|Name||Privacy Fraud Protection and Safety|
|Description||an Acumen Final video|
Welcome and congratulations on becoming an employer of record! We are pleased to be your Fiscal Agent and we look forward to working with you and your employees! This video training series presents general information to support and assist you in your role as an employer. NOTE: Always check with your Program to verify details of this information and specifics of the law as they apply to you. If you have questions, please contact us. Terms to know. Important NOTE: Self-directed services means that Participants, or their representatives if applicable, have decision-making authority over certain services and take direct responsibility to manage their services with the assistance of a system of available supports. “You” in the following descriptions is inclusive and refers to the Participant and/or designated representatives. Acumen – The Fiscal Agent that helps you manage employer-related financial and other responsibilities pertaining to your self-directed services. Authorization – Documentation that specifies approved services, service codes, and number of units, hours, or dollars for delivery of goods and services included in the Plan of Care. Case Manager – Person assigned by the Program to work with you and facilitate details of your self-directed program (a Case Manager may be known by other titles, depending on Program terminology). Employee – Person who works for you and provides services to the Participant. Employer – Person who hires and supervises staff to provide services to the Participant (the Employer may also be the Participant). Fiscal Agent – (Acumen) provides payroll processing, tax services, payments and other administrative functions authorized by the Program. Participant – Person receiving services authorized by the Program (the Participant may also be the Employer). Payment Services – Payroll Services (employee-related payments and processing); Vendor Services (vendor-related payments and processing). Plan of Care – Plan you create with your Case Manager and team to determine Participant needs and how to meet them, based on the Participant’s preferences, choices, and abilities. It assists the Participant in directing their services. It includes the number, type and duration of approved goods and services. Program Administrator – Entity that manages the Program and/or waiver funding. Welcome to the module An Overview of Privacy, Fraud Protection and Safety. As an employer, you are legally responsible to protect the privacy and safety of the Participant and your employees. This means that you will safeguard their personal information and provide a safe and secure work environment. You are also responsible to be alert to any signs of fraud or abuse and report them immediately. This module introduces terms you need to know about privacy, fraud protection, and safety. It answers frequently asked questions about these topics. Finally, it provides contact information if you need assistance or encounter problems in these areas. Questions we will answer: What are privacy laws? What personal information is considered confidential? What should I do to protect the personal information of the Participant and my employees? How does Acumen protect Participant and employee information? What is fraud and abuse and what do I do when I suspect it? How can I provide a safe work environment? What do I do if my employee is injured on the job? Let’s begin with an overview of your employer responsibilities related to your employees and the Participant. In your employer role, you must ensure employees’ privacy as you collect, submit, and maintain documentation for them that gives you access to their personal information. During employee enrollment you collect and turn in all required information so Acumen can complete the steps to clear the prospective employee to begin work for you under the Program rules. Throughout the period of employment, you maintain all employee records (in electronic or hard copy files, or a combination), including but not limited to: new hire information, time records and reports, daily logs, documentation, disciplinary actions, etc. On an ongoing basis, you will review, sign and submit employee time for payroll (either electronically or using an actual timesheet signature); comply with Department of Labor (DOL) laws; provide a safe work environment; provide adequate training for your employee(s) to perform their duties safely and avoid injury. In the course of employing staff, you collect and have access to several documents that contain personal employee Information, such as: background check results; social security number or other identification numbers; banking information; date of birth; pay rate; tax selection; personal references; and any other private records. As the employer, and because you have access to this personal information, you are responsible to keep it secure. This information is not to be shared with others except what is required for employment. In your role, you also have access to Participant Information. Privacy laws dictate that you are also responsible to take every precaution to safeguard their information. The extensive personal information you have about the Participant will likely include access to their personal health information, as well. It involves such information as: diagnosis and medical records; medical claim payments; their Program Plan of Care and Authorization information. It is essential to secure personal information. We recommend that you maintain a current file on each employee you hire, as well as a separate file to secure the Participant’s enrollment records and information. These files should contain a copy of all documentation that you submit to Acumen, including time records that have been submitted for payment, if you are working with paper-based materials. We also recommend that you note the date and time you submitted them on your copies. You must be sure to maintain the privacy of the Participant, as well as your employees, by keeping their records and any paperwork in a secure location, such as a locked