Caregiver Misconduct Reporting and Investigating Requirements

Entities must investigate and in some cases report incidents and allegations of caregiver misconduct to the Department of Health Services (DHS), Office of Caregiver Quality (OCQ). See Wisconsin Caregiver Program: Misconduct Reporting Requirements, P-63158 (PDF) and the Wisconsin Caregiver Program Manual, P-00038 (PDF) for a comprehensive overview of entity investigation and documentation responsibilities.

What is misconduct?

Misconduct is defined as abuse or neglect of a client, or misappropriation of a client’s property. Nursing homes participating in Medicare or Medicaid must also investigate injuries of unknown source and exploitation. These terms are defined in Misconduct Definitions, P-00976 (PDF).

What is a caregiver?

Caregiver means a person who is an employee or contractor of an entity, who is under the control of an entity, and who is expected to have, regular, direct contact with clients of the entity. The term also includes a person who has, or is seeking, a license, certification, registration, or certificate of approval issued or granted by DHS to operate an entity.

What is an entity?

“Entity" means a facility, organization or service that is licensed or certified by or registered with DHS to provide direct care or treatment services to clients; or an agency that employs or contracts with an individual to provide personal care services.

Misconduct Reports for Regulated Entities

Entities may access the Misconduct Incident Reporting (MIR) system to submit a misconduct incident report. Refer to Entity Requirements for Reporting Caregiver Misconduct for information on how to register for access.

File a Complaint

If any individual believes a caregiver or regulated provider has violated state or federal laws, that individual has the right to file a complaint.

These include:

  • Adult family homes (3-4 bed)
  • Ambulance service providers
  • Certified personal care providers
  • Community-based residential facilities
  • Community substance abuse services
  • Community support programs
  • Comprehensive community services
  • Emergency mental health services programs
  • Facilities serving people with developmental disabilities
  • Home health agencies
  • Hospices

“Entity” does not include:

  • Adult family homes (1-2 bed county-certified)
  • Alcohol labs
  • Ambulatory surgical centers
  • Clinical laboratories
  • Comprehensive outpatient rehabilitation facilities
  • Corporate guardianships
  • Hospitals (including clinics that are part of the hospital)
  • Mental health day treatment services for children
  • Nursing homes
  • Outpatient community mental health/developmental disabilities
  • Personal care services
  • Residential care apartment complexes
  • Rural medical centers
  • Supportive home care services provided by a licensed home health agency
  • Youth crisis stabilization facilities

 

  • End-stage renal dialysis
  • Outpatient rehabilitation services
  • Portable x-ray services
  • Rural health clinics
  • Swing beds
  • Transplant programs

Entity response to incidents or allegations of caregiver misconduct

Upon learning of an incident of alleged misconduct, entities must do all the following:

  1. Take whatever steps are necessary to ensure individuals are protected from subsequent episodes of misconduct while a determination on the matter is pending.
  2. Investigate all allegations of misconduct.
  3. Document the results of their investigation.
  4. Report allegations and incidents to OCQ.

Entity requirements for investigating caregiver misconduct

Entities must investigate all allegations or incidents of misconduct that are reported to them. A timely and thorough entity investigative report is critical. Entities must document the outcome of any investigations and must submit their reports through the MIR system.

Entity requirements for reporting caregiver misconduct

Resources

Refer to the following resources to determine when incidents must be reported to DHS.

In addition, the following documents are for nursing homes only:

Timing

Nursing homes are required by federal law to submit an Alleged Nursing Home Resident Mistreatment, Neglect, and Abuse Report, F-62617 (Word), including reports of injuries of unknown source and misappropriation of resident property, immediately and no later than 24 hours after discovery of the incident.

Nursing homes and intermediate care facilities for individuals with intellectual disabilities (ICFs/IID) that are certified to receive Medicare and Medicaid funds must submit a Misconduct Incident Report, F-62447 (Word) of alleged caregiver misconduct to DQA within five working days of the incident or the date the entity knew or should have known about the incident.

All other entities must submit reports of alleged caregiver misconduct to DQA using the Misconduct Incident Report, F-62447 (Word) within seven calendar days of the incident or the date the entity knew or should have known of the incident.

Misconduct Incident Reporting System

The Misconduct Incident Reporting (MIR) system is a secure, web-based system for entities to submit the Alleged Nursing Home Resident Mistreatment, Neglect and Abuse Report, F-62617 and/or the Misconduct Incident Report, F-62447 forms. Refer to DQA Misconduct Incident Reporting (MIR) System Entity User Instructions, P-02312A (PDF) for instructions on how to use the MIR system to submit reports.

Entities must create and register an account to access the MIR system. It may take up to three business days to process a registration. Refer to DQA Misconduct Incident Reporting (MIR) System: How to Sign Up, P-02312 (PDF) for instructions on completing these steps:

  • Step 1: Create a Wisconsin Logon Management System (WILMS) account for the regulated-entity/provider by accessing the WILMS website. Each provider may have up to two WILMS accounts for the purpose of submitting reports to the MIR system.

For assistance with WILMS, please contact helpdesk@wisconsin.gov or call 866-335-2180 and specify you are requesting assistance with the MIR system.

If the MIR system cannot be accessed, reports will be accepted via postal mail, fax, or email at:

Department of Health Services
Division of Quality Assurance
Office of Caregiver Quality
PO Box 2969
Madison, WI 53701-2969
Fax: 608-264-6340
Email: DHSCaregiverIntake@wi.gov

What happens after an entity submits a report of caregiver misconduct?

OCQ screens, tracks, and monitors all reports to determine whether further investigation is warranted. When a pattern of reported incidents by a caregiver occurs, an investigation may be opened at a later date. Investigation screening decisions are made on a case-by-case basis. Notification is provided by letter to the accused person, entity, staffing agency (if applicable), and complainant when an investigation will be conducted. Misconduct investigation may include on-site visits, requests for records, and in-person or telephone interviews. Entities must cooperate with OCQ in completing the caregiver misconduct investigation.

While a caregiver misconduct investigation is pending, all information pertaining to the alleged incident is kept confidential. Once the caregiver misconduct investigation is complete, OCQ issues a written decision describing the investigation’s outcome. All information regarding alleged incidents that are not substantiated remains confidential, whereas information regarding investigations that result in substantiated findings become public record. If OCQ’s decision is not appealed by the accused caregiver, or is not overturned on appeal, the individual’s name is added to Wisconsin’s Caregiver Misconduct Registry.

Can the public, family members, or victims report caregiver misconduct or rile other complaints relating to entities?

Any individual may file a complaint regarding any issues and concerns involving quality of care or quality of life (ex. lack of staffing, unsafe conditions, poor care, mistreatment, transfers, discharges, and caregiver misconduct) or if they believe that a caregiver or entity has violated state or federal laws pertaining to regulated entities.

 

Last Revised: February 5, 2020