CE Fraud: What is the cost & can it be prevented?

There will be plenty of fallout in the coming months from the continuing education fraud that occurred in Massachusetts (see cover story). The state’s Department of Public Health Office of EMS has already announced additional ethics training and greater oversight. The question going forward is: Can it happen anywhere? And if so, what’s the solution?

 

There appear to be several contributing factors for the case in Massachusetts, in particular: greed on the part of the instructors (despite the claims they were only trying to “help” their fellow medics); simple laziness or a cavalier attitude about the value of continuing education among the EMTs involved; and a breakdown in state oversight. Some would argue the EMS agencies also bear some responsibility, because they relied on outsourced education programs rather than providing quality-assured, in-house educational opportunities for their employees.

 

In addition to the legal consequences and damage to the community’s perception of EMS, there could be serious financial implications for many of the agencies involved.

 

“If these people are uncertified and the company is billing under the mandate that they have two EMTs, then you’ve got a problem,” Massachusetts Ambulance Association President Brian Connor said. “These companies may have to pay back Medicare all that money. It’s potentially millions and millions of dollars.”

 

What’s been reported in the media is probably “the tip of the iceberg,” Connor said. (The MAA represents private ambulance services in the state, several of which have or had employees caught up in the scandal.) “We traditionally have no oversight over these education companies,” he said. “This is really a byproduct of the state not going out and monitoring all these courses properly.”

 

But does Massachusetts, or any state for that matter, currently have the resources necessary to provide stringent oversight? “The way to prevent this is for the state authority to be very detailed in what they’re requesting for continuing education, and maybe even establishing some sort of master tracking document to track that,” said Kirk Schmitt, chief of the Bureau of EMS for the Iowa Department of Public Health.

 

“But the reality is that none of us have the funds or the manpower to create that sort of detail; none of the other allied health professions are doing it either, but we probably all should be.

 

“The EMS profession needs to step up and say, “˜We want to be a profession, and we’ll fund it.'”

 

The MAA believes one solution is to simply increase the frequency of testing to ensure competency. “Do away with the CE programs; do away with refresher courses; do away with mandated programs, and simply make the EMTs and medics retake the state exam every two or three years,” Connor said. “It’s not foolproof, but it’s a pretty good way to ensure competency.” The training incentive then changes; employees would attend voluntary courses because they have a vested interest in ensuring they pass the exam.

 

“Another option is to have anybody [who’s] offering a program hire a proctor or somebody to monitor every course, but then you add another layer of bureaucracy.”

The value of CE

“The next argument is, what’s the value of continuing education?” Schmitt said. “It’s hard to prove that continuing education actually keeps you skilled in your practice, and that goes across all health professions. But that’s really the only way any health profession can say that they’re professionals, because they’re doing something to maintain their skills, whether it’s valid or not.”

 

Jamie Orsino, the union president for Boston EMS–which did not have any employees involved in the training fraud–said many EMTs question the value of CE, but he makes no excuses for those who sought to avoid their obligations.

 

“I’m a 25-year EMT. I’ve gone to my refresher courses and looked around and said, “˜You’ve got to be kidding me; we’re doing this again?’ There’s certainly an element of that. But you knew what you were getting into when you took the job. It’s considered a condition of employment. You may not like it, but you have to go. If you don’t want to, then don’t be an EMT. From a union perspective, if somebody really did this, it’s indefensible. And it’s indefensible from a moral perspective, because we agreed to the terms and conditions of the contract, and it’s clear that you’ve got to maintain certification.”

A larger commitment

Orsino is hopeful some good will come out of the training scandal in Massachusetts. “If anything good comes out of this, it will be that the state makes a commitment to seeing that the EMTs and paramedics truly can afford to make sure they maintain their certifications.” (It should be noted, however, that many of the agencies involved not only paid for the training, but often paid employees overtime to attend.)

 

“It’s a blot on everybody,” Orsino said. “The news services ran pictures of Boston EMS ambulances along with the story. We didn’t do it, but we’re the billboards.”

 

On June 30, TheBostonChannel.com ran a story (“EMTs: Fake Certification Punishment Unfair”) suggesting suspensions in Massachusetts of 45 days to nine months are too harsh. Accused EMT “Kim” said they didn’t harm anyone, because “the refresher courses they’re required to take have no bearing on competence and knowledge.” (It’s worth noting that some fire department employees essentially received no punishment, because EMT certification isn’t a requirement for their position or they were simply reassigned to other duties.)

 

While the EMS community debates the merits of CE or whether the punishment fits the crime, the public watches. “This is sort of a watershed moment for EMS,” Schmitt said. “Do you want to be treated like a profession? That means doing things professionally, including continuing education, making sure your skill level is up there. Or, do you want to be treated as something different?”

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