Medicaid Applications

Be Aware of Trust Fund Theft At Nursing Homes

Published on: November 20, 2013 | by Ettinger Law Firm

Most fears about moving into a nursing home concern abuse and neglect. After living independent lives on one’s own, it is easy to understand why seniors may wish to avoid moving into a facility where they will rely on others (strangers) for day to day aid. Unfortunately, beyond the physical, emotional, and sexual mistreatment that can occur at these facilities, there is another risk–financial theft.

Wide Scope

As the USA Today reported recently, far too many nursing home workers use their position of control to enrich themselves at the expense of the residents in their care. One of the most common crimes is stealing discreetly from nursing home controlled trust accounts. When moving into a home, many seniors have their personal savings moved into trust funds managed by the facility. Yet, without properly oversight, those funds can be raided for personal gain without anyone ever discovering the problem. Even when it is discovered, it is sometimes too late for the senior to get any money returned. According to some advocates, this is a problem that has flown under the radar too long.

Ineligible Patients Enrolled in Medicaid Program by Agency in NY

Published on: November 6, 2013 | by Ettinger Law Firm

The New York Medicaid system is the largest in the nation. As most know, Medicaid is a joint federal-state program, paid for by both entities. While federal parameters must be met, each state is free to decide upon various details of the program, including eligibility and extensiveness of support provided. New York has elected to open Medicaid to many residents with comparatively generous support.

Of course, the more expansive system comes with a high price tag. In order to ensure every dollar spent on the program is used efficiently, the state has engaged in a recent push to crack down on Medicaid fraud.

NY Visiting Nurse Service Problem

Financial Problems at NY Nursing Home, Says Comptroller’s Audit

Published on: November 5, 2013 | by Ettinger Law Firm

A common theme in recent years regarding long-term care in New York is the shuttering of county-owned public nursing homes. Historically, facilities to provide specialized care to seniors were built in different communities, with operation and ownership in the hands of local policymakers. But with financial pressures mounting, that format is changing quickly.

In the latest news on the same topic, WAMC reported earlier last month on the state audit which found that many county homes were in poor financial health. For example, the story point to the fiscal challenges faced by the facility in Saratoga County. The report notes that the county’s entire budget was in trouble because of the cost of subsidizing the home.

According to the New York State Comptroller’s audit, the county’s general fund balance was more than halved in the period from the beginning of 2010 to the end for 2012 (from nearly $25 million to just over $10 million). This massive loss of reserves was caused almost exclusively by the increased fiscal burden of the local nursing home–Maplewood Manor. In order to keep the long-term care facility in operation, the county was forced to put $13 million into the facility from reserves.

Five Members of Long-Term Care Commission Issue Separate Report

Published on: September 25, 2013 | by Ettinger Law Firm

Yesterday we discussed the release of the federal Long-Term Care Commission’s final report. As mentioned, the major glaring issue with the report was its relative silence on financing solutions for this care. The Commission was made up of individuals with varying interests–from owners to residents–who have very different incentives. Issues regarding payment for long-term care services, particular Medicaid, is always a contentious topic. In that vein, it is perhaps not surprising that the report did not issue conclusive recommendations on that front.

Yet, that did not stop a subset of the Commission from issuing their own dissent which directly addressed the financing issue. A full version of that 17-page alternative report can be read online here.

Alternative Report

WSJ on the “Re-Thinking” of New York Medicaid

Published on: August 9, 2013 | by Ettinger Law Firm

Drastic revisions to the New York Medicaid system have been well documented in recent years. Most attention relates to a crackdown on fraud and similar cost-cutting measures. The spur for the alternations, as with so many government program decisions, is the hope of reigning in costs and ensuring the program’s viability for many years to come.

There is an assumption that saving on costs can only be accomplished by taking away available services. But that is not always the case. Take, for example, the long-term care aspect of Medicaid. The annual cost of care in a skilled nursing facility is incredibly high. New York homes have some of the steepest price tags in the country. On top of that, many residents would rather not live in the restrictive facilities in the first place. Obviously some of the most ill seniors simply must have around-the-clock care. But others who may be able to live off less intensive support are forced to move into a facility for lack of options. In other words, it is a situation where the state is paying significantly for a service that many would rather not have anyway.

Fortunately, in recent months the state has worked to flip the model, saving money and providing more tailored service in the process. A Wall Street Journal story last week touched on some of the general themes of the change.

