Resources

Gordon & Rees: Knicole C. Emanuel, Regulatory Compliance Litigator

North Carolina Department of Health and Human Services

North Carolina Office of Administrative Hearings

North Carolina Division of Medical Assistance

Centers for Medicare and Medicaid Services

Disability Rights of North Carolina

  1. Hi Knicole, I sent you an em ail regarding a few questions I have concerning an upcoming case the county has against my wife and myself. I apologise beforehand for it’s length.

  2. OMG!! I just found your site I love IT. I am a In Home Care Agency very very small due to 2009 and 2010 CCME. I am still hanging in there but ready to close my doors. People do not know or understand what is real and what is fake with in home care companies. First of all we only make around $15.00 an hour for our services. How are we suppose to get good CNA’s with such little money. The people we service is already on pub. assistance. It’s no way they can pay a co-payment or any other payment for care. So I pay my girls $8.00 down to $7.25. Wow!! who would sign up for that job of course. People that should not be hired period! So you make a deal with the devil just to get by. But what are we to do. Most of us owe the IRS because we all took a hit in 2009 and 2010. Its always the question of who to pay the IRS or the staff. Well if you don’t pay your taxes you woun’t have a business because IRS will close your company and take all moneies in your bank accounts they can find. They will also contact HP Enterprise and have them reroute your money stright to them. If you don’t pay your staff they will and I mean WILL call NCLABOR and you will be order to pay the staff or else. So now you have RN’s to at $35 – $45.00 and hour or visit. Then you have to pay rent for office spave 595.00, lights 75.00 and office phone $175.00 for 13 employees around $1700.00 per mo. for taxes. Accountant $300.00 per mo. Billing agency 200.00 and Supplies you gotta learn to use everything as many times as you can. All with $3.88 per 15 mins in a home. For a 3 hour a day client the agency will be paid $46.56 a day. So to pay the aide $8.00 an hour that is $24.00 that leaves a whole $22.56 x 5 days a week is $112.80 a week. Then try very hard to pay all of the above. I am sick of it. I have been in business for 8 years and I have seen good times and bad times. CCME PCG and who ever else with the fancy parties at the end of the year and the high paid fake RN’s are a joke. It’s sick and it leave the good agencies broke and defeated. But the bad agencies are living the good life.

    https://medicaidlawnc.wordpress.com/category/uncategorized/

  3. Nancy, Well said. Thank you for reading my blog. We have gathered a group of health care providers to bring a lawsuit for monetary damages against the state. If you are interested, contact me. It sounds like you have been through a lot too.

  4. Laverne Fesperman, MSW, LCSW

    Are there any instructions anywhere how to do a Medicaid self audit?

    • That’s a great question. I am not sure. Let me look into it.

      Until then, I’d recommend picking some random files from multiple different staff and analyze the documentation. Use the DMA Clinical Policy and determine whether all documents are compliant. Also, check the billing codes that were billed and compare those codes to the service notes. Check the units billed and compare to the service notes.

      Once you get through a percentage of your files, you will know whether you need to dive in deeper or whether you are compliant.

      You can also hire an independent contractor to come in and perform the audit. But if you go that route, please make sure the person you hire has the qualifications.

  5. THANK YOU!

  6. Hi Kemanuel – NCDHHS where holding weekly PCS Stockholder meetings by internet each Thursday now they have moved them to monthly and in person. The next meeting is this Thursday 10/24/13 from 1:00 – 2:30. I am 3 hours away. Can you send someone to listen in on what is going on? This is kinda shaddy sense most of the providers cannot justify 3 -4 hours driving for 1 1/2 meeting then 3-4 hours drive back.

  7. Latrina Winford, LPCS

    Hi, Love the blog. I am a smaller CABHA provider with clinicians who specialize in trauma therapy for children and adolescent sex offender treatment. We also provide treatment for very young children 3-6. We are contracted to provide IIH for this contract year. We have never had any adverse actions, financially stable, we utilize Evidence Based Practices that we are certified to provide and as a result we have a high percentage of success. In addition, we provide more outpatient care and medication management because this is best practice. Through an RFP process we were denied a continuation of those services with Center Point to the larger, established agencies, some of which I know have less than good track records. There has always been a buddy system or favoritism process here that obviously disregards quality of care and those who are not represented on boards or committees. It is discouraging when you put your all into your clients and there seems to be no real consideration for a fair process with the families in mind. However, the referrals are coming in for the pre-k’s and unfortunately very soon we may have to turn them away to less qualified providers. My fear is that we will have the same problem of children not getting better and being shifted through care. I don’t know when we will start investing in health and wellness rather than agendas.

  8. Latrina Winford, LPCS

    Everything I have read on your blog resonates with me and it is so sad that the cycle continues. Yes, we were sent an email thanking us for submitting the RFP but we were “unfortunately not selected”. I feel like fighting it because the service we provide to the community is important and we have invested in ourselves to provide quality care to those who are suffering the most. We care about our families and chose the toughest issues to address because we identified an unmet need years ago. If it is not valued by the management organizations than who will, other than the people who don’t have a voice. Some clients prefer smaller, more intimate agencies and we strive to eliminate the mental health stigma.

    We have substance abuse and mental health licensures and experience, we are certified in TFCBT and EMDR as well as other EB treatments. We are trained and receive ongoing training/consultation from a nationally recognized expert in sex offender treatment and are clinical supervisors in MH and SA. We are the gatekeepers within our profession and offer our clinical expertise to Master Level students but now are left to practice without the option of a continuum of care. We are clinically sound in providing mental health and substance abuse services to this high risk population, many of whom struggle with meeting basic needs. Outpatient therapy has been our foundation. MCO’s claim they want to save money but offer a contract to an agency that does not have adequate outpatient services so we are expected to support them when clients step down or do not qualify for the service. It baffles me but politics come before treatment here. Is there any recourse? Our current contract for IIH ends on 1/31/14. My hesitation is that I don’t know our rights related to this matter as an agency and the RFP itself stated that there is no appeal process.

  9. Latrina Winford, LPCS

    How do I fight it?

  10. I have a 6-year old relative whose Medicaid was recently terminated because of his mother’s tax return. She made $7000 last year. The child was in the process of being evalauted for autism or other learning disabilities and now she is liable for all the expenses. That does not sound right to me. Has the law changed that much>

    • Even if the child is no longer eligible for Medicaid, there are other health care programs that would be applicable. See my blog on Health Choice.

  11. Can you tell me where we can find an independent contractor to check to make sure our company is compliant in all areas?

    • Not sure what type of services you provide, but if you are talking about regulatory compliance you could either hire an attorney to review your documents or a consultant. Email me your type of services and I can give you some suggestions.

  12. The residential provider that I work has just completed a post payment review with Alliance. According to Alliance they now have a payback issues. The provider has followed the reconsideration process as outlined by Alliance but to no avail. The provide has asked for a OAH hearing but according to Alliance this is not an option as stated in their contract. Is this legal ?

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: