• Mandatory OSHA 300 Log Reporting and Record Keeping for 2015 and OSHA in 2015 and Beyond

    Monday January 5, 2015

    There are new OSHA Reporting Requirements now in effect. Beginning on January 1, 2015, there is a change to what covered employers are required to report to OSHA. Employers are now required to report all work related fatalities within 8 hours and all inpatient hospitalizations, amputations, and losses of an eye within 24 hours of finding out about the incident. The attachments below provide more information about the new Mandatory OSHA Reporting and Record Keeping requirements for 2015.

    Mandatory OSHA 300 Log Reporting and Recordkeeping for 2015
    OSHA in 2015 and beyond

  • Documenting After an Incident

    Wednesday January 7, 2015

    Recently, an incident was reported where a resident suffered a fall.  Unfortunately, after the incident the facility failed to document the resident's overall status during the next 24 hours.  As a result, it is difficult to   determine whether the change in status was related to the incident or another event/condition.  Attached is a resource for your facilities as a reminder and guidance for documenting after an incident. 

    Click here for file.

  • Winter Weather Preparedness Checklist

    Wednesday January 7, 2015

    The winter season is right around the corner and it is a good time to plan for and mitigate the property damage, employee illness and injury, and even business closures that can be caused by severe winter weather.The following checklist will help you identify the areas of your business that are most susceptible to winter hazards.

    Click here for Winter Weather Preparedness Checklist

    Disclaimer: I would like to emphasize that the discussions, examples and templates set forth above are from an insurance/risk management perspective and is NOT legal advice.  We do not provide legal advice as we are not qualified to do so.  I highly recommend that you seek the advice of legal counsel in order to become fully apprised of the legal implications related to these issues. The information contained herein was obtained from sources which to the best of the writer's knowledge are authentic and reliable.  Arthur J. Gallagher makes no guarantee of results, and assumes no liability in connection with either the information herein contained, or the safety suggestions herein made.  Moreover, it cannot be assumed that every acceptable safety procedure is contained herein, or that abnormal or unusual circumstances may not warrant or require further or additional procedures, resources or advice. 

  • Arthur J Gallagher’s Risk Management Strategies Webcasts

    Monday January 12, 2015

    Arthur J Gallagher put together a series of webcasts on risk management strategies that included Generating a Culture Change Mindset in Workplace Safety, Simple Steps for Creating a Strong Safety Structure, and Safety Communication for Speakers of Spanish and Other Languages.

    View the three Risk Management Strategies Webcasts

    Disclaimer: I would like to emphasize that the discussions, examples and templates set forth above are from an insurance/risk management perspective and is NOT legal advice.  We do not provide legal advice as we are not qualified to do so.  I highly recommend that you seek the advice of legal counsel in order to become fully apprised of the legal implications related to these issues. The information contained herein was obtained from sources which to the best of the writer's knowledge are authentic and reliable.  Arthur J. Gallagher makes no guarantee of results, and assumes no liability in connection with either the information herein contained, or the safety suggestions herein made.  Moreover, it cannot be assumed that every acceptable safety procedure is contained herein, or that abnormal or unusual circumstances may not warrant or require further or additional procedures, resources or advice.  

  • Responding to an OSHA Inspection – Document Production

    Monday January 12, 2015

    In many cases, employers are experienced with the walk around and employee interview aspect of an OSHA Inspection, but are unsure of what documents the compliance officer is entitled to inspect and to request copies. The article in the link below is intended to give guidance in this area.

    Click here for article  - Responding to An OSHA Inspection IV.

    Disclaimer: I would like to emphasize that the discussions, examples and templates set forth above are from an insurance/risk management perspective and is NOT legal advice.  We do not provide legal advice as we are not qualified to do so.  I highly recommend that you seek the advice of legal counsel in order to become fully apprised of the legal implications related to these issues. The information contained herein was obtained from sources which to the best of the writer's knowledge are authentic and reliable.  Arthur J. Gallagher makes no guarantee of results, and assumes no liability in connection with either the information herein contained, or the safety suggestions herein made.  Moreover, it cannot be assumed that every acceptable safety procedure is contained herein, or that abnormal or unusual circumstances may not warrant or require further or additional procedures, resources or advice. 