Back to the Basics: Understanding Medicaid Asset Protection Trusts in New York

Published on: July 18, 2013 | by Ettinger Law Firm

The tremendous benefit of planning ahead for possible long-term care needs cannot be explained enough. The typical New York family is understandably most concerned about paying monthly bills, attending birthday parties, fixing up the house, and the thousand other activities that fill the day. Taking the time to think about serious illness, death, and inheritance often falls quite low on the priority list.

The motto, “I’ll cross that bridge when I get there” may work well for issues that cannot be dealt with ahead of time, but that is certainly not the case when it comes to long-term care and similar elder issues. Planning makes all the difference, not just for the senior, but also their family. That is why it is critical to fight the inertia and be prudent about planning.

The MAPT

Comptroller Claims New York Medicaid Still Rife with Waste

Published on: July 16, 2013 | by Ettinger Law Firm

News about potential fraud and waste within the New York Medicaid system keeps on coming. It seems as if every week there is a new allegations of practices which unnecessarily cost the state money in unnecessary Medicaid payments. With Governor Cuomo’s continued focus on rooting out problems with the system, we can likely expect even more information to come out regarding these issues in the next few months.

In fact, just last week the Capitol Confidential published a story discussing how the New York Comptroller, Tom DiNapoli, recently released two new audits which suggest widespread waste in the system.

One of those audits suggests that the NY Department of Health paid out more money for certain procedures than is allowed under current Medicaid rules. The administrative rules for Medicaid set specific maximum rates for certain procedures. Care providers—from nursing homes to hospitals–know those set rates. Those facilities do not necessarily get to set their own price.

Battles Continue Over New Medicaid Eligibility for NY Home Health Programs

Published on: June 25, 2013 | by Ettinger Law Firm

In an effort to more efficiently use state funds, over the past few years the New York Medicaid program has been closely analyzed by state groups looking to root out fraud. Those investigations have returned hundreds of millions of dollars back into the programs following problematic practices at New York nursing homes, senior day care facilities, and many other settings.

While rooting out excess and fraud is a net positive, one must not forget the real lives that are affected any time that changes are demanded by program officials. Many New York seniors are in delicate situations, and any time that a nursing home, at-home provider, or other entity is no longer able to operate as a result of bad practices, many seniors struggle to deal with caregiving changes.

Finding Good Elderly Home Care in New York

NY Nursing Home Kickback Settlement – Reminder of Need to Make Careful Nursing Home Choices

Published on: June 19, 2013 | by Ettinger Law Firm

The New York Medicaid program has been making many headlines in recent months. Implementation of the Affordable Care Act and efforts to control state spending all have significant implications for the program. Interestingly, these developments have opposing outcomes. As the Affordable Care Act provisions are unrolled the program will be expanded, offering services to more New Yorkers. Conversely, the state’s push to control costs and root out fraud limits services in a few ways, sometimes impacting local seniors and their families.

Fraud Repayment From Estate

On the fraud issue, the NY Daily News reported last week on a settlement reached between the Attorney General and the estate of a former nursing home owner.

Audit of NY Office of Medicaid Inspector General

Published on: May 29, 2013 | by Ettinger Law Firm

The latest developments with the NY Medicaid program relate to concerns about the performance of the state Office of Medicaid Inspector General (OMIG). The OMIG’s role is to ensure maximum efficiency of the program. Considering the constant chatter about possible program changes in order to save costs, the work of the OMIG is critical for all New York residents who rely on Medicaid assistance in any number of ways.

The OMIG identifies that its goal is “to enhance the integrity of the New York State Medicaid program by preventing and detecting fraudulent, abusive, and wasteful practices within the Medicaid program and recovering improperly expended Medicaid funds while promoting high-quality patient care.”

However, many observers have grown worried that the office is not maximizing its capabilities, allowing unnecessary funds to go out, hurting the overall efficiency of the Medicaid program. Those concerns were likely amplified in recent weeks as information came out regarding the potential abuse of adult day care programs funded by Medicaid. In addition, a congressional panel recently issued sharp criticism of the NY Medicaid program. That panel noted that New York maintains the largest Medicaid program in the country ($56 billion), and that the ballooning costs may be related, in part, to poor investigation of Medicaid fraud and abuse. The federal government pays for a portion of all Medicaid services, and so federal decision-makers can play in role in state Medicaid policy,.