Tanya Hobson Williams Archives - Page 6 of 7

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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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.

Dividing Caregiving Responsibilities between Siblings

Caring for an elderly parent or family member is a serious responsibility to take on and can bring joy and purpose into one’s life but may also cause both emotional and financial strain on a caregiver and his/her family. Having another person such as a sibling to help rely on, can help make things easier, but it can also lead to conflict and resentment. It is important to understand the issues that may arise when two or more adult siblings are caring for an elderly parent, and the best ways to resolve problems.

The main question that is usually asked between siblings taking care of a sole elderly parent is: “Who will be the primary caregiver, and what factors go into the decision?” One of the main factors taken into consideration is the proximity of the siblings in regards to the elderly parent’s home. Yet there are plenty of other factors that siblings should consider while creating a plan for the caregiving. Such as:

Work Schedules
Individual’s Family Income
Individual’s Personal Skills such as day-to-day hands on care or the financial planning and organizing

The best way to avoid conflict and confusion is to communicate openly and often. Good communication is probably the most important factor in making these decisions. Ideally, responsibilities will be divided in whatever way feels fair to everyone involved, and arriving at the best outcome depends on communication.

Finally, as with most things, careful planning will save a lot of headaches and keep your loved one as best protected as possible. Just as the schedule of doctor’s appointments and daily medications needs to be kept track of, so should the finances be kept in careful order and hiring an experienced attorney can make all the difference. If you are splitting responsibilities for caring for a loved one, or believe that you will be taking on such a responsibility in the near future, contact a skilled elder law attorney to help ensure that the right steps are taken to protect your loved one.

Suburban Commercial Real Estate Market Makes a Comeback

After announcing its death when vacancy rates hovered around 20% to 30% during the most recent recession, the suburban office market has suddenly resurrected. The office market recovery has reached outside the city limits, more specifically into so-called “premier” locations where technology- and energy-related companies are driving growth.

According to CoStar, suburban markets have accounted for 87% of office demand, which is 13% more than their “fair share” based on the total market size, compared with CBD office markets. Suburban areas leading the way include Waltham-Watertown, Massachusetts; northwest Austin, Texas; Bellevue, Washington; at Katy Freeway West, Texas. Such markets make up just 19% of the office inventory but drew 29% of the demand over the last six quarters, according to CoStar data.

Suburban office absorption tends to perform well during good economic times and when the economy starts to recover, while CBD properties do better during difficult economic times. That’s because companies can take advantage of lower rental rates so they can secure space closer to the urban areas. But with the economy improving, office rental rates are starting to increase and many companies are staying away from the pricey CBD buildings and finding affordable rates outside the cities.

This is showing up in the net absorption rates. Cities with high absorption rates in their outlying areas include Sacramento and San Jose, California; Austin, Texas; Kansas City, Missouri; and Charlotte, North Carolina.

When it comes to commercial real estate, it’s not just about location. It’s also about representation. Before entering into any such transaction, please consult with an attorney who is experienced in commercial real estate law.

A Living Will vs. A Healthcare Proxy

A Living Will is often confused with a Healthcare Proxy and vice versa by many individuals. Although both provide advance directives regarding medical decisions, they both are separate documents with distinct features and purposes.

It is vital to become aware of these terms, what they mean, and the impact both documents can have on your life and the lives of your loved ones. Get informed and ensure that your legal rights are protected.

A Living Will

A Living Will is a written statement of an individual’s wishes regarding medical treatment. This document is created to define a person’s specific plan as to how their health care will be handled if they are gravely ill or incapacitated in the hospital. The primary issue to be determined in a Living Will is whether a person wishes to be put on life support, and what type of life-preserving measures should be taken.

A Living Will is vitally important not only for the ill person, but for the family. Without a Living Will, a physician may call upon the family members to make very difficult judgment calls. These types of matters have been increasingly more common with advancements in medical science, and the increased ability to extend life.

Living Wills give detailed instructions regarding medical treatment if an individual is in a persistent vegetative state, in a coma, or otherwise unable to communicate how she wants his/her medical treatment handled. Perhaps a person does not believe in being kept alive by artificial means, particularly if there is no hope of recovery. A Living Will stating this fact would give this person control over their own health care when they are unable to express their own wishes.

A Healthcare Proxy

A Healthcare Proxy varies from a Living Will in that a Health Care Proxy appoints a particular person to speak on your behalf regarding medical decisions, if you are in a situation where you can’t make them yourself. The idea behind a Health Care Proxy is that someone makes the decisions you would have made, had you been able to do so.

You must choose your proxy thoughtfully since he/she will be acting on your behalf. After appointing your proxy, it is extremely important to discuss your wishes with them about your medical care, including resuscitation, artificial nutrition and hydration and personal goals for quality of life. Knowledge of your wishes will help guide the decisions your proxy will have to make with your medical team. Knowing that any decisions made are based on your personal values and wishes will be a comfort to family and friends during a stressful time.

Contact an Attorney

If you become unable to direct your own medical care because of illness, an accident, or advanced age, the right legal documents are your lifeline. When you don’t write down your wishes about the kinds of medical treatment you do or don’t want to receive and name someone you trust to oversee your care, these important matters can be placed in the hands of estranged family members, doctors, or sometimes even judges, who may know very little about what you would prefer. In order to ensure you are protected, contact an experienced attorney today.

Guardianship 101: A Brief Intro into Guardianship

As people go through life, it is obvious that familiarizing oneself to legal terminology is not a high priority. Yet, as we get older, it is important to get ourselves informed about decisions and circumstances that one day we may find ourselves in. Below is some general information to get you acquainted with the topic of guardianship. It is vital to keep yourself informed to ensure your legal rights are protected. Read below and keep up with our Blog!

What is a guardian?

A guardian is an institution/individual appointed by the court (or voluntarily appointed by an elderly individual) to make personal needs or property management decisions for an incapacitated person. Continue reading “Guardianship 101: A Brief Intro into Guardianship”