  • Responding to an OSHA Inspection – Employee Interviews and Employee Interview Rights

    Monday January 12, 2015

    During an OSHA inspection, the Compliance Officer will request employee interviews in order to gather facts as to whether there may have been violations of the Agency's regulations. Many employers fail to advise their employees of their rights during such interviews and these rights are never exercised. The links below provide you with the general rights of employees during employee interviews.

     Click here for article - RMSI - Responding to An OSHA Inspection II - Employee Interviews

     Click here for article - RMSI - Responding to An OSHA Inspection III - Employee Interview Rights

    Disclaimer: I would like to emphasize that the discussions, examples and templates set forth above are from an insurance/risk management perspective and is NOT legal advice.  We do not provide legal advice as we are not qualified to do so.  I highly recommend that you seek the advice of legal counsel in order to become fully apprised of the legal implications related to these issues. The information contained herein was obtained from sources which to the best of the writer's knowledge are authentic and reliable.  Arthur J. Gallagher makes no guarantee of results, and assumes no liability in connection with either the information herein contained, or the safety suggestions herein made.  Moreover, it cannot be assumed that every acceptable safety procedure is contained herein, or that abnormal or unusual circumstances may not warrant or require further or additional procedures, resources or advice. 

  • A Minute For Safety

    Wednesday March 4, 2015

    A close call or an accident without injury is easy to shrug off and forget. But there is a danger in brushing off accidents that don't hurt, harm or cause damage. This article provides you with information on what you should consider doing when an accident or close call occurs.    

    Read the article.

  • Whistleblower Claims Under the Patient Protection and Affordable Care Act: An Emerging Concern for Employers and Insurers

    Thursday March 5, 2015

    This article provides information about the rise in OSHA related whistleblower claims and Affordable Care Act whistleblower protected activities.

    Read the article.

  • Legionella Prevention Plan Introduction

    Friday March 6, 2015

    Legionella 101

    Legionellae are rod-shaped, gram negative bacteria. Over 40 species of Legionella have been identified; L. pneumophila appears to be the most virulent and is associated with approximately 90% of cases of Legionellosis. The risk of acquiring Legionnaires' disease is greater for older persons and for those who smoke tobacco or have chronic lung disease. Persons whose immune system is suppressed by certain drugs or by underlying medical conditions appear to be at particularly high risk.

    Legionellae bacteria are commonly present in natural and man-made aquatic environments. The organism is occasionally found in other sources, such as mud from streams and potting soils. In natural water sources and municipal water systems, Legionellae are generally present in very low or undetectable concentrations. However, under certain circumstances within manmade water systems, the concentration of organisms may increase, a process termed "amplification." Conditions that are favorable for the amplification of legionellae growth include water temperatures of 25-42 degrees Celsius (°C) (77-108 degrees Fahrenheit), stagnation, scale and sediment, biofilms, and the presence of amoebae. Legionellae infect and multiply within several species of free-living amoebae, as well as ciliated protozoa. The initial site of infection in humans with Legionnaires' disease is the pulmonary macrophage. These cells engulf Legionellae, provide an intracellular environment that is remarkably similar to that within host protozoa, and allow for multiplication of the bacterium. Growth in nature in the absence of protozoa and/or in the absence of complex microbial biofilms has not been demonstrated.

    There is an indication that growth of Legionella is influenced by certain materials. Natural rubbers, wood, and some plastics have been shown to support the amplification of Legionella, while other materials such as copper inhibit their growth. Generally, Legionella thrive in diverse, complex microbial communities because they require nutrients and protection from the environment. Controlling the populations of protozoa, and other microorganisms may be the best means of minimizing Legionella.

    Transmission of Legionnaires' Disease

    Most data on the transmission of Legionnaires' disease are derived from investigations of disease outbreaks. These data suggest that, in most instances, transmission to humans occurs when water containing the organism is aerosolized in respirable droplets (1-5 micrometers in diameter) and inhaled by a susceptible host. A variety of aerosol-producing devices have been associated with outbreaks of Legionnaires' disease, including cooling towers, evaporative condensers, showers, whirlpool spas, humidifiers, decorative fountains, and a grocery store produce mister. Aspiration of colonized drinking water into the lungs has been suggested as the mode of transmission in some cases of hospital-acquired Legionnaires' disease. Numerous investigations have demonstrated that cooling towers and evaporative condensers have served as the sources of Legionella-contaminated aerosols causing outbreaks of community- and hospital- acquired infection. A number of outbreaks of Legionellosis associated with cooling towers and evaporative condensers have occurred after these devices have been restarted following a period of inactivity. Shower heads and tap faucets can also produce aerosols containing legionellae in droplets of respirable size.

