This the second video on Medicare fraud. It’s an excellent intro on the types of scams created by the bad guys.
Medicare Scams: Watch Out!
December 16th, 2010Preventing Medicare Fraud
December 10th, 2010This a great video about health care fraud from SMP, and how to avoid being victimized…
7 Simple Tips to Prevent Medicare Fraud
December 3rd, 2010In the previous post, we alerted you about the possible dangers relating to Medicare fraud, and how that can seriously impact the care you need, when you need it…
Here are some practical tips that can help prevent a disaster for you or your loved ones.
1) Protect your Medicare card, like you would a credit card of Social Security card. Do not ever give your Medicare number when talking to someone you don’t know over the phone. Any kind of stranger who asks for your Medicare number is suspect — even if they claim to be conducting a government-sponsored health care survey.
2) Never allow a friend or relative to use your card. They may be trustworthy, but your number can be stolen from them. And of course, should you lose your card, you should report it immediately. Time is of the essence.
3) Never accept offers for medical equipment, supplies, or services that you do not need – or that you are already currently using. For example, you or loved one might be receiving dialysis treatment and be approached by someone offering “free supplies.” If you unwittingly give that person access to your name, address, and Medicare information, you may indeed receive these “gifts” and have Medicare fraudulently billed without you knowing. When this happens, report it immediately.
4) Do not give your insurance information to anyone offering a free medical service. They do not need your insurance information (except of course to scam you by harvesting your Medicare number to commit fraud on your account!)
5) Check your Medicare statements regularly. Review them carefully (just like you would check your credit card bill). Be on the lookout for suspicious charges — for example, bogus charges for doctor visits that didn’t occur, provider names that you don’t know, or any equipment or supplies that you have never received. Check with you physician or health provider first, just to rule out honest mistakes in billing or accounting. If you have an “unexplained,” suspicious entry, report it immediately.
6) Keep a log of your doctors visits and other medical services you receive, so that way you can check it against your statements. Buy a 50 cent spiral notebook and write this information down (see tip number 5).
6) Be careful of enrollment periods — this is the time when criminals victimize seniors by peddling bogus prescription plans. Sometimes these swindlers offer products and services that aren’t even covered by Medicare, to entice the unsuspecting senior. Go check out this link to see if the insurance plan you are considering is legitimate. If they are not listed here, be specially wary. Investigate further.
7) Review you credit reports regularly. If you find out that you have unpaid medical bills, that may very well be a result of a fraudulent transaction billed to your name.
Write the following phone number down, and tape it on your refrigerator. This is the number you need to call if you suspect or encounter fraudulent activity:
(1-800-447-8477) or 1-800-HHS-TIPS
Their email is HHSTips@hhs.gov
In addition, you can go this link to find the Senior Medicare Patrol in your state (which is part of the State Health Insurance Counseling and Assistance Program.)
Beware of Medicare Fraud!
November 29th, 2010Last 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…
Alzheimer’s and Money Problems
November 21st, 2010This 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.”
Medi-Cal Eligibility Quick Checklist
November 14th, 2010If 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:
- Have been screened for breast and/or cervical cancer (Breast and Cervical Cancer Treatment Program)
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
Key Facts on Alzheimer’s Disease
November 12th, 2010As 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.
Basic Planning Steps for Seniors
November 5th, 2010We 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.
Planning for Long-Term Care
October 29th, 2010Planning for long-term care helps identify what service options are available in your community, as well as what special conditions may apply for receiving services (e.g., age, cost, payment options). Obtaining this information is good preparation for the time when a person will be needing long-term care. It will help you understand what choices you have, and control over what, where, and how you receive the services you will need.
About 70 percent of people over the age of 65 require some services. The likelihood of needing care increases as we age. Planning is critical because the cost of long-term care services often exceeds what the average person can pay from income and other resources. If you plan ahead, you may be able to save your assets and income for uses other than long-term care.
With effective planning, there is of course greater likelihood of being able to preserve your estate for your loved ones, by minimizing the costs of paying for long-term care. It also translates to less financial stress and emotional wear-and-tear on you and your family. The chances of being able to stay at home as long as possible and within your community will be much greater. Most importantly, it helps ensure a greater degree of independence if and when you need care.
Despite the importance of planning, a lot of people fail to do so. There are many reasons for this shortcoming. People have a natural tendency to avoid thinking of unpleasant things, of being dependent on others as we age. We don’t like to think about getting older, being disabled, becoming less independent, or needing help with our own personal care. There is also a lot of existing misinformation about long-term care needs, as well as their costs and payment options associated with these services.
For example, most people have no idea how expensive long-term care can be, and how it is paid. Many seniors don’t realize that health insurance, Medicare, and/or disability coverage do not pay for most long-term care services. Medicaid (Medi-Cal) pays for some long-term care services, but only if one qualifies due to income and financial resource limitations.
Planning for long-term care is a difficult subject of conversation in most families. Adult children may hesitate to bring up the subject, for fear that they may be patronizing their parents. They may think that their eagerness to bring up this topic may be misconstrued as not wanting to provide care for their parents “when the time comes.” Parents may not want discuss the details of their financial life with their children. It may also be as simple as not knowing how to go about the planning process itself.
In future posts, we will talk about some of the key information and resources you need to know in order to plan ahead…
The Basics of Medi-cal
October 23rd, 2010Medi-cal (called Medicaid in other states) is a program that helps low income persons and others with limited resources and high medical expenses.
Medi-Cal is different from Medicare Insurance. It is a needs-based program, and eligibility is based on the amount of income and resource a person has.
You should be aware that Medicare does not pay for all medical expenses, and usually must be supplemented with private insurance. Furthermore, there is no Medicare coverage for nursing home care beyond 100 days in any single benefit period. It also only pays for “skilled nursing care,” and therefore does not cover any “custodial care” expenses.
Also, it should be noted that there are a number of other Medi-Cal programs for special categories of consumers. This post focuses on Medi-Cal for long-term care.
Eligibility
To be eligible for Medi-Cal’s long-term care services, you must meet the requirements for: (a) income, (b) assets (real or personal property), (c) residence, and (d) citizenship.
Most of the eligibility requirements relevant to long-term care can be grouped into two general categories:
(1) those classified as categorically needy and therefore qualify for Medi-Cal;
(2) those who are medically needy and may become eligible by incurring medical expenses each month.
These categories include some low-income Medicare beneficiaries who are also eligible for Medi-Cal.
Low income individuals who receive cash assistance from programs like CalWORKS or Supplemental Security Income (SSI) qualify for Medi-Cal automatically. Other eligible groups are those who meet financial criteria but are not receiving cash assistance, including those with specific health needs like dialysis; individuals who are in a long-term care institution; or individuals who would require the level of care provided in a nursing home.
Individuals who are medically needy are those with high medical expenses who may have too much income or property to qualify as categorically needy. However, they must meet the cash assistance requirements (e.g., age, blindness, disability) to be eligible. These individuals may be eligible with or without a “share of cost.” This refers to the amount of medical expenses an individual must incur before Medi-Cal kicks in. Share of cost is determined by income.
Once you pay your monthly share of cost towards your medical expenses, you will receive a Medi-Cal card, which you can then use to pay for Medi-Cal covered services. Share of cost works like an insurance deductible. It is determined by the Medi-Cal Office and is generally defined as the difference between your gross monthly income, minus deductions and the need standard.
