RUG Reviews: Signing Documents Provided by the Reviewers
During the exit interview of a RUG review, you will be asked to sign and initial documents. It is very important that you understand what you are initialing or signing. Carefully review the document that you are asked to sign and ask questions if you don’t understand it before you sign or initial. These documents create a record that may become relevant in a Reconsideration or Appeal.
Let us discuss the details by first reviewing the pertinent regulation. The regulations require that you sign a records affidavit “for each MDS assessment for which copies of clinical record documentation are provided to the nurse reviewer, attesting that the facility used its best efforts to obtain all relevant records, and that the documentation provided to the HHSC-OIG nurse reviewer is as complete a compilation as was possible during the onsite review.” The purpose of this seems to be to authenticate the clinical record underlying the MDS assessment and to tie you down to a statement that you made your best efforts to obtain all relevant records. The significance of tying you down to a statement that you made your best efforts, could be that the OIG will later try to undermine your credibility if you provide additional documents outside the onsite review or during a Reconsideration.
If you believe that you were prevented from putting forth your best efforts to provide complete documents, you should not sign any such affidavit. Instead, consult your attorney as the regulations allow you to provide an explanatory statement in lieu of signing the affidavit. Let your attorney guide you in the decision and in preparing the statement.
However, the records affidavit we have seen provided by the reviewers does not seem consistent with the regulations. See below.
The above appears to refer only to an client records inventory created by the reviewers, not clinical records. The ones we have seen specify only 1 or 2 pages of inventory and claim that those pages are made by the nursing home in the course of business, which is not true. If you are asked to sign an affidavit which claims things which are not true, call your lawyer for guidance during the process
Moreover, there is no attestation that the facility used its best efforts to obtain all relevant records in the affidavit. Rather, there is an attestation which you are asked to sign that is attached to the back of the Preliminary Statement of Findings given at the exit interview. This attestation states that the provider is agreeing that staff was “given the opportunity to ask questions during the onsite review and review conference.” Do not sign the document if that is not true. Call your lawyer for guidance.
It is very important that you don’t sign documents which are not true. If you are not allowed to ask questions; if you were not given the opportunity during the onsite review to retrieve documents you would be making a false statement. Signing them could undermine later attempts to show that the OIG did not follow proper procedure and denied you due process.
Next week, we will discuss the exit interview.