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.
Tag: medicaid
Elderly Misuse of Antipsychotics: A Disturbing National Trend
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.*
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Nursing Homes Attempt to Lure in More Medicare Patients to Increase Profit
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.
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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”
Special Needs Trust Can Provide Effective Financial Relief for the Disabled Elderly.
Federal and State law provides a number of programs to help a person with disabilities. Such programs include. Security Income and Medicaid. Supplemental Security Income, or SSI, is a federal program that provides monthly cash payments to people in need. SSI is for individuals who are 65 or older, as well as for blind or disabled people of any age, including children.
However, to qualify for SSI and Medicaid an applicant must own less than $2,000 in assets. The value of your home does not count if you live in it. Usually, the value of your car does not count and the value of certain other resources, such as personal items or a burial plot, may not count either. Continue reading “Special Needs Trust Can Provide Effective Financial Relief for the Disabled Elderly.”
Elder Law Changes in 2014
While many things remain the same, the laws in the United States are constantly subject to change and revision. Elder law is no different. It is crucial to stay informed and understand the latest regulations that concern you or your loved ones. Below are a few changes made in 2014 regarding elder law (or laws that are particularly relevant for seniors and their families who are attempting to plan for the future):
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.
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.
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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.
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