Regional News in Review - May 2015

Accessible home search difficult

Tanesha Johnson is 28 years old and has lived in a Minneapolis nursing home since July 2014. She’d like to be reunited with her young children but cannot find accessible, affordable housing.

Johnson is paralyzed from the chest down and uses a wheelchair. She was shot and injured by a man she barely knew, after she told him that someone had stolen from him. He is serving a prison sentence.

After months of hospitalization and rehabilitation at Courage Kenny Rehabilitation Institute to learn new skills, Johnson was cleared to go home. But her old garden-level apartment has steps and she couldn’t return there.

Johnson’s two young children lived with her mother in a one-bedroom apartment, in an adults-only building. That was supposed to be temporary, as was the nursing home stay. But it took a long time to find a home for the family. Johnson said her experience was frustrating.

“Inside of these institutions, they want to push you to group homes,” Johnson said, recalling her conversation with one local housing non-profit. “I still want to be there for my kids. I still want to, that’s my family. I want to reunite my family.’ They just can’t understand that,” she told Minnesota Public Radio. With the help of her social worker, Johnson applied to 30 places: subsidized and market rate, non profits and public housing with years’ long waiting lists. Desperate, she signed a six-month lease for a two-bedroom market-rate apartment in Brooklyn Center.

After she pays her $929 monthly rent, she has $121 left over. After living in the nursing home for eight months without her kids, anything was worth it. She is hoping to get into a less expensive apartment in the future and is still on a number of waiting lists.

“This is just a very heartbreaking story about what has happened to her,” said Alex Bartolic, director for disability services at the Minnesota Department of Human Services. “That is not what we want to have happen in this state.” A proposal at the Minnesota Legislature would create housing assistance for people living in institutions and group homes so they can spend it where they wish to live. (Source: Minnesota Public Radio)

 

 

 

State steps up enforcement

After years of criticism that it is soft on fraud, the Minnesota Department of Human Services (DHS) has stepped up efforts to combat illegal over-billing in the state’s publicly funded health insurance program. The agency more than doubled its recoveries last year from health care providers who billed for services not rendered and other improper billing practices. Recoveries from fraud and over-payments totaled $3.9 million last year, up from $1.8 million in 2013, according to recent DHS data.

The surge in recoveries reflects a broader shift at DHS, toward increased oversight of doctors, pharmacies, home caregivers and others that bill the state-federal Medicaid program for services delivered to more than 1 million poor and disabled Minnesotans. For years, the agency has been chided for lax supervision, particularly in cases where elderly and disabled people receive care at home.

Because of Medicaid’s massive size — it is the biggest program in Minnesota government, with outlays of nearly $9 billion last year — even modest recoveries can add up to large sums.

The DHS Office of Inspector General has undertaken the broadest expansion of its powers since being created four years ago. The office has doubled the size of its fraud investigative unit, from seven to 14 staff; launched an intensive effort to conduct hundreds of unannounced, on-site screenings of Medicaid providers and has initiated fingerprint background checks on tens of thousands of health care and social service workers statewide.

The office is on pace this year to refer a record number of Medicaid fraud cases, more than 110, to the state attorney general’s office for possible prosecution. “We are trying to hit on all cylinders,” said DHS Inspector General Jerry Kerber. “It’s a recognition that more ought to be done to [check on providers] before we start shipping out boatloads of money.”

The increased surveillance, however, has revealed a disturbing level of fraud and abuse within the insurance program, known in Minnesota as Medical Assistance. Of roughly 250 on-site screening visits completed this year, the agency has found enough cause for suspicion to refer 67 providers — or 27 percent of those screened — to the agency’s fraud investigative unit. Some of the providers were home care agencies that lacked basic records for services rendered.

Several influential state lawmakers, said the findings show that Minnesota still needs to spend more at the front end to screen out unscrupulous providers. In 2013, Minnesota ranked last among states in antifraud outlays as a percentage of total Medicaid spending, according to federal officials. (Source: Star Tribune)

 

 

Duluth woman sentenced for fraud

The owner of two home care agencies in Duluth, who was convicted of health care fraud in February, was sentenced April 22 in St. Louis County District Court to five years’ of probation and ordered to pay restitution to the Minnesota Department of Human Services (DHS). Lisa Marie Huffman was charged with billing for qualified professional services that were not provided and billing for personal care assistant services that were not properly supervised totaling $164,234. The improper billing occurred between July 3 and December 18, 2012. Huffman can be discharged from probation after one year if she meets all conditions, including repaying restitution in full. A restitution hearing is scheduled for early June.

Huffman owns Peace of Mind Health Services Inc. and PCA Services North in Duluth. DHS Inspector General Jerry Kerber described Huffman’s actions as putting vulnerable Medical Assistance clients at risk. “The defendant’s activities impact a number of people, from clients who are put at risk, to taxpayers whose money is obtained fraudulently,” Kerber said.

“The department is rigorously pursuing every fraud tip we receive. This case should put providers on notice that we are committed to putting an end to this misuse of health care dollars that should rightfully go to Minnesota’s neediest individuals.”

DHS was first notified about the provider’s possible fraudulent activity after two Medical Assistance recipients transferred to another provider. DHS Surveillance and Integrity Review Section (SIRS) staff initiated an investigation in the fall of 2012 and referred the case to the Minnesota Attorney General’s Office in February 2013. On May 3, 2013, SIRS ordered MA payments to stop for both home care agencies (Source: Minnesota DHS)

 

 

Student working to change signs

A high school student is leading the fight to update the wording of accessibility signs. Champlin resident Hope Hoffman was born with spina bifida and uses leg braces to walk. Hoffman was disturbed when a Target building put the word “handicapped” on signs for parking spaces. She wrote Target officials but never heard back.

So Hoffman channeled her frustration by drafting a piece of state legislation. It would require that the words “handicapped” and “disabled” and “disability” be eliminated from signs for parking stalls, building entrances and restroom doors. The word “accessible” would replace those words on the signage.

The message is that words matter.

“Not everyone who uses those entrances has a disability,” Hoffman told a KARE-11 reporter. “Women who are pregnant, the elderly, a lot of people recovering from injuries. Those words are very marginalizing and we need to refer to people first.” Hope Hoffman’s father, Sen. John Hoffman (DFL-Champlin), is carrying the bill in the Senate. Her aunt, Rep. Yvonne Selcer (DFL-Minnetonka), is author of the House version.

“This word ‘disabled’ is synonymous with broken down, incapable and powerless. I was born with spina bifida, and I’m none of those adjectives,” Hoffman told members of the Senate State Government Committee last month. “Handicap references a time in old England when veterans would come back from war with disabilities. Being denied employment, they were forced to beg on the streets for money with a ‘cap handy’ in their hands — cap in hand.”

The measure would also require the term “accessible” be used as a substitute for those words in digital media for government agencies. (Source: KARE-11 News)