Medicaid fraud is a persistent issue across the country, costing state governments billions of dollars every year. It was estimated in a report by PBS that nearly one in every ten Medicaid payments are in some way erroneous and potentially fraudulent. But what exactly is it, and what are you supposed to do if you get charged with it? Continue reading “What Happens if You Are Charged with Medicaid Fraud”
A new law, recently passed by the New York State Legislature and signed by Governor Andrew Cuomo, will have a significant impact for anyone receiving Personal Care Services or Home Care services through Medicaid. Among these changes are the imposition of a “look back” period for determining whether a person meets the requirements to be eligible for the Medicaid Home Care program. Previously, there was no “look back” period for the Medicaid Home Care program. There are also changes to services under the Consumer Directed Personal Assistance Program (CDPAP) and Personal Care Services (PCS). All these changes will be effective October 1, 2020. Continue reading “Recent NYS Law Has Significant Impact for Medicaid Home Services”
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.
Continue reading “Guildnet Closes Its Doors”
Applying for Medicaid or any other government benefits can be challenging. If an application for Medicaid or other government benefits is denied, it is important to understand that you have the right to appeal the denial to the State in an administrative proceeding called a Fair Hearing. (NOTE_- You must also request an internal appeal of an adverse decision with your healthcare provider in addition to requesting a NYS Fair Hearing)
Continue reading “Fair Hearings – Medicaid”
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”
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”
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 National Public Radio (NPR) investigation revealed that nearly 20 percent of senior nursing home residents receive some form of antipsychotic medications.
Similar reports, drawing from the NPR investigation, found significantly higher rates of antipsychotic drug usage concentrated in the Western New York area. In the Rochester region, data revealed that antipsychotic drug usage rates reached up to 30 percent.*
A recent exposé by the New York Times revealed that as nursing homes revamp their facilities to include luxury living quarters, the disparity between the lavish amenities of short term accommodations, and the quality of care can be drastic. Although nursing homes are attempting to lure in patients whose short stays will be funded by Medicare dollars, in lieu of Medicaid, many patients are being discharged from the facilities before they have been rehabilitated. Or worse yet- they leave with more medical issues than they had upon admittance.