    Common amplifiers (growth factors) associated with building water systems, including the treatment recommended to minimize the risk of Legionellosis, are discussed below.

    Potable Water Systems

    Factors associated with the plumbing system that may influence the growth of legionellae are as follows:

    • Chlorine concentration;
    • Temperature; and
    • Plumbing system design and materials

    Municipal potable water supplies are generally chlorinated to control the presence of microorganisms associated with sewage. Legionellae are more tolerant of chlorine than many other bacteria, and may be present in small numbers in municipal water supplies. Potable water can also support legionellae growth if the water temperature is in the range of 77-108°F. Plumbing design and materials also influence the growth of legionellae.

    Growth of legionellae may occur in portions of the system with infrequent use, in stagnant water, and in portions of the system with tepid temperatures. Growth may also occur in dead-end lines, attached hoses, shower nozzles, tap faucets, hot water tanks, and reservoirs. Rubber washers and fittings, including water hammer arrestors and rubber hoses with spray attachments, have been shown to provide sites for growth of legionellae. Organic compounds leached from plumbing materials may contribute to growth of heterotrophic bacteria, including legionellae.

    Contaminated potable water sources present the greatest risk when dispersed into the air in a very small droplet size (less than 5 micrometers) that can be inhaled deeply into the lungs. Actions that may generate small droplets are those that break up the water stream, i.e., shower nozzles, aerators, spray nozzles, water impacting on hard surfaces, and bubbles breaking up. Both dead and living microorganisms, biofilms, and debris may provide nutrient sources for legionellae growth. When legionellae are found in plumbing systems, it is common to detect the microbes in the sediment in hot water tanks, and in peripheral plumbing fixtures that accumulate sediment.

    Where practical in high-risk situations, cold water should be stored and distributed at temperatures below 20°C (68°F), while hot water should be stored above 60°C (140°F) and circulated with a minimum return temperature of 124°F. However, great care should be taken to avoid scalding problems. One method is to install preset thermostatic mixing valves. Where buildings cannot be retrofitted, periodically increasing the temperature to at least 66°C (150°F) or chlorination followed by flushing should be considered. Systems should be inspected annually to ensure that thermostats are functioning properly. Where practical in other situations, hot water should be stored at temperatures of 120°F or above. Those hot or cold water systems that incorporate an elevated holding tank should be inspected and cleaned annually. Lids should fit closely to exclude foreign materials.

    Where decontamination of hot water systems is necessary (typically due to implication of an outbreak of Legionellosis) the hot water temperature should be raised to 160~170°F and maintained at that level while progressively flushing each outlet around the system. A minimum flush time of five minutes has been recommended by the Center for Disease Control. However, the optimal flush time is not known and longer flush times may be necessary.

    Emergency Water Systems-safety Showers, Eye Wash Stations, And Fire Sprinkler Systems

    These systems are generally plumbed to the potable water system, have little or no flow with resulting stagnant conditions, and may reach temperatures warmer than ambient. The presence of legionellae, heterotrophic bacteria, and amoebae in these systems has been documented. When the devices are used, aerosolization is expected.

    Safety shower and eye wash stations should be flushed at least monthly. In the case of fire sprinkler systems, it is recommended that fire-fighting personnel wear protective respiratory gear and that non- firefighting personnel exit the burning area. Appropriate precautions should be taken when checking the operation of fire sprinkler systems.

    Architectural Fountains And Waterfall Systems

    In these systems, water is either sprayed in the air or cascades over a steep media such as rocks, and then it returns to a man-made pool. These systems are sometimes operated intermittently with on-time often scheduled only during certain time periods. Systems that are operated intermittently may encourage greater biocontamination.

    Because of the high temperature ranges needed for proliferation of legionellae bacteria, outdoor fountains and pools in hotter climates, and indoor fountains and pools subject to sources of heat may be susceptible to legionellae growth. Temperature increases may be facilitated by heat from pump/filter systems themselves. Intermittent operation may also create situations where temperature increases occur in isolated areas of the system. Fountains are subject to contamination from a wide variety of potential nutrient sources, including materials scrubbed from the air and returned to the pool with the falling water droplets as well as organic and inorganic materials dropped, thrown, or blown into the pool.  

