Kimberly Noble - Agency for Health Care Administration - MyFlorida ...

After-Action Report
Tampa ALF/Assistive Care Services Initiative
March 12-15, 2013
Initiative: ALF/Assistive Care Services Initiative. Twenty-nine (29) facilities were visited.
Contact for Initiative: Penny Taylor, Program Administrator, Medicaid Program Integrity, Tampa Field
Office, Phone: 813-350-4847, Penny.Taylor@ahca.myflorida.com
Date: March 12 – 15, 2013
Location: Tampa, Florida
Initiative Participants: The Initiative consisted of five teams which included staff from AHCA’s Office of
Inspector General/Medicaid Program Integrity, AHCA’s Division of Health
Quality Assurance and representatives from the Centers for Medicare and
Medicaid “Medicaid Integrity Group”.
Purpose:
To determine if Assistive Care Services providers are rendering, billing and documenting
services in accordance with Medicaid policy;
To ensure that the homes with provider numbers are not “sharing” the number with other
homes who do not have Medicaid provider numbers;
To verify that all enrollment information on the FLMMIS system is correct;
To determine if Assistive Care Services are being rendered by staff that have been
successfully background screened;
To ensure that the provider, staff, each relief person, and all adult household members
have submitted a statement from a licensed health care provider that he or she is free
from apparent signs and symptoms of communicable diseases, including tuberculosis;
To ensure that annual TB updates have been received by the provider;
To ensure the health and safety of the residents residing in these facilities;
To ensure that the residents with services billed to Medicaid are currently residing in the
licensed facility billing Medicaid; and
To make appropriate referrals to other entities as needed or required.
The pre-initiative training included:
Pertinent information from the provider files was compiled for each of the teams,
including all known provider numbers, claims billed during the identified timeframe,
number of Medicaid residents in the home, etc.
Identifying the referral process between AHCA MPI and AHCA HQA to avoid duplicative
work by both bureaus, yet enabling the combining and tracking of all findings;
Discuss any questions or concerns about the initiative, including questions related to
statutes or handbooks;
Phone conferences with MPI and CMS/MIG to discuss initiative details;
A contact list enabling teams members to contact the appropriate person with additional
questions.
Tampa ALF/Assistive Care Services Initiative
March 12 – 15, 2013 Page 1 of 3

The teams met every morning beginning on March 12, in the designated command center to go over
files, turn in files and reports, and to address any questions or concerns arising during the initiative.
Penny Taylor coordinated the findings that may impact follow-up visits, pending documentation and
possible sanctions. Anne Avery coordinated the findings for AHCA’s Bureau of Health Quality Assurance.
Kimberly Noble coordinated the findings for specific non-compliance issues and communicating with the
Agency’s Management team and the Communications office. Penny Taylor, Anne Avery and Kimberly
Noble managed the command center and were available to assist with confirming documentation,
calling other agencies, checking on background screenings when computer access was needed and any
other situation as needed. The command center had many people from various agencies, including law
enforcement, on alert to assist as necessary.
The following compliance issues were documented by Medicaid Program Integrity:
Background
Screening
TB
Current
Communicable
Disease Statement
Service
Plans
Service
Logs
Health
Assessment
(1823/ 1023)
Certification of Medical
Necessity
13 34 22 107 52 20 113
The following issues were encountered by Health Quality Assurance staff:
Provider Name Citations
A 30 smoke detectors, A55 OTC meds unsecured, A77 no core, A79
HYDE PARK ASSISTED LIVING
staffing pattern A93 menus posting, A52 physical plant
TORIA'S SUPPORT CARE SERVICES, INC A 08 1823,A 78TB CD,A 52 insulin syringe
CASA LORETO ASSISTED LIVING FACILITY A 78 Communicable DZ, A 26 activities,
SHARON M BUTLER
A 30 RR for staff sleeping in common areas, A 93 Menu, A 79 staffing
schedule, A 161 Communicable DZ, A 162 Resident records
TRACY BURR A 78 TB,CD
MAGALY VALDESPINO, INC A 78 Communicable DZ, A 815 BGS, A 30 bedrails
YETEY ENTERPRISES INC A 008-1823
YETUNDE ADEGBOLA 3 without TB and 1 without Communicable A 78
CASTLE COURT ALF,INC
A 008 falsification of 1823's A 52 improper procedure for selfassistance,
A AZ 815 BGS055 storage of meds, A 93 meal pattern off
for timing, A 0161 staff records-CD and fraudulent,
ADRIANNE WILSON A 55 storage, A 152 physical plant-door knobs
ROCKY CREEK RETIREMENT PROPERTIES AE
A 30 RR for privacy, A 55 unsecured room meds, A 161 lack of CD
SHADY OAKS LIVING CENTER, INC. statement
MICHELINE LYNCEE A 008- incomplete 1823
PHOEBE WILLIAMS F 401 TB, F 609 No background
SONYA WILLIAMS F1101 physical plant
Concerns about LNS services related to oxygen-emailed Sally Leonard
SENIOR HEALTH TLTC LLC
and both recommend an LNS monitoring visit
AZ 815 for BGS 3 employees, A 152 Physical plant, A 78
HOME FORCE GROUP, INC
Communicable DZ and TB
EMMA KELLY F 401 TB and CD, F 612 BGS, F 203 Health assessments
ELIANNE D JEROME F 203 Health Assessment, F 401 TB,F 1101
THE HERTIAGE ALF, INC possible complaint with AHCA unlicensed activity
Tampa ALF/Assistive Care Services Initiative
March 12 – 15, 2013 Page 2 of 3

Lessons Learned: No unexpected or emergency findings were encountered during this
initiative. Because the Agency’s Inspector General had alerted the trade
associations of pending initiatives, many facilities were expecting the
Agency staff. However, the advance notice did not result in 100%
compliance to licensing and Medicaid laws, rules and policy. It was
recommended that the folders be given to the teams earlier than the
morning of the site visit in order for them to acquaint themselves with
the files and the facility. This will be done for future initiatives.
Tampa ALF/Assistive Care Services Initiative
March 12 – 15, 2013 Page 3 of 3