Last updated by at .

Guildnet Closes Its Doors

On August 21, 2018, Guildnet CEO, Alan R. Morse, notified employees that the company will be closing its doors as of December 1, 2018, leaving New Yorkers in need of managed long-term care (MLTC) services at a disadvantage. The Guildnet program was designed to offer therapeutic/medical care, home healthcare services, case management, and medical equipment to those who qualify and will be in need of the provided services for a minimum of 120 days. Guildnet announced that by January 1st of 2019, all medical services to their 8,211 managed long-term care members will be terminated. United Healthcare, who until recently offered a partial MLTC plan, will also be pulling out of several counties in up-state New York by February of 2019, affecting nearly 1,500 enrollees who are said to be notified of these changes by November.

Guildnet’s managed long-term care members will be given a 90-day grace period to enroll in a new plan. Members who fail to switch care programs before the deadline will be automatically assigned to a care plan.  After enrolling in a new plan, Guildnet members will be able to switch their plan within 120 days should their new plan be deemed insufficient. The new care plan must honor the same service plan that the former Guildnet member received in the past and allow members to be seen by the same providers unless otherwise agreed to. The new care plan must perform a comprehensive care evaluation.

The void left by Guildnet and other MLTC providers leaving can bring about uncertainty about the continuity of home care services. If you or a loved one has been affected by the closing of Guildnet or the disruption of service from another MLTC association, it is imperative that you contact an experienced New York Medicaid and elder law attorney, who can guide you through the process. The attorneys at Hobson-Williams, P.C. are dedicated to representing clients with diligence and compassion. For an initial consultation, contact the New York Medicaid attorneys at Hobson-Williams, P.C. by calling 866-825-1LAW.

 

Determining Medicaid Eligibility

Medicaid is a joint federal and state public assistance program that provides health insurance to low-income Americans, regardless of age, and is based on financial need and hardship. This program is publicly funded through taxes that are collected from each working individual.
Continue reading “Determining Medicaid Eligibility”

Expect to Pay More for Home Health and Assisted Living Costs

According to the most recent data from the U.S. Census Bureau, there were 2,797,589 people in New York who were aged 65 and over in 2016 which is 14.6% of the state’s population. Compare that number to 2015, when 2,724,135 seniors lived in New York State (14.3% of the population), and 2014 (2,655,913 people ages 65 and over, 14.0% of the population). Continue reading “Expect to Pay More for Home Health and Assisted Living Costs”

How Joint Accounts and Gifting Affect Medicaid Eligibility

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.

Continue reading “How Joint Accounts and Gifting Affect Medicaid Eligibility”

What is Medicaid Fraud?

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.

Continue reading “What is Medicaid Fraud?”

Medicare Prescription Drug Abuse on the Rise

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.

According to the data collected between, 2007-2012, the number of senior patients receiving Medicare prescriptions for opioid-based pain medications has increased by more than 30 percent to upward of 8.5 million beneficiaries.

Specifically, the use of the most commonly abused painkillers, like hydrocodone and oxycodone, rose by more than 50 percent. The data also showed a significant increase of the personal supply of each narcotic provided to the average recipient rose about 15 percent over approximately three months. Continue reading “Medicare Prescription Drug Abuse on the Rise”

Medicaid Myths

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 harsh truth is that 7 out of 10 people over the age of 65 will require expensive long-term care at some point. Would you be able to foot the bill for an extended stay at a nursing home, assisted living facility or at-home care for you or your spouse? Even if you could, would you prefer to pass your savings and other assets to your loved ones rather than have those assets depleted by costly long term care expenses? To protect your lifestyle and assets, Medicaid Planning is necessary.

Continue reading “Medicaid Myths”

NYS Breaks Record in Medicaid Fraud Recoveries

The New York Office of the Medicaid Inspector General (OMIG), reports that in 2013, it recovered what seems to be the highest ever recovery amount regarding Medicaid fraud in the history of the agency. Gov. Andrew Cuomo made the announcement early this February, reporting a sense of pride in New York and explaining the figures as an illustration of how New York State is “truly leading the nation in fighting fraud and protecting taxpayer dollars.” The exact figures calculated reached $1.7 billion over the past three years, and a record of $851 million in 2013 alone.

Continue reading “NYS Breaks Record in Medicaid Fraud Recoveries”

Medicare Wants the Power to Ban Certain Doctors

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”

New York City Settles Allegations of False Medicaid Claims

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.

Continue reading “New York City Settles Allegations of False Medicaid Claims”