    The recommended treatment for fountains includes:

    • Regular cleaning is recommended; and
    • Use of filters should be considered; however, systems with a small water volume may be drained, and refilled with fresh water every few weeks in lieu of filtering.

    Microbial fouling control is important, especially where the conditions are such that there are significant periods of time when the temperature of the fountain water is in the range that is favorable for the amplification of legionellae growth. When biocidal treatment is employed for microbial fouling control, the biocide must be registered with the United States Environmental Protection Agency (USEPA) for use in decorative fountains.

    Cooling Towers Including Fluid Coolers (closed-circuit Cooling Towers) And Evaporative Condensers

    Evaporative heat rejection equipment such as cooling towers and evaporative condensers have been implicated in numerous outbreaks of Legionnaires' disease, and studies have shown that detectable levels of legionellae are present in many of these devices.

    A cooling tower is an evaporative heat transfer device in which atmospheric air cools warm water, with direct contact between the water and the air, by evaporating part of the water. Air movement through such a tower is typically achieved by fans, although some large cooling towers rely on natural draft circulation of air. Cooling towers typically use some media, referred to as "fill," to achieve improved contact between the water and the cooling air. The typical temperature of the water in cooling towers ranges from 85°F to 95 °F although temperatures can be above 120 °F and below 70°F depending on system heat load, ambient temperature, and system operating strategy.

    Closed-circuit cooling towers and evaporative condensers are also evaporative heat transfer devices. Both are similar to conventional cooling towers, but there is one very significant difference. The process fluid (either a liquid such as water, an ethylene glycol/water mixture, oil, etc., or a condensing refrigerant) does not directly contact the cooling air. Rather, the process fluid is contained inside a coil assembly. Water is drawn from the basin and pumped to a spray distribution system over the coil assembly while the cooling air is blown or drawn over the coil by fans. Removal of heat is achieved by evaporating part of the water. Water temperature in closed-circuit cooling towers and evaporative condensers is similar to that in cooling towers.

    Cooling towers and evaporative condensers incorporate inertial stripping devices called drift eliminators to remove water droplets generated within the unit. While the effectiveness of these eliminators can vary significantly with the design (new state-of-the-art eliminators are significantly more efficient than older designs) and the condition of the eliminators, it should be assumed that some water droplets in the size range of less than 5 micrometers leave the unit. In addition, some larger droplets leaving the unit may be reduced to 5 micrometers or less by evaporation.

    Because cooling towers and evaporative condensers are highly effective air scrubbers and because they move large volumes of air, organic material and other debris can be accumulated. This material may serve as a nutrient source for legionellae growth. Diverse biofilms, which can support the growth of legionellae, may be present on heat exchanger surfaces, structural surfaces, sump surfaces, and other miscellaneous surfaces.

    The key recommendations are that the system be maintained clean and that a biocidal treatment program be developed and implemented. It is also recommended that the services of a qualified water treatment specialist be used to define and oversee the treatment. Keeping the system clean reduces the nutrients available for Legionella growth. Regular visual inspections should be made for general cleanliness. The cold water basin of the unit should be cleaned when any buildup of dirt, organic matter, or other debris is visible or found through sampling. Mechanical filtration may be used to help reduce these solids. Strainers, cartridge filters, sand filters, centrifugal-gravity-type separators, and bag-type filters can be used to assist in removal of debris. The drift eliminators should also be inspected regularly and cleaned if required or replaced if deteriorated or damaged.

    An effective water treatment program allows more efficient operation due to lower fouling, a longer system life due to decreased corrosion, and safer operation of the system due to reduced chances of microbial exposure to the public.

    Control of scaling and corrosion is necessary in many water treatment programs. Scale such as calcium carbonate and/or other minerals containing silica, magnesium, and phosphate may precipitate onto heat exchanger and piping surfaces. Scaling can be minimized by use of inhibitors containing phosphonates, phosphates, and polymers to keep calcium and carbonate and other minerals in solution. Corrosion can be minimized by the use of inhibitors such as phosphate, azoles, molybdenum, and zinc. Scale and corrosion inhibitors are effective if microbial fouling and biofilm development are properly controlled. Microbial fouling can influence scaling and corrosion processes and can affect the performance of inhibitors. Microbial biofilms on surfaces can consume certain inhibitors (such as phosphates, phosphonates, and azoles), prevent access of inhibitors to surfaces, create localized oxygen-depleted zones, change the pH near surfaces, and accumulate or trap deposits onto surfaces.

