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”

New Changes to Rent Stabilization Law in New York

January of this year, Gov. Andrew Cuomo signed into law numerous amendments to the system of rent stabilization in New York State. Both landlord and tenants agree that the new amendments strongly help tenants’ rights, while limiting those of landlords.

Currently, laws impose a four-year limitation on checking rent history, but now regulators will be able to look back more than four years to determine whether there was ‘a fraudulent scheme’ to destabilize the apartment. Tenants can also go directly to the state to request rent reductions because of service complaints, whereas before they were required to first inform the landlord.

Additionally, the state will begin to enforce and keep tabs on whether or not a building has any housing violations, and they will reject a landlord’s request to increase rent if any violations exist. Previously, they state would only look up violations if someone filed a complaint. Landlords will also be required to make “extensive new disclosures” when they increase rents, so there will be more oversight from the state. Continue reading “New Changes to Rent Stabilization Law in New York”

Daughter of 85-year-old Being Denied Guardianship Rights

As a loved one grows older or when he/she suddenly becomes incapacitated, the basic human instinct is to protect them from harm. And although there are many cases involving family and friends with bad intentions, it is clear that if the ability to make decisions for your loved one was stripped away from you, the results would be heartbreaking. That is what a Pittsburgh woman is claiming regarding the medical treatment and control of her mother.

Mirsada Begovic, the daughter of 85 year-old Enisa Begovic, claims that in the last two months, the University of Pittsburgh Medical Center (UPMC) has restricted her access to her mother and has required her to be escorted to her mother’s room by security, after the hospital accused her of interfering with her mother’s medical care. Mirsada, a physician trained in Bosnia who once was part of the University of Pittsburgh Medical School staff, says however, her only offense has been advocating forcefully for her mother. Continue reading “Daughter of 85-year-old Being Denied Guardianship Rights”

Gov. Cuomo Ensures Fair Immigrant Housing for Renters

Earlier this January, Gov. Andrew Cuomo announced that he has ended the reported harassment and intimidation of mainly Spanish-speaking immigrant tenants in nearly 1,800 apartments by reaching a settlement with Castellan Real Estate Partners/Liberty Place Property Management. The official agreement is between the New York State’s Tenant Protection Unit (TPU) and the real estate company which owns nearly 49 buildings in Harlem, Washington Heights, Brooklyn and the South Bronx — the sites of the alleged mistreatment.

The allegations against Castellan, that led the TPU to open its investigation earlier this year, included failure to provide renewal leases; false fees on individuals’ rent statements when tenants have payment receipts; and requesting tenants provide documents proving income or Social Security numbers to determine citizenship status, all of which are illegal to do to existing leaseholders. Continue reading “Gov. Cuomo Ensures Fair Immigrant Housing for Renters”

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”

Medicaid Reportedly Loses Over 1.5 Million Dollars from Russian Diplomat Scheme

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.

 

New Medicare Requirements to Cover More Mental Health Treatment

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.”

Medicaid vs. Medicare 101

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

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

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.

Testimonials

“I want to take this time to thank Tanya and Keith for their professionalism and their ability to keep me calm during this process. Tanya was very helpful in explaining the whole guardianship process and my next steps. Despite my numerous emails, I never felt ignored or that they were growing weary of me. Even after being granted guardianship when I had an issue with the bank releasing money Tanya stayed calm and found a way to get what I was entitled to. I hope I never need to do this again but if I do, I will definitely come back to Tanya and her team. Thank you Thank you Thank you. Love from Bermuda.”

-K. Durham.
(An attorney in Bermuda transferring a Bermudian guardianship to NY)

Read More »

  • Elder Law Attorney Serving Queens Bronx Brooklyn

    Elder Law

    Elder Law encompasses a broad range of legal matters. It is important for everyone, regardless of age or health, to plan for the future.

  • Guardianships Attorney Serving Queens Bronx Brooklyn

    Guardianships

    The legal system recognizes that some adults, whether due to disease, dementia, mental deterioration, or disability, are unable...

  • Medicaid / Medicare Fraud Attorney Serving Queens Bronx Brooklyn

    Medicaid / Medicare Fraud

    Medicaid is a joint state and Federal program that provides insurance to individuals based upon their income and resources, while Medicare...

  • Reverse-Mortgage Foreclosures Attorney Serving Queens Bronx Brooklyn

    Reverse-Mortgage Foreclosures

    Reverse mortgages are becoming an increasingly popular way for aging homeowners to refinance...

  • Landlord-Tenant Attorney Serving Queens Bronx Brooklyn

    Landlord-Tenant

    Landlord Tenant law can be a complex and confusing subject. Disputes over leases and rent payments are often emotionally...

  • Business Law Attorney Serving Queens Bronx Brooklyn

    Business Law

    From the initial startup of your business to any issues you may encounter along the way, you can rely on Hobson-Williams, P.C. for effective...

  • Collections Attorney Serving Queens Bronx Brooklyn

    Collections

    Hobson-Williams, P.C. has a full-service debt collections department, with experienced debt-collection attorneys who will...

  • Real Estate Transactions Attorney Serving Queens Bronx Brooklyn

    Real Estate Transactions

    Many people question why they need an attorney to purchase or sell a home.

Litigator of the Year
Women-Owned Law Firm
Long Island's 50 Top Women
Minority-Owned Law Firm
Brooklyn Bar Association
Queens County Bar Association
New York State Bar Association
Lawyers of Distinction
Outstanding Women in Law

24 hour service
Call Toll-Free:
24 Hours a Day, 7 Days a Week

Phone: 1-866-825-1LAW
Phone: 1-866-825-1529

Queens Office:

  • 87-01 Midland Parkway, Lobby A
    Jamaica Estates, New York 11432
  • Phone: 718-210-4744
  • Fax: 718-928-2210

Brooklyn Office:

  • By Appointment Only
  • Phone: 718-210-4744
  • Fax: 718-928-2210
Skip to content