file cabinet or safe. Electronic records should be maintained with password protected files following best practices for securing such information. You will have access to information about the Participant that you must not disclose except at appropriate times or in emergency situations. HIPAA and privacy laws require your compliance. HIPAA is the Health Insurance Portability and Accountability Act. It protects “individually identifiable health information” from being disclosed inappropriately. In other words, it makes it illegal to inappropriately share any information related to an individual’s health and/or healthcare claims. HIPAA regulations also provide for penalties when such information is treated carelessly, or recklessly. This information is known as PHI, or protected health information. As an employer, you will be aware of and responsible for the Participant’s PHI or protected health information. It is important that you keep this information secure and private, and only disclose information when absolutely necessary. How does Acumen protect personal information? Acumen keeps employee information secure. Acumen also complies with all applicable HIPAA and privacy laws in order to protect the Participant’s account information. When you call us, please be prepared to verify a few pieces of identifying information to confirm you are authorized to discuss the Participant’s account. Acumen also utilizes a secure email system so that information contained in email correspondence is encrypted. It can only be read by the intended recipient who will be authorized to log into the secure email. One of the primary protections privacy laws provide is to protect against identity theft. Criminals have been known to illegally obtain and use a person’s personal information in an attempt to obtain credit in the victim’s name, or for other illegal purposes. This is called identity theft. Identity theft is a federal crime, regarded as a felony offense. It is punishable by a fine, time in prison, and/or restitution to the victim. Be sure to report suspected identity theft to your local authorities as soon as you become aware of any fraudulent activity. However, identity theft is only one form of fraud. Are there other forms of fraud? Any misuse of funding is also considered fraud. This includes submitting (or billing for) time worked for services that were not provided. What if my employee fills out their own timesheets? Your employee may fill out their own timesheets or enter their time in a web-based system. But it is your responsibility as the employer to review all time entries before approving them (electronically or by signature) to make sure they are correct. By approving employee time entries in a web-based system, or by signing your employee’s timesheets, you, as the employer, confirm that the hours being submitted for payment accurately reflect services provided. WARNING: approving anything with knowledge that it is inaccurate, could be considered fraud or fiscal abuse. This has serious consequences for anyone involved. It may result in being removed from the Program, and possibly include prosecution, and/or repayment of funds. What if my employee changes their timesheet after I approve or sign it? Acumen will not pay for any services that you did not approve electronically or that are not signed by you. NOTE: you are responsible to check your Account Statements carefully. An Account Statement is documentation Acumen prepares and sends you regularly (electronically or by mail) showing the status of your program funds. It will show you what payments were made. You can check these and your available balances for accuracy. You can plan ahead with the information. The Account Statement also shows if your employee has any certifications coming due (if the Program requires). You can also check this information if you’re using a web-based time entry system by running reports. For more information, view the module, Understanding Account Statements and Pay Stubs, in this training series. How do I report fraud? If you suspect fraud, please call Acumen’s Customer Service Department immediately using the toll-free phone number Acumen assigned to you for your program, or the general number, (866) 795-7163, so we can notify the appropriate authorities. Abuse is another harmful behavior that must be avoided. Abuse comes in many forms: physical, emotional, verbal, sexual, and encompasses neglect, abandonment, financial exploitation, even self-neglect, and more. What is adult or child abuse? Abuse is described by the harmful behaviors we just listed that are detrimental to an individual. Anyone can become a victim. A Participant might suffer abuse from their caregiver, or an employee might be abused by the Participant or employer. No one should have to suffer being in an abusive environment. How do I report abuse? If you suspect abuse, neglect, or exploitation, it is your responsibility, by law, to report it to Child Welfare or Adult Protective services immediately so quick action can be taken. To report abuse call your local Adult and Child Abuse Hotline or contact your local police department immediately. Be sure to report abuse to your Program’s Case Manager, as well. Occasionally, someone, such as a neighbor or relative or others, will report a situation to Acumen. Here’s what to expect if a report is filed with Acumen. Acumen reports the information to the Program Administrator. We do not conduct the investigation ourselves. Acumen gathers basic information such as how to contact you and passes this information on to the Program Administrator. The Program may contact you for more information, so be sure to keep good records and documentation of any suspicious activity. Your Program may require you to take additional steps after they receive a critical incident report. NOTE: Acumen is not able to provide information about the status of any pending investigation. At the Program’s request, Acumen may suspend the account and temporarily stop making payments for services. Payments will resume only when the Program notifies Acumen to do so. Next, let’s discuss safety. As an