Archive for November, 2010

Beware of Medicare Fraud!

Monday, November 29th, 2010

Last October,  more than 40 members of a crime syndicate were arrested and charged in an extensive Medicare fraud case. The suspects stole the identities of thousands of physicians and patients, and used these information at more than 100 fake health clinics in 25 states to bill Medicare for more than $100 million. In another case, a Miami mental health organization was charged with filing $200 million fake claims for therapy sessions.

These are the large scale scams that make the news.

However, there is a lot of fraud happening below the radar, so to speak, that can affect us directly.

For example, criminals often offer unsuspecting patients medical equipment and supplies they don’t even need, or even qualify for, to collect Medicare information. These swindlers then bill for other supplies and services the patients never received and pocket the reimbursements. Sometimes they even offer “free services” like cholesterol screening or diabetes check-ups, to get Medicare numbers. Though seniors trapped in these criminal set-ups rarely face financial liability, the fact is their medical records get compromised. This can negatively affect their health benefits in the future, without them even knowing that something bad has happened to their file.

For example, one senior needed a wheelchair, but was denied one by Medicare.  Her records indicated that she already had a wheelchair for the last five years. In fact, the individual’s Medicare number had been already compromised — and she didn’t even know when it happened!

Sometimes, Medicare recipients apply for long-term care, and their application gets denied due to that fact that their medical records are full of bogus tests and medical treatments. This affects not only these individuals directly in need of these services, but also the rest of the population. Fraud raises premiums. Also, whenever there are “crackdowns” to assuage the public about the rising incidence of these scams, it makes it extra difficult for people with true medical needs to apply for the care they require and deserve.

In our next post, we will cover some practical steps you can take to prevent these kinds of  abuse…

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Alzheimer’s and Money Problems

Sunday, November 21st, 2010

This excellent short video is a cautionary tale about the dangers of Alzheimer’s for Seniors. The following background story about Alzheimer’s and Money Problems is from CBS News. (“Senior Moment:” As the Boomer Generation Ages, Dr. Jon LaPook Examines How Easily Warning Signs for Alzheimer’s Are Missed. by Jonathan LaPook)

“Dr. Max Gomez was a successful OB-GYN in Miami, delivering thousands of babies. He lived the good life, but admits he was bad with money. Gomez has suffered more than a few bad investments. He is now penniless, living in a care facility paid for by Medicaid.

His son is WCBS medical correspondent Dr. Max Gomez. Even with his training, he missed the warning signs of Alzheimer’s disease until three years ago — when he discovered his father had lost every dollar he’d earned.

Dr. Gomez’s father was not practicing medicine, but still had the title of medical director at a clinic. That clinic made him legally responsible for multiple commercial loans, and took out mortgages in his name.

A girlfriend wrote thousands of dollars in checks against his savings account.

The FBI started investigating after his ID was used to file millions of dollars in false Medicare claims.

“Here he was helpless and being taken advantage of left and right,” Dr. Gomez says of his father. He adds, “There’s never one big ‘ah ha’ moment.”

Patients can seem lucid. Even as, in Dr. Gomez’s case, the disease is destroying the brain. In Alzheimer’s disease, nerve cells die in key brain regions. One of the first is the hippocampus. Damage to the hippocampus, and later the frontal lobe, affect the ability to plan organize and reason – crucial for managing money.

“You can’t retain the facts because of memory, and you can’t utilize the facts efficiently,” explains Mony John de Leon, director of the NYU Center for Brain Health. “It’s very hard – as people become deteriorated – to manage finances.”

The financial services industry realizes brokers and bankers may see aging clients more often than out-of-town families do. They’re training representatives to report warning signs including confusion, mood swings, and losing things. Susan Axelrod of the Financial Industry Regulator Authority adds, “Also importantly, changing a long term investment strategy suddenly.”

