Archive for the ‘Medicare/Medicare Billing Fraud’ Category


Change in Minnesota Elder Care Rules to Raise Nursing Home Population

Written By: Kenneth LaBore | Published On: 31st January 2014 | Category: Caregivers Resources, Medicare/Medicare Billing Fraud | RSS Feed
Protect Seniors - Lakeland Nursing Home Abuse Lawyers Kenneth LaBore and Suzanne Scheller - Enforcement of Nursing Home Rules

Protect Seniors – Lakeland Nursing Home Abuse Lawyers Kenneth LaBore and Suzanne Scheller – Enforcement of Nursing Home Elder Care Rules

New Minnesota Elder Care Rules Concerning Benefits

In a state that seems to be building more and more elder care facilities every year, new elder care rules in Minnesota could result in a rise in the nursing home population. This can increase the number of tired and overworked nursing home workers, thus contribute to an increase in nursing home neglect cases.

Starting this month, thousands of low-income elderly Minnesotans started losing the government benefits that were intended to help them stay out of nursing homes and in their own homes.

In an effort to get runaway Medicaid spending under control, Minnesota is implementing stricter rules that will make it harder for senior citizens to qualify for home care services, which could potentially leave them with no care at all or cause them to go into a nursing home that they may not want to go to.

It is estimated that there are 2,800 low-income seniors who are receiving Medicaid and other state benefits to help them with their basic living. They need help with such tasks as cooking and bathing, but they will now not qualify for help under these new rules.

New Medicaid Payment Elder Care Rules

State officials say that the changes had to be made because they had to preserve the Medicaid program, which is funded by the state and federal governments. State officials also said that the baby boomer population is overwhelming the system. Left unchecked, the Medicaid costs would cause spending to be cut on other public services, such as roads and schools.

The Minnesota Department of Human Services said that the changes will save taxpayers nearly $50 million over a four year period. However, many low-income seniors and their advocates are afraid that limiting access to home care could cost the taxpayers more because of the thousands of seniors that will be pushed out of their homes, which could reverse the gains that Minnesota has seen in the reduction of senior dependence on nursing home care and helping people remain in their neighborhoods. This means that it could become much harder for seniors to live out thir last years in their own homes.

It is estimated that the number affected by the new rooms include 22,600 low-income Minnesotans that are enrolled in the state’s Elderly Waiver program.

The Elderly Waiver program allows seniors to remain in their homes by paying for services, such as supplies and visits by skilled nurses. The average benefit received is around $1,200 per senior.

Until now, it has been somewhat easy for poor Minnesotans to qualify for this program. All they had to do was show that they needed assistance with one of their daily activities, such as dressing or bathing. The new rules say that seniors have to show that they need assistance in at least four daily activities or one critical activity, such as going to the bathroom.

There is one exception, however, and that is that seniors will not lose their waiver if they are able to show that they are at risk of homelessness, have suffered a fall that has resulted in a broken bone within 12 months, or they are at risk for self-neglect.

To help the Minnesotans losing assistance stay in their homes, there is a limited program that the state has created called Essential Community Supports. This program will cover a smaller number of services in the home. The limit is $400 per month.  

Report Suspected Violations of Elder Care Rules

Click Here For Link To Report Abuse To Adult Protection

Click Here For Link To Report Abuse To Adult Protection

For more information from the Minnesota Department of Health, Office of Health Facility Complaints concerning nursing homes, assisted living and other elder care providers view resolved complaints at the MDH website.

If you have concerns about financial exploitation or any other form of elder abuse or neglect contact Minnesota Elder Abuse Attorney Kenneth LaBore toll free at 612-743-9048 or toll free at 1-888-452-6589 or by email at KLaBore@MNnursinghomeneglect.com.

Disclaimer

Free Consultation on Issues of Elder Abuse and Neglect Serving all of Minnesota Toll Free 1-888-452-6589

Free Consultation on Issues of Elder Abuse and Neglect Serving all of Minnesota Toll Free 1-888-452-6589

 

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Minneapolis Health Care Agency Accused of Medicaid Fraud

Written By: Kenneth LaBore | Published On: 22nd January 2013 | Category: Caregivers Resources, Medicare/Medicare Billing Fraud | RSS Feed
Medicare and Medicaid Fraud in Nursing Homes - Home Care Agency Accused of Medicaid Fraud

Medicare and Medicaid Fraud in Nursing Homes – Home Care Agency Accused of Medicaid Fraud

Health Care Agency Dealing With Accused of Medicaid Fraud

Medicare and Medicaid fraud occurs in nursing homes, home health agencies, and other care facilities and companies.

Right now, the operator of a home health agency based in Minneapolis is accused of filing over $400,000 in fraudulent Medicaid billings. This is the operator’s second bout with legal trouble sine doing business in the city.

Abshir M. Ahmed was charged with health care fraud earlier in January in federal court. The 40-year-old is accused of false claims being submitted between January 2008 and June 2011 through Lucky Home Health Care for services that were not performed by the health care providers.

This is just one of the many cases of Medicaid fraud that have occurred in Minnesota, as financial abuse by agencies that serve the aging population is a growing issue. It was stated in 2009 by the Legislative Auditor that much of this has to do with a lack of oversight by the state, leaving the personal care industry vulnerable to such abuses. In fact, there were a total of 423 instances in which the health care agencies would say their care assistants worked over 24 hours in a single day.

Being that the services that are provided are to elderly individuals, they are very important and financial abuses can hurt the industry and the patients.

Ahmed’s previous episode of legal trouble occurred in the late 1990s while he co-owned a restaurant. The restaurant was cited a number of times for severe health violations. If he is convicted of health care fraud, he could face 10 years in prison.

Report Suspected Abuse and Neglect –  When Accused of Medicaid Fraud

Click Here For Link To Report Abuse To Adult Protection

Click Here For Link To Report Abuse To Adult Protection

For more information from the Minnesota Department of Health, Office of Health Facility Complaints concerning nursing homes, assisted living and other elder care providers view resolved complaints at the MDH website.

If you have concerns about financial exploitation or any other form of elder abuse or neglect contact Minnesota Elder Abuse Attorney Kenneth LaBore toll free at 612-743-9048 or toll free at 1-888-452-6589 or by email at KLaBore@MNnursinghomeneglect.com.

Disclaimer

Free Consultation on Issues of Elder Abuse and Neglect Serving all of Minnesota Toll Free 1-888-452-6589

Free Consultation on Issues of Elder Abuse and Neglect Serving all of Minnesota Toll Free 1-888-452-6589

 

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Medicare does not pay for “PREVENTABLE INJURIES” in Hospitals

Written By: Kenneth LaBore | Published On: 23rd June 2012 | Category: Caregivers Resources, Medicare/Medicare Billing Fraud | RSS Feed

Medicare Won’t Pay for Preventable Injuries and Medical Errors

Originally Published in 2008

Published: September 30, 2008

Medicare will no longer pay for preventable injuries also known as “never events”.

ST. PAUL — If an auto mechanic accidentally breaks your windshield while trying to repair the engine, he would never get away with billing you for fixing his mistake. On Wednesday, Medicare will start applying that logic to American medicine on a broad scale when it stops paying hospitals for the added cost of treating patients who are injured in their care.

Dr. Peter Cole with Cynthia Kehborn prior to her surgery at Regions Hospital in St. Paul, Minn. Mr. Cole’s initials are written on Ms. Kehborn’s leg to indicate which ankle to operate on.

Medicare, which provides coverage for the elderly and disabled, has put 10 “reasonably preventable” conditions on its initial list, saying it will not pay when patients receive incompatible blood transfusions, develop infections after certain surgeries or must undergo a second operation to retrieve a sponge left behind from the first. Serious bed sores, injuries from falls and urinary tract infections caused by catheters are also on the list.
Officials believe that the regulations could apply to several hundred thousand hospital stays of the 12.5 million covered annually by Medicare. The policy will also prevent hospitals from billing patients directly for costs generated by medical errors.

Preventable Injuries According to Medicare

Because Medicare is the largest insurer in the country, its decision to refuse payment for preventable conditions has already influenced others — public and private — to set similar criteria.

Over the last year, four state Medicaid programs, including New York’s, have announced that they will not pay for as many as 28 “never events” (so called because they are never supposed to happen). So have some of the country’s largest commercial insurers, including WellPoint, Aetna, Cigna and

Blue Cross Blue Shield plans in seven states. A number of state hospital associations, including here in Minnesota, have brokered voluntary agreements that members will not bill for medical errors. In April, Maine became the first state to ban the practice statutorily.

The Congressionally mandated Medicare measure is not projected to yield large savings — $21 million a year, compared with $110 billion spent on inpatient care in 2007. But it carries great symbolism in the Bush administration’s efforts to revamp the country’s medical payment system, which has long been criticized as driving up costs through perverse incentives that reward the quantity of care more than the promotion of health.

The real money, many health economists believe, may come from reorienting the payment system to encourage prevention and chronic disease management and to discourage unnecessary procedures. The two major-party presidential candidates support such a realignment, a rare point of consensus in a polarized health care debate.
“This is a specific case of the larger pay-for-performance trend, the idea that you should pay more for quality than lack of quality, or in this case pay less for defects,” said Dr. Donald M. Berwick, president of the Institute for Healthcare Improvement. “This whole trend is like a juggernaut, and it is not going to stop.”

For the rest of the story see the New York Times: http://www.nytimes.com/2008/10/01/us/01mistakes.html?pagewanted=2&_r=2

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Be on the Look out for Medicare and Medicaid Fraud in Minnesota Nursing Homes

Written By: Kenneth LaBore | Published On: 7th February 2010 | Category: Medicare/Medicare Billing Fraud, Nursing Home Care Issues | RSS Feed
Medicare and Medicaid Fraud in Nursing Homes

Medicare and Medicaid Fraud in Nursing Homes

False Billing to Medicare and Medicaid Fraud in Nursing Homes

Medicaid Fraud can occur in a number of different ways. In many instances, the nursing home staff will not provide the documentation needed to Medicaid or Medicare. In other instances, the nursing home make false claims to Medicare or Medicare on your behalf in attempt to bolster profits from the facility. Nursing Homes and other Medicare and Medicaid medical providers are required to only bill for actual services provided to residents. If you suspect that services billed to Medicaid and Medicare is not being provided, then it may be fraud contact a nursing home fraud lawyer to assist you investigate the matter and hold the facility or other perpetrator accountable.

Medicare and Medicaid Fraud

The rules and regulations surrounding healthcare fraud are complex, we can assist you in ensuring the care is provided as needed and that the facility is held accountable for any attempts to defraud the state or federal government. There is both a state and federal False Claims Act, create a cause of action against facilities that participate in Medicare and/or Medicare Fraud. This type of claim is often called a “Qui tam” claim and the “whistleblower” may be entitled to compensation for original source information which substantiates fraud sufficient to receive the support of the Minnesota Attorney General’s office or the federal Department of Justice.

When it comes to how you handle your finances, under the Minnesota Nursing Home Residents’ Bill of Rights, you have the right to “manage your own personal financial affairs, unless a court has decided otherwise. You may delegate this responsibility to the facility for a period of time. The facility must provide you with at least a quarterly accounting of your financial transactions.”

The Vulnerable Adults Act Prohibits Financial Exploitation of Nursing Home Residents

Minnesota Statute § 626.5572, Subd. 9. Financial exploitation.”Financial exploitation” means:

(a) In breach of a fiduciary obligation recognized elsewhere in law, including pertinent regulations, contractual obligations, documented consent by a competent person, or the obligations of a responsible party under section 144.6501, a person:

(1) engages in unauthorized expenditure of funds entrusted to the actor by the vulnerable adult which results or is likely to result in detriment to the vulnerable adult; or

(2) fails to use the financial resources of the vulnerable adult to provide food, clothing, shelter, health care, therapeutic conduct or supervision for the vulnerable adult, and the failure results or is likely to result in detriment to the vulnerable adult.

(b) In the absence of legal authority a person:

(1) willfully uses, withholds, or disposes of funds or property of a vulnerable adult;

(2) obtains for the actor or another the performance of services by a third person for the wrongful profit or advantage of the actor or another to the detriment of the vulnerable adult;

(3) acquires possession or control of, or an interest in, funds or property of a vulnerable adult through the use of undue influence, harassment, duress, deception, or fraud; or

(4) forces, compels, coerces, or entices a vulnerable adult against the vulnerable adult’s will to perform services for the profit or advantage of another.

(c) Nothing in this definition requires a facility or caregiver to provide financial management or supervise financial management for a vulnerable adult except as otherwise required by law.

A nursing home billing for care they are not providing or substandard care may be participating in Medicare or Medicaid fraud for failing to use the financial resources of the vulnerable adult to provide food, clothing, shelter, health care, therapeutic conduct or supervision for the vulnerable adult, and the failure results or is likely to result in detriment to the vulnerable adult.

If you or a loved one has suffered an injury from neglect or abuse in a nursing home or other care facility that serves the elderly in Minnesota please contact our firm for a free consultation and information regarding the obligations of the facility and your rights as a resident or concerned family member. To contact Attorney Kenneth L. LaBore, directly please send an email to KlaBore@MNnursinghomeneglect.com, or call Ken at 612-743-9048 or toll free at 1-888-452-6589.

Disclaimer

Free Consultation on Issues of Elder Abuse and Neglect Serving all of Minnesota Toll Free 1-888-452-6589

Free Consultation on Issues of Elder Abuse and Neglect Serving all of Minnesota Toll Free 1-888-452-6589

 

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