    Microbial fouling is controlled by the use of biocides, which are compounds selected for their ability to kill microbes while having relatively low toxicity for plants and animals. In the USA, the Environmental Protection Agency has regulatory authority for biocides and requires registration of all biocides. In addition, registration is required in each state where the biocide will be distributed. Non-oxidizing biocides include many organic compounds registered with the USEPA for cooling water applications. These biocides function in a number of ways, including reacting with intracellular enzymes, solubilizing cell membranes, and precipitating essential proteins in microbial cell walls. Properly used, non-oxidizing biocides are effective for control of the microbial fouling process in cooling water systems. It is generally good practice to regularly alternate the biocides used for a cooling water system to avoid the selection and growth of resistant strains of microbes. The alternating biocide approach has been emphasized with the rationale that the population that survives the biocide treatment one week is susceptible to the alternate biocide a week or two later. Alternating the dose and frequency of the same biocide is also used to achieve this goal.

    Equally important to controlling scale and corrosion is keeping the system clean and free of sediment. Common sources of sediment include materials scrubbed from the air (dirt, leaves, paper, kitchen or other organic exhaust), precipitated solids (calcium, magnesium, carbonate silica), and corrosion products (rust). Microbes including bacteria, protozoa, algae, and (infrequently) fungi can grow in cooling systems and use the above materials as nutrients. Consequently, it is desirable to either prevent the entry of the material into the system or to remove it from the system.  

    When the system is to be shut down for a period of more than three days, it is recommended that the entire system (cooling tower, system piping, heat exchangers, etc.) be drained to waste. When draining the system is not practical during shutdowns of short duration, the stagnant cooling water must be pretreated with an appropriate biocide regimen before tower start-up.

  • OSHA Updates Guidance for Protecting Healthcare and Social Service Workers from Workplace Violence

    Wednesday April 15, 2015

    This article provides guidance from OSHA for protecting healthcare and social service workers from workplace violence.    

    Click here to view the article

  • CMS Data Submission Payroll Based Journal (PBJ)

    Wednesday April 15, 2015

    CMS has developed a system for facilities to submit staffing and census information - Payroll Based Journal (PBJ). This system will allow staffing and system information to be collected on a regular and more frequent basis than currently collected. It will also be auditable to ensure accuracy. All long term care facilities will have access to this system at no cost to facilities. The following links contain technical information related to the PBJ and are available below. 

    Click here for pdf.

    Click here for link.

  • Chubb (Federal Insurance Company) Policyholder Loss Control Services

    Wednesday July 1, 2015

    If you are a Chubb Policyholder then you have access to valuable loss prevention information. Chubb designs comprehensive risk management services to accurately fit a client's risk needs. Many of these value added services are available to Chubb clients at no additional fee. The attachment to this News Article includes a list of the risk management services that are available to Chubb clients.  

    Download the attachment

  • ICD-10 Quick Start Guide

    Tuesday July 7, 2015

    This guide outlines 5 steps health care professionals should take to prepare for ICD-10 by the October 1, 2015, compliance date. You can complete parts of different steps at the same time if that works best for your practice.

    Download the attachment

  • ICD-10 Compliance Date October 1, 2015

    Wednesday July 8, 2015

    In response to requests from the provider community, CMS is releasing additional guidance that will allow for flexibility in the claims auditing and quality reporting process as the medical community gains experience using the new ICD-10 code set. For more details, please see the joint announcement on the CMS ICD-10 website. The website link is included in the attachment to this News Article.        

    Download the attachment

  • Article From McKnight’s on the Increasing Importance of Statistical Analysis in Defending Against Fraud and Abuse Allegations and Billing Errors & Omissions Liability Insurance Coverage

    Friday August 14, 2015

    The article below is from a recent edition of McKnight's and addresses the importance of Statistical Analysis in defending fraud and abuse allegations in long term care facilities. To learn more about Arthur J Gallagher's Billing Errors & Omissions Liability Insurance Program please open the attachment below. Please contact Gerry Gilbert in our office to discuss this Liability Insurance Program and its availability. He can be reached at 205-414-6184 or by email at gerry_gilbert@ajg.com.