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Medi-Cal Eligibility Quick Checklist

Sunday, November 14th, 2010

If you are enrolled in one of the following programs, you can get Medi-Cal:

  • SSI/SSP
  • CalWorks (AFDC)
  • Refugee Assistance
  • Foster Care or Adoption Assistance Program
  • In-Home Supportive Services (IHSS)

You can also get Medi-Cal if you are:

  • 65 or older
  • Blind
  • Disabled
  • Under 21
  • Pregnant
  • In a skilled nursing or intermediate care home
  • On refugee status for a limited time, depending how long you have been in the United States
  • A parent or caretaker relative or a child under 21 if:

    • The child’s parent is deceased or doesn’t live with the child, or
    The child’s parent is incapacitated, or
    The child’s parent is under employed or unemployed

  • Have been screened for breast and/or cervical cancer (Breast and Cervical Cancer Treatment Program)

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Key Facts on Alzheimer’s Disease

Friday, November 12th, 2010

As Elder Law attorneys, we are witness to the painful and ravaging impacts of this disease.

A  2009 report from the University of California  projected a dramatic rise in the number of Alzheimer’s cases in the state. A task force has been formed  to develop a plan on how California can best respond to an impending Alzheimer’s epidemic.

Joshua Chodosh, a UCLA geriatrician who researches dementia and health services utilization, was named co-chair of the state’s Alzheimer’s disease plan task force, which will present its findings to the state in early 2011.

“As the baby boomer generation ages and as people live longer, Alzheimer’s disease has become an urgent issue,” said Patrick Fox, co-director of the UCSF Institute for Health and Aging and an author of the report.

He noted that among California’s baby boomers age 55 and older, one in eight will develop Alzheimer’s.

Here are the key findings from UCSF’s Institute for Health and Aging report for the Alzheimer’s Association:

• The number of people in California with Alzheimer’s will nearly double from 588,000 today to nearly 1.1 million by 2030.

• One-tenth of the nation’s Alzheimer’s patients reside in this state.

• The number of California’s Latinos and Asians living with the disease will triple by 2030, and the number of African Americans will double.

• The annual cost for caring for Californians with the disease could soar to nearly $100 billion in the next 20 years.

• Some 1.1 million Californians today take care of people with Alzheimer’s. Three-fourths of these caregivers are family members.

• Alzheimer’s is now the sixth leading cause of death in the state.

You can go to this link to the University of California article that discusses the scientific inroads to Alzheimer’s diagnosis.

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Basic Planning Steps for Seniors

Friday, November 5th, 2010

We all know that long-term care can be very expensive. Many of us will be surprised to learn that Medicare and most health insurance plans, including Medigap policies (Medicare supplemental insurance), do not cover long-term care. State Medicaid (Medi-Cal in California) cover some long-term care services only for people who have a low income and few resources.

Costs for a nursing home averages to more than $6,000 a month, which means that it can cost seniors upwards of $70,000 a year out-of-pocket. People who receive long-term care services at home spend can be spending more than $1,600 per month.

Some seniors can cover the long-term care they need in the future with long-term care insurance, savings plan annuities, certain life insurance policies, and reverse mortgages. The optimum solution really depends on one’s personal finances and family situation. Planning for disability or incapacity is something that we can’t afford not to do.

There are basic steps every one can take to start thinking about how to provide for health care as we all age:

1. Estimate how much of the cost of long-term care you could afford on your own.

2. Talk with you independent financial planner for more information about your financial situation.

3. Ask your current or former employer if you are eligible for group long-term insurance, savings plan annuities, or similar long-term care benefits.

4. Do some research and learn about long-term care insurance, trusts, annuities, reverse mortgage or other options for financing long-term care needs.

5. Call your local Area Agency on Aging to finds out about other programs that might help pay for long-term care. Look under “aging” or “Human Services” in the local government blue pages of the phone book for the number. You can also call 1-800-677-1116, which is the toll-free information line for the Eldercare Locator. (This is a public service of the U.S. Administration on Aging connecting you to services for older adults and their families.)

6.  If you have low income, you may qualify for Medicaid (or Med-Cal in California). If you live in California, you can go to the Department of Health Care Services Medi-Cal page to get more information about the program.

7. Last but not the least, if you happen to live in Southern California, you can call the Cal Elder Law office to make an appointment for a consultation: (562) 920-6100. As elder law attorneys, our expertise is in helping seniors plan for their their long-term care needs, at the same time protecting their hard-earned savings and assets.

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