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Tiffany Cunningham, 26, was indicted by a Lubbock County grand jury in September and charged with two counts of assault, allegedly for slapping Alzheimer’s residents in January. Lubbock County Sheriff’s Office deputies assisted the Attorney General’s officers in making the arrest Thursday at Cunningham’s place of employment in Brownfield. (emphasis added)

Obviously, at the time of the arrest, Ms. Cunningham was no longer working at the facility where the alleged abuse took place. Was it really fair to her new employer to arrest her at that location.? In fact, why make arrests with guns on hip in a place where elderly and vulnerable people reside?

Didn’t these “Attorney General’s officers” have her home address? If this isn’t grandstanding, I don’t know what is.

I have two news items to share this morning.

Regarding the Star+Plus Program, long term care providers with limited but relevant information about a client (Client Name, Social Security Number, Client Number, Date of Birth) can submit a Medcaid Eligibility Service Authorization Verification (MESAV), and Managed Care information will be available, effective November 4, 2005.

As long as Managed Care information on a client (with valid information) exists, MESAV will return Medicaid and Managed Care information (PDF copy of provider letter).

In Medicare news, a new finding about stent surgery may encourage Medicare to expand coverage for the procedure. According to a report released last week, doctors with limited experience can successfully perform surgery to open carotid arteries. From the New York Times (free registration required):

The federal government has estimated that as many as 200,000 Americans undergo carotid-clearing surgery each year. Regulators approved marketing the stents to a high-risk group that could include as many as 25 percent of those people, but Medicare is covering fewer than 10 percent of them.

Last Wednesday, President George W. Bush approved a Medicaid plan for Florida that will shift from the traditional “defined benefit” plan to a “defined contribution” plan, allowing the state to set a ceiling on spending for each recipient. From the New York Times (free registration required):

Joan C. Alker, a senior researcher at the Health Policy Institute of Georgetown University, said: “Florida’s proposal is one of the most far-reaching and radical proposals we’ve seen to restructure Medicaid. The federal government and the states now decide which benefits people get. Under the Florida plan, many of those decisions will be made by private health plans, out of public view.”

Vernon K. Smith, a former Medicaid director in Michigan who is now a consultant to many states, said: “Florida’s program is groundbreaking. Every other state will be watching Florida’s experience. South Carolina has developed a similar proposal. Georgia and Kentucky are waiting in the wings.”

Will states like Texas, New Mexico, Oklahoma, and Nevada follow suit? What are the implications for long term care providers if states are allowed to shift Medicaid plans from “defined benefit” to “defined contribution?” Garlo Ward is committed to analyzing legal issues affecting long term care providers, so stay tuned for updates.

Sounds like an ominous title for a documentary, doesn’t it? In many ways, it could be.

All providers must follow the prescribed reporting guidelines when reporting “unusual incidents” associated with Hurricane Rita to the Consumer Rights and Services Division by calling 1-800-458-9858 (see PDF copy of provider letter). The reasons go without saying, but just in case:

• Proper reporting will assist in studying the effects of the hurricane on long term care providers and patients.
• The information will be useful in creating more effective disaster management plans.

Long term care providers should report abuse, neglect, exploitation, deaths (even “natural causes” deaths and those “directly and indirectly attributed” to Rita-related events) in cases involving “unusual circumstances.” Specifically regarding deaths:

Providers should report all resident deaths (even those deemed to be due to “natural causes” and chronic or terminal medical conditions) which could be either directly or indirectly attributed to Hurricane Rita-related events, such as stressful environmental conditions, fatigue, anxiety, unavailability of needed medical care, insufficient medical history information, or insufficient water, food or medication.

Providers should also report missing residents and “drug diversions.”

Providers are bracing themselves for another hurricane and more tough decisions. Nursing homes are faced with whether to evacuate patients, some connected to feeding tubes and oxygen tanks, or ride out Hurricane Wilma in place. From the Washington Post:

The decision to stay or flee in the event of a hurricane can be difficult even for the able-bodied. But as the evacuations for hurricanes Katrina and Rita showed this year, the decisions made at nursing homes more likely could be a matter of life and death. Several nursing home patients died in Louisiana because they were not evacuated before Katrina hit, and in one case the owners of a home were charged with negligent homicide. On the other hand, several nursing home patients perished because they were evacuated; they died in transit.

In the aftermath of Hurricane Katrina, Senator Chuck Grassley asked the Office of Inspector General of the U.S. Department of Health and Human Services to investigate nursing home deaths last month. I blogged about it here. No doubt deaths resulting from Hurricane Wilma will spark more investigations.

Hurricane Wilma struck the Florida mainland this morning.

Starting in January 2006, Medicare will begin offering coverage for prescription drugs, and attempts to defraud the system have already begun.

According to the National Consumers League, “con artists” are taking advantage of the plan’s choice provision.

“Choice can be a very good thing, but crooks are always looking to take advantage of opportunities and might pretend to be from the government or legitimate companies to trick people into handing over their money or personal information,” said Susan Grant, National Consumers League Vice President and Director of the National Fraud Information Center. “But there are ways to determine if you’re looking at a real deal; to start with we always advise people to be extremely careful about giving out their Social Security and bank account numbers.”

The Centers for Medicare and Medicaid Services (CMS) is helping consumers fight back (see PDF copy of provider letter). Along with offering common sense advice for beneficiaries, CMS is working with Medicare Rx Integrity Contractors who will help find waste, fraud, and abuse in the new prescription drug program.

Consumers will need to be on alert for phony drug plans, but the best and most practical way to prevent fraud is in their hands: Don’t provide personal information until you’re sure the person or plan is Medicare-approved.