As individuals begin to age, long-term care services and how to finance them become major concerns. Many turn to Medicaid to pay for their long-term care needs. Medicaid is a joint Federal and State funded program that provides medical insurance and long-term care payments on behalf of middle- to low-income individuals, including those who are elderly and disabled. However, since Medicaid eligibility is determined by the combined value of income and assets, gifting money and joint accounts may impede a person’s ability to secure Medicaid benefits.
There are several types of Medicaid fraud, such as those who receive Medicaid fraudulently. Medicaid recipient fraud may include an applicant falsifying information on the application and certification failure to disclose information about income and assets owned, and the failure to disclose income earned by a spouse or other household member. Other activities that can be deemed as fraud are loaning another person their Medicaid identification card, changing or creating a falsified order or prescription, using more than one Medicaid identification card, deliberately receiving excess, duplicative or conflicting medical service and/or supplies, and selling Medicaid-provided supplies to others.
A recent examination of federal data conducted by USA Today has recently revealed that the number of U.S. senior citizens receiving narcotic painkillers and anti-anxiety medications under Medicare’s prescription drug program is sharply rising. Recreational drug use can still be classified under medication-related problems (MRPs). Caregivers can play a key role in identifying and managing substance abuse issues, however, they may also be held liable if they fail to notice the signs of substance abuse.
We all expect and hope to have long and healthy lives. However, the truth is, no one lives forever and all too often health issues and accidents occur, leaving many individuals unprepared and in trouble. But there is something you can do to ensure you are never put in this position: PLAN! By planning ahead, you are able to answer the tough questions and make arrangements while you are in good health and mind.
The Office of the Medicaid Inspector General works to eliminate fraud by responding to allegations, doing specialized reviews of home health claims and inventory reports, while targeting providers who inappropriately bill Medicaid for services and patients who are provided services they aren’t entitled to receive.
While the main focus of Medicare has historically been to provide affordable and accessible medications to seniors, its focus has recently changed. Early this January, The U.S. Centers for Medicare and Medicaid Services (CMS) announced a proposed rule that would bring significant changes to the federal agencies.
The most notable change offered by the proposal is the agency’s new authority to kick out physicians and other providers who engage in abusive prescribing. It could also take such action if providers’ licenses have been suspended or revoked by state regulators or if they were restricted from prescribing painkillers and other controlled substances.
Additionally, the agency will tighten a loophole that has allowed doctors to prescribe to patients in the drug program (known as Part D) even when they were not officially enrolled with Medicare. Under the new rules, doctors and other providers must formally enroll if they want to write prescriptions to the 36 million people in Part D. This requires them to verify their credentials and disclose professional discipline and criminal history. Continue reading “Medicare Wants the Power to Ban Certain Doctors”
The case of Ohlmeyer ex rel. United States of America v. City of New York, a whistleblower action brought by the federal government against the city of New York has been settled. The 2012 complaint accused the city’s education department of submitting false claims to Medicaid for counseling services to special education students, and as of January 2014, New York City has agreed to pay $1.37 million in an official settlement.
The complaint, charged that New York City’s Department of Education (DOE) knowingly billed Medicaid for psychological counseling services for individual special education students who did not receive two monthly counseling session, the minimum number required for payment, between 2001 to 2004.
Dozens of current and former Russian Diplomats and their spouses have been accused of committing Medicaid fraud in a criminal complaint filed in December 2013. The diplomats, which include employees of Russia’s consulate, employees of its mission to the U.N., and trade representatives, were among 49 individuals charged in a complaint unsealed in federal court in Manhattan. Though no arrests were made and only 11 of the diplomats and their spouses remained in the United States, the complaint said Medicaid, a health care program for the poor and disabled, lost about $1.5 million in the scheme since 2004.
The complaint alleges that the defendants submitted fraudulent applications for medical benefits for pregnancies, child births and care for young children. Federal prosecutors said the diplomats qualified for Medicaid benefits by underreporting their income, often by tens of thousands of dollars, yet were enjoying countless luxury amenities while in the United States.
In court papers, FBI agent Jeremy Robertson described an 18-month investigation, saying investigators had discovered a pattern of falsified applications. He said 58 of the 63 births attributed to Russian diplomats and their spouses in New York City between 2004 and 2013 were funded through Medicaid, which is largely federally funded but also includes money from state and local governments.
Robertson wrote that the diplomats and their spouses generally underreported household income to an amount below the applicable Medicaid eligibility level, and some of them lied about the citizenship status of their children to obtain continuing health coverage for them.