    In this month's McKnight's article, the author reviews the increasing importance of statistical analysis in defending against fraud and abuse allegations.

    False Claims Act enforcement, and the attendant risk of financial liability, is on the rise. The United States Department of Justice has obtained almost $44 billion in FCA settlements and judgments since 1986, and almost $6 billion in 2014 alone. Significantly, roughly $2.5 billion of the funds recovered in 2014 came from the health care industry, marking the fifth straight year of fraud recoveries in excess of $2 billion. If FBI estimates that 3% to 10% of all federal healthcare billings are lost to fraud, then it would appear that these eye-popping numbers still have room to grow.

    FCA enforcement in the long term care industry has been no exception. The industry has been squarely in the sights of government enforcement attorneys following a 2012 report from the Office of Inspector General that found roughly 20% of all Medicare Part A SNF claims were upcoded to a higher RUG group in 2009, resulting in $1.2 billion in improper payments. Recent FCA complaints have relied on a number of arguments to substantiate the submission of false claims for Medicare reimbursement: systematic upcoding to higher RUG levels due to corporate pressure on front line care providers; targeting therapy at or around RUG thresholds; increasing therapy during look back periods; and providing skilled therapy that was not required for improvement in functioning.
    Although long-term care providers and other FCA defendants have raised a wide range of reasonable explanations for the billing patterns identified in recent complaints, the DOJ and private whistleblowers have been emboldened by a series of significant settlements. Enforcement attorneys have also been given a new, and potentially game-changing, tool thanks to a series of recent court opinions involving the use of statistical sampling and extrapolation to demonstrate FCA liability.

    Wait, don't they need to identify an actual claim?

    While courts have long recognized statistical sampling as a valid method of proof, its use in FCA cases has been, until recently, fairly limited. The reasons for this limitation are somewhat intuitive, as sampling has typically been used to prove the amount of damages resulting from a fraudulent billing scheme (i.e., the amount the government was overbilled). This status quo, however, was disrupted in late 2014 when the Eastern District of Tennessee gave its blessing for prosecutors in U.S. ex rel. Martin v. Life Care Centers of America to use statistical sampling and extrapolation to prove not only damages, but actual liability under the FCA.

    Life Care operates over 200 skilled nursing facilities nationwide that received $4.2 billion in Medicare reimbursement between 2006 and 2011. In Martin, the company is alleged to have engaged in a systematic practice of upcoding and providing medically unnecessary services that resulted in the submission of 150,000 false claims involving over 54,000 patients. In the typical FCA case, the government would have needed to demonstrate which of those 150,000 claims were false (i.e., submitted for medically unnecessary services) and whether the defendant knew those claims were false at the time they were submitted to a federal health care program. In Martin, however, the government analyzed just 400 representative sample cases and then sought to extrapolate the percentage of claims identified as false to the larger universe of 150,000 unidentified claims. Not surprisingly, Life Care sought summary judgment (i.e., that there is no factual dispute and the law requires a judgment in its favor) as to the unidentified claims, arguing that the falsity of an individual claim cannot be determined through statistical means.

    Contrary to established expectations, the court denied Life Care's motion and allowed the case to go to trial. While granting that using extrapolation to establish damages when liability has been proven is different than using extrapolation to establish liability and finding no definitive precedent for doing so, the court still found that the government could use the evidence to prove its case due to the general acceptability of statistical analysis. Life Care, meanwhile, would be free to argue that the jury should not credit the government's analysis because it is wrong or flawed.

    As a practical matter, the use of statistical analysis to prove liability instead of damages would do two things. First, it would dramatically reduce the time and scrutiny of individual claims that is usually necessary to prosecute a credible FCA case. Second, and relatedly, it would allow the government and/or private whistleblowers to expand vastly the universe of allegedly false claims and set the stage for an environment where, once a handful of allegedly false claims is identified, every claim a defendant made within a specific time period could be fair game. And in this sort of environment, long-term care providers could see their FCA exposure driven less by pesky details like fact and medical necessity, and more by their ability to hire a better mathematics expert than their whistleblower.

    This is not good news for providers, especially in light of the other recent changes to the FCA statute that have made it easier for whistleblowers to extract significant settlements.

    A slippery slope ahead

    Already, Life Care is beginning to bear fruit for whistleblowers and their attorneys. In U.S. ex rel. Ruckh v. CMC II LLC, for example, a federal judge in the Middle District of Florida cited Life Care in an order allowing the relator to use statistical evidence to prove liability in an FCA case involving roughly identical allegations of upcoding and medically unnecessary procedures. If Life Care continues to gain traction in cases such as Ruckh, it will create a dangerous precedent for long term care providers.

    Download the attachment

    Categories :
  • Helping Victims of Mass Violence and Terrorism

    Sunday October 4, 2015

    The link below contains a website developed by the Office of Justice Programs designed to help victims of mass violence and terrorism. This website's toolkit provides tools and resources for developing a comprehensive victim assistance plan that can be incorporated into your facility's existing emergency response plan. Victim assistance plans support and enhance your response and recovery efforts. The toolkit's Partnership and Planning Section reviews how to create and maintain partnerships, addresses resource gaps, and develop victim protocols, and its Response and Recovery Section covers how to use the protocols after an incident of mass violence or terrorism. The Tools Section includes checklists, samples, a glossary, and a collection of victim assistance resources.   

    http://www.ovc.gov/pubs/mvt-toolkit/   

  • Article from McKnight’s on new proposed rules from CMS that will establish specific requirements when a long term care facility uses bed rails on a resident’s bed.

    Thursday October 8, 2015

    The link below contains a good article from McKnight's on new proposed rules from CMS that will establish specific requirements when a long term care facility uses bed rails on a resident's bed.

    http://www.mcknights.com/guest-columns/examining-bed-rail-use-in-long-term-care/article/443728/?DCMP=EMC-MCK_Daily&spMailingID=12611976&spUserID=NDM1NzE4MTg1NTMS1&spJobID=640492421&spReportId=NjQwNDkyNDIxS0

     

  • Article from McKnight’s on different ways to provide good customer service at your long term care facility.

    Thursday October 8, 2015

    The link below contains a good article from McKnight's on different ways to provide good customer service at your long term care facility.

    http://www.mcknights.com/guest-columns/delivering-good-customer-service-in-long-term-care/article/442886/?DCMP=EMC-MCK_Daily&spMailingID=12589489&spUserID=NDM1NzE4MTg1NTMS1&spJobID=640364571&spReportId=NjQwMzY0NTcxS0

     

  • Article from McKnight’s on resident’s chronic pain in long term care facilities and the use of opioids as part of the pain management treatment.

    Thursday October 8, 2015

    The link below contains a good article from McKnight's on resident's chronic pain in long term care facilities and the use of opioids as part of the pain management treatment.

    http://www.mcknights.com/guest-columns/america-should-talk-about-chronic-pain/article/442864/

  • Investigation and Reporting of Visitor Injuries Checklist

    Friday October 9, 2015

    The attachment below contains an Investigative and Reporting Visitor Injuries Checklist that can be used as a resource to help develop or revise your facility's Visitor Injury Guidelines. These guidelines should not be interpreted as facility policy and should only be used as a resource.

    Download the attachment

     

  • Billing Errors & Omissions Coverage for Healthcare Providers

    Thursday November 12, 2015
    Healthcare is one of the most regulated industries in the U.S. and healthcare providers are extremely vulnerable to allegations of improper billing by both governmental payers and private commercial payers. The Gallagher Billing E&O Program provides important protection to healthcare providers against such allegations .This exclusive program provides the following key benefits:
    
    ·         Indemnity and Defense Protection from regulatory fines & penalties associated with billing errors
    ·         Protection includes both governmental payers and private payers
    ·         Qui Tam Plaintiffs
    ·         Coverage for EMTALA, Stark, or HIPAA Proceedings
    ·         Expert panel defense counsel
    ·         Prior acts coverage available
    ·         Expeditious Quotation and Underwriting process
    Please contact Gerry Gilbert for questions and to secure a quote for this coverage. Gerry can be reached by telephone at 205-414-6184 or by email at gerry_gilbert@ajg.com.  
  • What You Should Know for the 2015-2016 Influenza Season

