral character standard!

NEW YORK does NOT require fingerprinting or background checks as a condition for obtaining a license. Relies solely on applicant disclosure of past misconduct.

POST HIRE… SED does NOT actively monitor nurses once licensed to identify issues, and relies on self-disclosure, only every 3 years. Some nurses are not truthful in disclosures, SED does not take

advantage of other resources that could be helpful. YOU are at risk in this case!!!


What does the audit mean to you?


Pre-Hire Due-DiligenceWhat are you doing prior to engaging nurse?

Moral Character DeterminationHow to best determine this?

Post-Hire Due-DiligenceMonitoring behavior?

What is the TRUE cost of 1 complaint?Failing to conduct adequate due-diligenceReputation, Litigation

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Reasons…..Why should you be conducting background investigations?


Positions of AuthorityFalse credentials

Medical Fraud Costs $$$Frauds, Lawsuits from corrupt medical professionals

Duty to provide safe haven for patientsWhat responsibility do you have for your customers (patients?)

Travelling NursesHIGHER risk due to nature of location

Case Study 1: NURSE with sex crimes in background slipped through….


01/23/18: Nurse convicted of sex crimes never faced state background checkThomas Moore, 45 yrsMolested 10 patients CO, WYAt the time of crime, CO was 1 of 5 states that didn’t

allow collection of fingerprints for background checksHad prior DUI and Child Abuse charges in record from

2011, he lost his Alaska License in 20142018 new law now forces new nurses to get

fingerprintedIt DOES NOT impact prior licensees, so what is risk?

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Case Study 2: NURSE stole $390K from Medicaid


2017: Private-Duty Nurse submitted false claimsAnyanwu Mueller, 47 Worked as a private duty nurse Billed for false claims that he never provided to two (2)

severely disabled patientsFalse claims included instances where recipients were in

hospital, when another nurse provided careDefendant was in Europe at the timeFor a period of time he sent an unlicensed person to the

recipients home but billed Medicaid as if he provided care himselfTHIS could be your NEXT hire?

Case Study 3: NURSE pleads guilty to taking photos of private parts of unconscious patient


2016: NYS Nurse convicted of improper MORAL conductKristen Johnson, 27Disseminating unlawful surveillance photo and videosArrested May 2015 after she took photos of multiple

patients and then sent to co-workersUsed iPhone to take video of another nurse cleaning an

incapacitated female’s GI blood clotHow MORALLY FIT is she to work in your facility?THIS could be your NEXT hire?

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What does NYS/Government do for you now?Employees of Nursing Homes, Adult Care, Home Health Care, anyone

that is certified by NYS DOH that has DIRECT patient contact. CNA, HHA, Dietary Aides, Housekeepers, Maintenance)CHRC Background Check (fingerprint)NYSDCJSFBI CheckDetermination letter is sent to applicant and employer

WHO is NOT subject to CHRC?Licensed health care employees Nursing home administratorsEmployees without patient contactVolunteers

Challenges? Accuracy of information & searches conductedNOT compliant with FCRANOT Court Records and typically dispositions are not complete - opening

up significant exposure

What can you do to be proactive? Determine your “tolerance” and budget What is your TRUE cost of a bad hire? Review the SED guidelines & compare to your

process Establish internal Best Practices Follow-up throughout the process Pre- and Post Employment Don’t rely on the “system” ultimately YOU are liable!


Best Hiring practices to save money…

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Background Investigations: SSN

SS# Verification/Address History A building block of every background investigation

WHY is this so important? Verifies that SSN is valid and date issued Provides list of names/aliases used Provides a list of addresses reported/associated

with applicant

Criminal Convictions Searches

MisdemeanorsA minor crimePunishable by fine or confinement Typically less than 1 year in jail EXAMPLES INCLUDE: petit larceny, DWI, assault,

batteryFelonies A serious crime Punishable by more than one year of imprisonment up

to death EXAMPLES INCLUDE: rape, murder, burglary,

serious drug-related offenses

Background Investigations: Criminal Searches

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Local, City, Town, VillageMisdemeanors

County, State, DistrictFelonies and Misdemeanors

Federal

InternationalVaries by country and available records

Criminal Court Levels

Multi-jurisdictional (National)

PROS“National” CoverageFast Turnaround time (same day/within hours)Ideal as a supplemental search Inexpensive

CONSNot comprehensiveOften not accurate and missing informationDoes not limit liability Requires additional research

Background Investigations: National

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Countywide PROS

Comprehensive countywide research for felonies only in most jurisdictions

Generally 3-4 day turnaround time in most jurisdictions and sometimes available online through direct court access

Relatively inexpensive compared to a statewide search

CONS

Covers felonies only and no misdemeanors – common misconception

Limits research to an “assumed” area of possible crime

If crime is pled down to lesser charge, will not be reported in county search if not felony

Statewide vs. Countywide Which to choose?? (Countywide Pros & Cons)

Statewide vs. Countywide Which to choose?? (Statewide Pros & Cons)

Statewide

PROSGenerally felony & misdemeanor records throughout the entire

state, depending on the stateComprehensive, includes all available jurisdictions, towns & villagesEliminates the need for countywide searches

CONSRequires additional due-diligence if an adverse record is foundNot available in several states

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References, Verifications and More…

EmploymentEnsure that prior employment history is accurate and

dates/job descriptions are accurateLook for gaps in employment/dates

ReferencesSeek references that are NOT listed on the applicant’s

resume

Education and LicensingDig DEEP into degree(s) and ensure valid Ensure license is valid and no complaints, etc.

Moral CharacterIdentify past associates that can attest to this

Post-Hire Screening: How to be compliant

Employers conduct background investigations at the onset of an employment decision, HOWEVER what is being done throughout the employment process?

Ensure that the initial release form is compliant and sets the groundwork for future screening for various purpose(s)

Retention, Promotion, etc. etc.

Establish groundwork and budget for due-diligence required

What to do if you suspect an “issue”, does FCRA apply?

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How is it accessed?

Inaccurate, missing data in several states

What does it contain?

Arrest Information without disposition

Lacking a disposition is useless for employment decision

Who can utilize this method?

Over 30M checks annually as reported in 2014-15, but inaccurate!

INTERESTING FACT: Biometrics and Facial Recognition Database?: Has been tested outside of the US!

Use of the “FBI” Check:


In closing………….

Nurses are a critical part of your organization, what are you doing to ensure they are properly vetted.Don’t assume that because the State doesn’t “require”

it that you are not liable or at risk.Continually assess your current process to ensure

compliance, easy and inexpensive is not necessarily best. Assess the “true” cost of a bad hire, not the line item.Ensure legal or partner reviews process at least

annually, from application through final decisionEnsure your provider is educating you on the changes

in legislation

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QUESTIONS?

Mario S. Pecoraro, CEOAlliance Worldwide Investigative Group [email protected](800) 579-2911 extension 128

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