employer, you are responsible for the safety of both the Participant and for providing a safe work environment for the employee. What does safety mean in your self-directed program? This means making sure your employees are properly trained to perform their duties. Employees should always THINK SAFETY! when working. They should do their best to ensure the Participant’s safety and avoid incident or injury to themselves, as well. Trainings you provide may cover a broad range of situations. Training for your employees should focus on your specific circumstances. Your state Program may also have certain requirements, so it is important to check with your Case Manager about any specific training requirements. Areas of general interest may include, but are not limited to: hand washing hygiene; proper use of personal protective equipment (PPE), such as gloves, masks, shoes, clothing, etc.; proper lift and transfer techniques, if these apply, and exercises that strengthen and help with movement. Depending on Participant’s needs and those of your employees, there are many online resources you can access that demonstrate best practices for these topics, and more. Having an emergency plan is an important safety consideration, as is training employees how to handle potentially unsafe situations. Here are some ideas for your emergency plan. Keep a first aid kit handy at all times, and make sure everyone knows where it is located. Store medications or hazardous materials in a secure location. Keep emergency contact phone numbers readily available, such as 911, doctor’s name and phone number, and nearby family members who can help in an emergency. Make a list of all current medications, dosage information, and medical conditions in case paramedics need to be called. Have a back-up or emergency employee on standby in case of accidents or injuries that may require assistance with transporting an injured worker to the doctor or possibly an emergency room, or in the event your employee calls in sick. Keep all walkways and exits clear in case you need to exit quickly and make sure any access to stairways, or an area that may have curbing is properly illuminated with lighting and/or safety tape. Make sure employees know how to handle various types of emergencies that are specific to Participant’s needs. However, in spite of your best efforts to ensure safety, an employee may have an accident or be injured on the job and you need to know what to do. With that in mind, let’s discuss Workers’ Compensation. What is Workers’ Compensation? Workers’ Compensation is a form of insurance that may be required from employers. It provides compensation and medical benefits for workers who are injured on the job. Be aware that there are exceptions. What you’ll want to know is: are my employees covered? Most programs require employers to provide Workers’ Compensation insurance. Check with your Program or Acumen to determine if it is a requirement. If coverage is mandatory, the answer is “Yes.” Your employees will automatically have Workers’ Compensation coverage. If this is the case, it is included in the employer taxes and burden that are paid out of your Authorization. This covers all your employees while they are clocked in and working for you. This is true as long as they are employed by you and for the duration of their employment with you. Let’s get back to that important question. What if my employee has an accident or is injured on the job? Here’s the answer. With any injury, you should assess the injury or situation immediately. If the injury is life-threatening, dial 911 to seek medical attention. In all other cases, if your Program is covered by Workers’ Compensation, (remember, most are), contact Acumen’s Workers’ Compensation reporting line during regular business hours (5 am to 5 pm MST, Monday-Friday) at 480-295-4922). If an incident occurs after hours, on the weekend, or a holiday, you may employee in touch with Acumen’s Workers’ Compensation get instructions on how to file a claim, if needed. You may also call the toll-free customer service number Acumen assigned to you for your Program, and you will be connected to the Workers’ Compensation representative. It is your responsibility to acquaint yourself with the procedures and important time frames for all Workers’ Compensation reporting. Let’s summarize what we talked about today. Summary – it is your legal responsibility to keep Participant and employee records and information secure. If you suspect identity theft, report it to your local police department right away. If you suspect fraud, call the toll-free customer service number Acumen assigned to you for your Program, or call Acumen’s Customer Service Department (866) 795-7163 so we can notify the appropriate authorities. If you suspect abuse, contact the local Adult and Child Abuse Hotline or your local police department, and notify your Case Manager promptly. Create an emergency plan that includes a first-aid kit that is readily accessible and everyone knows where it is; emergency phone numbers; list of Participant’s medications; clear access to exits and walkways; employee training (initial and on-going). If your employee has an accident or gets hurt on the job, assess the situation immediately. If the injury is life-threatening, call 911 to get medical attention. In all other cases, if your Program is covered by Workers’ Compensation (most are), call Acumen’s Workers’ Compensation reporting line: regular business hours (5 am to 5 pm MST, Monday-Friday, 480-295-4922. For after hours, weekend, or holiday emergencies only (866) 472-2297. You may call the toll-free customer service number Acumen assigned to you for your Program, for assistance with issues, or questions about this information, or your self-directed program. Congratulations! And thank you for completing the Acumen Employer Training module, An Overview of Privacy, Fraud Protection and Safety. We hope this module provided you with some information and ideas to help protect the people in your self-directed program! Welcome to Self-Direction. Welcome to Acumen!
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