    Wednesday November 18, 2015

    The link below contains information from the CDC that you should know about the 2015-2016 influenza season.     

    http://www.cdc.gov/flu/about/season/flu-season-2015-2016.htm

  • Active Shooter/Workplace Violence

    Friday August 12, 2016

    With the recent shooting tragedies in healthcare facilities, businesses, schools, etc., it is apparent that no facility/business is immune to these acts of violence.  These tragedies should be an alert for all businesses to evaluate current policies, practices and drills in order to prepare staff on how to respond in these potential situations that place residents and staff at risk.  Attached please find sample resources relating to Active Shooter policies, Workplace Violence policies, and a resource published by FEMA, HHS, US Department of Homeland Security, and the Assistant Secretary for Preparedness and Response.  Please feel free to utilize these tools as you evaluate your current procedures.  

    Active Shooter Policy-AJG 2015

    Active-shooter-planning-eop2014

    Workplace Violence Policy-AJG 2014

  • Winter Weather Preparedness

    Friday December 4, 2015

    With the winter weather season upon us it's time to review your winter weather preparedness procedures to make sure your facility is ready for winter weather. The attachment below contains a Winter Weather Preparedness presentation that was developed by Arthur J Gallagher and Agility Recovery. This information may be helpful to you when you are making sure your facility is ready for winter weather.

    Agility Winter Weather Preparedness Webcast Handouts 2015

  • Are Pregnant Employees Entitled to Light Duty?

    Friday December 11, 2015

    Probably, as a result of the Supreme Court's recent decision in Young v. UPS.

    Many employers have had a long-standing policy or practice of providing temporary light duty only to employees who are returning to work from an on-the-job injury. "Light duty" is typically a job or project that is specially created to help an injured worker that would otherwise not exist. Limiting these special assignments to workers who get hurt at work makes sense. Employers feel an obligation to their employees that get hurt at work, and employers have a financial interest in these employees coming back to work as soon as possible. Also, most employers have limited light duty opportunities and, therefore, want to preserve them for employees who are recovering from work-related accidents. Someone with a condition unrelated to the job, such as injuries from a car accident or pregnancy, does not get light duty under the typical policy. If the employee with a non-occupational injury cannot do the essential functions of the job, even with accommodation, he must go on leave of absence.

    That is what happened to the pregnant UPS driver in Young v. UPS. Her doctor put her on a lifting restriction that prevented her from lifting some UPS packages. Although it would have allowed someone injured at work with the same lifting restriction to perform light duty, Young had to go on unpaid leave and could not afford to keep her health insurance.

    Ultimately, the United States Supreme Court rejected both parties' positions and created a new standard for judging the legality of such policies. If a company's policy "significantly burdens" pregnant workers (as most light duty policies do), the company must advance "sufficiently strong" reasons to justify the burden. Cost and inconvenience are not sufficient, the Court said. The Supreme Court sent the case back to the lower court for further litigation under this new standard. Given what the Court has required that it prove, however, UPS is not likely to be able to successfully defend its policy.

    Policies like UPS's, which are common, will now be very difficult, if not impossible, to defend. Even if such a policy can be successfully defended, an employer will spend a lot of money doing it. In our opinion, an employer would have to have substantial operational reasons, apart from cost and inconvenience, to limit light duty opportunities to only those who have been hurt at work and to the exclusion of pregnant workers. All employers should review their policies and consult with counsel about the ability to defend them after this important change in the law.

    Click on the link to read the Young v. UPS U.S. Supreme Court decision.

    http://www.supremecourt.gov/opinions/14pdf/12-1226_k5fl.pdf

     

  • Electronic Submission of Staffing Data through the Payroll-Based Journal (BPJ) will soon be mandatory:

    Monday December 14, 2015

    CMS has allowed nursing homes to voluntarily submit staffing and census data through the PBJ system since October 1, 2015.  As of July 1, 2016, collecting this staffing and census data will be mandatory for all nursing homes.  Section 6106 of the Affordable Care Act (ACA) requires facilities to electronically submit direct care staffing information (including agency and contract staff) based on payroll and other auditable data.  The data, when combined with census information , can be used to not only report on the level of staff in each nursing home, but also to report on employee turnover and tenure, which can impact the quality of care delivered.  (Resource: www.CMS.gov )

    For registration and training, please refer to the attached PDF.