Meanwhile, the diplomats and their spouses spent tens of thousands of dollars on vacations, expensive jewelry and designer clothing at luxury retail stores including Bloomingdale’s, Tiffany & Co., Jimmy Choo, Swarovski and others, the court papers said. The complaint said they also spent tens of thousands of dollars on electronic merchandise at Apple Inc., bought concert tickets, robotic cleaning devices and chartered helicopters.
Charges in the criminal complaint included conspiracy to commit health care fraud, conspiracy to steal government funds and make false statements relating to health care matters.
“Being a diplomat does not give you the right to commit health care fraud,” said George Venizelos, head of the FBI’s New York office, he added, “The defendants selfishly took advantage of a health care system designed to help the unfortunate and should be punished.”
Common penalties for Medicaid fraud include monetary fines, disqualification, garnishment of wages, and even criminal prosecutions. If you or a loved one have been charged with Medicaid fraud, the consequences you may face can be severe. As a result, you should immediately contact an experienced Medicaid attorney to receive the representation you deserve.
For decades, older Medicare beneficiaries who suffer from mental health issues, such as depression, anxiety, and other conditions have received unequal coverage and treatment. Medicare, a program that provides health insurance for individuals over 65, has been paying a smaller share of the bill for therapy from psychiatrists, psychologists or clinical social workers than it does for medical services. But the disparate coverage may be a thing of the past sooner rather than later, as a result of the newest Health Laws.
As of Jan. 1, Medicare is required to pay the same amount for mental health care treatment as it does for most medical services. Although there have been steps forward before, this most certainly is the closest step taken by the government to close the gap in this vital program.
Under the 2008 Medicare Improvements for Patients and Providers Act, Medicare was required to cover a larger portion of the cost of outpatient mental health services which brought the requirements to about 50% of the cost of such treatment, and increased even further to 65% in 2013. But now, with the newest regulations, Medicare is required to pay 80% of the cost of mental health services, bringing coverage for those treatments in line with most medical services.
Andrea Callow, a policy lawyer at the Center for Medicare Advocacy, said, “Hopefully, older adults who previously were unable to afford to see a therapist will now be more likely to do so.”
Although the new provisions are deemed positive by many, there are still many elements that are considered lacking. Parity under Medicare remains incomplete, and hurdles still stand in the way of older adults receiving services. A 190-day lifetime limit on inpatient services at psychiatric hospitals is the most notable example. There is no similar cap on any other inpatient medical services provided through Medicare.
Additionally, critics argue that the new requirements do little to address an arguable shortage of mental health professionals who are trained to work with elderly U.S. residents who also accept Medicare insurance plans. Gary Kennedy, director of the division of geriatric psychiatry at Montefiore Medical Center in New York City, said, “There are a lot of mental health providers out there, but very few have training to work with older adults.” “Providers have little incentive to treat elderly patients because Medicare reimbursement rates are low compared with private insurers.”
Although Medicaid and Medicare provide essential services for our loved ones and thousands of Americans, many people either do not know the specifics of each program or simply do not know the difference. Well not anymore! Provided below are the basics everyone should know when dealing with these two aid programs and a basic layout of their differing eligibility requirements, coverage, and funding.
Medicare is a federally funded and administered program that provides health insurance for individuals older the age of 65, individuals with disabilities, or individuals with End-Stage Renal Disease (ESRD). Its coverage includes: inpatient services from a hospital or nursing facility, outpatient services, doctor visits, and preventive care, prescription drug costs, or a combination of these services. Most seniors are automatically enrolled when they turn 65, yet those that are disabled are required to contact their local Medicaid office if interested in being enrolled, however cost is not distinguished by qualifying factors but rather is the cost depends on the “level of coverage” assessed.
Medicaid is a federal and state program that is administrated by the state government with the purpose of providing coverage for low-income families. Its coverage includes: hospital and nursing care, certified pediatric and nurse practitioner services, access to federally qualified centers, as well as access to rural health clinic or birth centers licensed by the family’s state. All of those who wish to receive Medicaid benefits must apply within their state office in order to become eligible and costs depend on the income of each family.
Can A Person Qualify for Both Medicare and Medicaid in New York?
Individuals may be dually eligible for both programs. In many of these cases, Medicaid will cover Medicare premiums or co payments for the services covered under Medicare. This allows for effective and comprehensive health coverage.
Contact an Attorney
If you believe you qualify for Medicare or Medicaid and wish to receive benefits, or if you have been previously denied coverage, contact an experienced New York Elder Law Attorney. A skilled attorney can analyze your situation, discuss your options with you, and help ensure your legal rights are protected.