SMQT- Fraud & Abuse
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https://quizlet.com/_821kxr
1. ABUSE PROHIBITION REVIEW: Description: The Abuse Prohibition Review
is a determination of whether the facility has both DEVELOPED &
OPERATIONAL- IZED policies and procedures designed to protect residents from
the following:
- Abuse
- Neglect
- Involuntary seclusion
- Misappropriation of their property
This includes policies and procedures for:
- Hiring practices
- Training
- Ongoing supervision for employees and volunteers who provide services
- Reporting and investigation of allegations and occurrences that may indicate abus
2. ABUSE PROHIBITION REVIEW: General Procedures: General Procedures:
The review includes components of the facility's policies and procedures as con-
tained in the Guidance to Surveyors. These include policies and procedures for:
- Screening of potential hirees (or employees)
- Training of employees (both for new employees and ongoing training for all
employ- ees)
- Prevention policies and procedures
- Identification of possible incidents or allegations that need (or require) investigation
- Investigation of incidents and allegations
- Protection of residents during investigations
- Reporting of incidents, investigations, and facility response to their investigations
, SMQT- Fraud & Abuse
Study online at
https://quizlet.com/_821kxr
- The general procedure for the Abuse Prohibition Review is to use/follow the
Abuse Prohibition Investigative Protocol to complete the task.
3. QUIZ QUESTION:
What is the general objective of the Abuse Prohibition Review?: ANSWER:
The general objective of the Abuse Prohibition Review is to determine if the facility
has BOTH developed & operationalized policies & procedures that PROHIBIT
1) abuse
2) neglect
3) involuntary seclusion
4) misappropriation of property for all residents.
4. Investigative Protocol for Abuse Prohibition: The investigative protocol
for abuse prohibition is to be used in EVERY long term care standard survey.
This protocol requires your team to perform certain procedures. They are as follow
- Obtain and review policies and procedures
- Interview the responsible individual(s)
- Request written evidence
- Interview several residents and families
- Interview at least FIVE direct care staff persons
- Interview at least THREE front line supervisors
- Obtain a list of recently hired employees
5. Investigative Protocol for Abuse Prohibition
1) Obtain & Review Policies & Procedures: - Obtain and review the facility's
abuse prohibition policies and procedures.
- Determine if the policies and procedures include these key components:
- Screening
- Training
- Prevention
- Identification
, SMQT- Fraud & Abuse
Study online at
https://quizlet.com/_821kxr
- Investigation
- Protection
- Reporting/response
- Note that it is not necessary for these items to be collected in one document or
manual.
- In other words, you may have to obtain and review multiple documents to find
all of the key components.
6. Investigative Protocol for Abuse Prohibition:
2) Interview the Responsible Individual(s): Interview the individual(s) identified
by the facility as responsible for coordinating the policies and procedures that
prohibit abuse, neglect, involuntary seclusion, and misappropriation.
The individual(s) identified should be responsible for evaluating how each compo-
nent of the policies and procedures is operationalized.
The components include screening, training, prevention, etc. as specified in F226.
You will need to conduct interviews of such individuals if it is not obvious from the
policies how each component is operationalized.
7. INTERVIEW QUESTIONS:: INTERVIEW QUESTIONS:
- During your interview of the individual(s) responsible for evaluating how each
com- ponent of the facility's abuse prohibition policies and procedures are
operationalized, ask the following questions:
1) How do you monitor the staff when they are providing and/or supervising the
delivery of resident care and services to make sure care is provided in a way
to ensure neglect of care does not occur?
2) How do you determine which injuries of unknown origin should be
investigated as alleged occurrences of abuse?
3) How are you ensuring that residents, families, and staff feel free to
communicate concerns without fear of reprisal?
8. Investigative Protocol for Abuse Prohibition:
Study online at
https://quizlet.com/_821kxr
1. ABUSE PROHIBITION REVIEW: Description: The Abuse Prohibition Review
is a determination of whether the facility has both DEVELOPED &
OPERATIONAL- IZED policies and procedures designed to protect residents from
the following:
- Abuse
- Neglect
- Involuntary seclusion
- Misappropriation of their property
This includes policies and procedures for:
- Hiring practices
- Training
- Ongoing supervision for employees and volunteers who provide services
- Reporting and investigation of allegations and occurrences that may indicate abus
2. ABUSE PROHIBITION REVIEW: General Procedures: General Procedures:
The review includes components of the facility's policies and procedures as con-
tained in the Guidance to Surveyors. These include policies and procedures for:
- Screening of potential hirees (or employees)
- Training of employees (both for new employees and ongoing training for all
employ- ees)
- Prevention policies and procedures
- Identification of possible incidents or allegations that need (or require) investigation
- Investigation of incidents and allegations
- Protection of residents during investigations
- Reporting of incidents, investigations, and facility response to their investigations
, SMQT- Fraud & Abuse
Study online at
https://quizlet.com/_821kxr
- The general procedure for the Abuse Prohibition Review is to use/follow the
Abuse Prohibition Investigative Protocol to complete the task.
3. QUIZ QUESTION:
What is the general objective of the Abuse Prohibition Review?: ANSWER:
The general objective of the Abuse Prohibition Review is to determine if the facility
has BOTH developed & operationalized policies & procedures that PROHIBIT
1) abuse
2) neglect
3) involuntary seclusion
4) misappropriation of property for all residents.
4. Investigative Protocol for Abuse Prohibition: The investigative protocol
for abuse prohibition is to be used in EVERY long term care standard survey.
This protocol requires your team to perform certain procedures. They are as follow
- Obtain and review policies and procedures
- Interview the responsible individual(s)
- Request written evidence
- Interview several residents and families
- Interview at least FIVE direct care staff persons
- Interview at least THREE front line supervisors
- Obtain a list of recently hired employees
5. Investigative Protocol for Abuse Prohibition
1) Obtain & Review Policies & Procedures: - Obtain and review the facility's
abuse prohibition policies and procedures.
- Determine if the policies and procedures include these key components:
- Screening
- Training
- Prevention
- Identification
, SMQT- Fraud & Abuse
Study online at
https://quizlet.com/_821kxr
- Investigation
- Protection
- Reporting/response
- Note that it is not necessary for these items to be collected in one document or
manual.
- In other words, you may have to obtain and review multiple documents to find
all of the key components.
6. Investigative Protocol for Abuse Prohibition:
2) Interview the Responsible Individual(s): Interview the individual(s) identified
by the facility as responsible for coordinating the policies and procedures that
prohibit abuse, neglect, involuntary seclusion, and misappropriation.
The individual(s) identified should be responsible for evaluating how each compo-
nent of the policies and procedures is operationalized.
The components include screening, training, prevention, etc. as specified in F226.
You will need to conduct interviews of such individuals if it is not obvious from the
policies how each component is operationalized.
7. INTERVIEW QUESTIONS:: INTERVIEW QUESTIONS:
- During your interview of the individual(s) responsible for evaluating how each
com- ponent of the facility's abuse prohibition policies and procedures are
operationalized, ask the following questions:
1) How do you monitor the staff when they are providing and/or supervising the
delivery of resident care and services to make sure care is provided in a way
to ensure neglect of care does not occur?
2) How do you determine which injuries of unknown origin should be
investigated as alleged occurrences of abuse?
3) How are you ensuring that residents, families, and staff feel free to
communicate concerns without fear of reprisal?
8. Investigative Protocol for Abuse Prohibition:
