Archive for the ‘Medicaid’ Category


April 11, 2013

Millions of Americans place their loved ones in nursing homes every year with the belief that their parents and grandparents will be cared for at all times. Unfortunately, with one out of every three nursing homes cited for abuse across the country, nursing home abuse is a very real problem in the United States. From dehydration and malnutrition to mental and sexual abuse, there are a variety of ways that residents can be mistreated in a nursing home facility. One common way many nursing home or assisted living facility residents can suffer is through overmedication.

One of the most important parts of nursing home care is ensuring nursing home residents are receiving the proper amount of medication at all times. And with the average nursing home resident taking seven to eight different medications a month, this can be a very involved process. Even with federal regulations in place to ensure nursing homes have a system to provide residents with the appropriate amount of medication according to their doctor or pharmacist’s orders, many residents suffer from overmedication every year.

In 2010, statistics from the Centers for Medicare and Medicaid Services (CMS) reported that over 17 percent of all nursing home patients were receiving antipsychotic medications that exceeded the recommended levels on a daily basis. This number has reportedly been as high as 25 percent in the state of California and even a staggering 71 percent in the state of Florida. Even more alarming statistics suggest that close to 40 percent of nursing home residents were given antipsychotic drugs in 2010 even though they were not diagnosed with psychosis.

Unfortunately, a large number of nursing home abuse cases go unreported.
The new trend of using psychoactive medication to control nursing home residents is extremely dangerous. The Food and Drug Administration estimates roughly 15,000 nursing home residents die every year from unprescribed anti-psychotics.

Full Article and Source:
How to Spot Overmedication in Nursing Homes

How To Prevent Financial Abuse of the Elderly

March 28, 2013

Elder financial abuse is an expensive drain on the U.S. economy. A study of media reports from April to June 2010 “estimated that financial exploitation cost older adults at least $2.9 billion” that year, according to a report by the Government Accountability Office, or GAO. According to the report: “The money that older adults lose in these cases is rarely recovered, and this loss can undermine both the health of older adults and their ability to support and care for themselves.”

That often means that taxpayers end up footing the bill for housing and medical care once an exploited senior has been drained of his or her assets. In fact, the report says that in 80 cases involving Utah’s elderly, that state’s Medicaid program could pony up about $900,000 in Medicaid costs alone.

The GAO report points out that unless law enforcement, the courts and adult protective services get better at protecting the assets of older adults, this country could see a sharp increase in the amount of public dollars replacing private funds that are illegally drained from their estates. And as the senior population increases, those numbers will only continue to climb. Certified Fraud Examiner Steve Lee says that “pre-grave robbing” — which often goes unreported — is an issue frequently encountered by private investigators, specialists in elder care law and colleagues.

Tom Fields’ personal experience has led him to crusade for more effective legislation targeting elder financial abuse. “There is a clear lack of protection under current laws and legislation,” says Fields, who is from Mentor, Ohio. He believes that in addition to current law being insufficient, law enforcement often has little idea of how to handle these cases.

It’s true that police reaction to cases of elder financial abuse varies widely from jurisdiction to jurisdiction, and there is little crime-specific training available to them. Many jurisdictions treat these cases as civil, rather than criminal, cases, leaving families to struggle with stopping the siphoning of an elderly person’s assets via a sluggish court system.

Full Article and Source:
How to Prevent Financial Abuse of Elderly Parents

Government takes steps to expose financial ties between drug makers and doctors

February 13, 2013

WASHINGTON D.C. – After more than a year of prodding from the Senate Special Committee on Aging, the federal government took a major step today aimed at exposing potential conflicts of interests between doctors and drug companies.

The long-awaited rule – drawn from the Physician Payments Sunshine Act – was released late Friday by the Centers for Medicare and Medicaid Services. The rule puts in place a system requiring pharmaceutical and medical device makers to disclose payments and gifts given to physicians. Consumers will have access to the information through a database administered by the U.S. Department of Health and Human Services.

Critics have long contended that the drug industry’s practice of paying doctors influences medical decisions and leads to over-prescribing medicines and patients receiving unnecessary and expensive drug treatments.

Full Article & Source:
Government takes steps to expose financial ties between drug makers and doctors

Dementia Patient "Overqualified" for Medicaid

January 20, 2013

“A man that’s worked all of his life, two to three jobs at a time has never asked for help,” said Rosemary of Gene.

“Now he severely needs help and can’t get it.” Rosemary said Gene needs medicaid to help cover the cost of assisted living or in-home care.

But because of the 1.7% social security raise, Rosemary said Gene no longer qualifies for medicaid. He’s overqualified by $15 too much in income.
Source: Dementia Patient “Overqualified” for Medicaid

Doctor Sued in Huge Prescription Fraud Case

November 28, 2012

A psychiatrist who lives in Skokie is being sued for orchestrating what federal authorities are calling the largest prescription fraud case ever in Chicago.

The defendant, Dr. Michael J. Reinstein, received illegal kickbacks from pharmaceutical companies and submitted at least 140,000 false claims to Medicare and Medicaid for antipsychotic medications he prescribed for thousands of mentally ill patients in area nursing homes, according to a civil health care fraud lawsuit filed today.

Reinstein also submitted at least 50,000 claims to Medicare and Medicaid, falsely stating that he provided “pharmacologic management” for his patients at more than 30 area nursing homes and long-term care facilities, the lawsuit alleges.

The lawsuit seeks triple damages under the False Claims Act, plus a civil penalty of $5,500 to $11,000 for each alleged false claim.

“This is the largest civil case alleging prescription medication fraud against an individual ever brought in Chicago,” said Gary S. Shapiro, Acting United States Attorney for the Northern District of Illinois.

Full Article and Source:
Doc Sued in Huge Prescription Fraud Case


August 9, 2012

We at ProbateSharks continue to have concerns about OBRA Special Needs Pooled Trusts. OBRA Trusts were created to allow people who have special needs to qualify for Medicaid by depositing their money into these trusts. The intention of these trusts was to preserve estates of disabled people by allowing them to qualify for public aid nursing homes while preserving their estate for their special needs.

Unfortunately, these trusts are being abused by certain guardians in Cook County. Elderly disabled people with large estates are being targeted for guardianships through unscrupulous methods including: Illegal removal of Powers of Attorney, deceit of the elderly by owners of guardianship companies, and inaccurate medical reports being submitted into court records to make the elderly appear to be disabled with dementia. Once the rich elderly disabled person becomes a ward of the court, the unscrupulous guardians place the wards’ estates into OBRA trusts, place the ward into for-profit Medicaid-funded nursing homes, and then deplete the estate through guardian fees, care management fees, and attorneys fees.

In other words, OBRA Trusts are being used by some to financially exploit the elderly disabled while profits are obtained for the guardians, attorneys, case managers, and for-profit nursing home owners. This is being done at the expense of the wards, and the taxpayers in the state of Illinois.

In June of this year, Governor Quinn signed Senate bill 2840, which became Public Act 97-0689.It is called the Save Medicaid Access and Resources Together (SMART) Act. Its impact is anything but friendly to Illinois seniors, especiallly those who are wards of the 18th floor of the Daley Center.

Unlike the January 1st rules changes, which were driven by federal laws, these new rules changes are almost entirely due to the well-known Illinois budget problems. The new law cuts $1.6 billion from the Medicaid budget, primarily by modifying eligibility requirements and benefits.

The biggest change made by SMART is the elimination of Pooled Payback trusts (also called OBRA d(4)(c) special needs trusts) in Medicaid planning for those over the age of 65, UNLESS THEY ARE WARDS OF THE STATE OR PUBLIC GUARDIAN!!!

Full Article and Source:

Abuse of Brain Injured Americans Scandalizes U.S.

August 1, 2012

Soon after Peter Price arrived at the Florida Institute for Neurologic Rehabilitation to recover from a brain injury, he pleaded for a rescue.

“Jess, they beat me up,” Price told his sister, Jessica Alopaeus, in May 2009. “You have to get me out of here.”

Staffers at his new home held him down and punched him in the face and groin, Price said. When Alopaeus’s efforts to transfer him stalled, Price said his desperation led him to a step aimed at speeding his release.

He swallowed five fish hooks and 22 AA batteries he’d picked up during a patient outing at Wal-Mart. After emergency surgery to remove the objects, he was allowed to transfer to another facility.

Residents at the Florida Institute have often been abused, neglected and confined, according to 20 current and former patients and their family members, criminal charges, civil complaints and advocates for the disabled.

These sources and over 2,000 pages of court and medical records, police reports, state investigations and autopsies contain an untold history of violence and death at the secluded institute known as FINR, which is located amid cattle ranches and citrus groves in Hardee County, 50 miles southeast of Tampa.

Patients’ families or state agencies have alleged abuse or care lapses in at least five residents’ deaths since 1998, two of them in the last 18 months. Three former employees face criminal charges of abusing FINR patients — one of whom was allegedly hit repeatedly for two hours in a TV room last September.

Sparse Care

The complaints underscore the problems that 5.3 million brain-injured Americans are having finding adequate care. Their numbers are growing, according to the U.S. Centers for Disease Control and Prevention, as better emergency medicine and vehicle safety mean that fewer die from traffic accidents, bullet wounds and other causes of traumatic brain injuries.

The long-term ills range from memory loss and physical handicaps to the inability to control violent anger or sexual aggression. Yet because insurance benefits for rehabilitation are scarce, less than half of those who need it receive it, according to the Brain Injury Association of America.

Organized as a company and operated for profit since 1992, FINR has become one of the largest brain-injury centers in the country, with 196 beds. Three rival providers say they know of no place bigger. Multi-site operator NeuroRestorative, owned by a holding of buyout firm Vestar Capital Partners, handles more patients.

FINR hasn’t grown by opening its doors to anyone who needs rehabilitation, customers say. Rather, its marketing is focused on the relative few who can pay bills that reach $1,850 a day.

Michigan Mandate

That includes those injured on jobs with generous worker’s compensation benefits, and car-crash victims in Michigan –which mandates unlimited lifetime benefits for automobile injury coverage.

Those who have clashed with the company over the treatment of patients say its efforts to keep costs down and extend the duration of stays take priority over care and rehabilitation.

“All people are to them is a monetary gain,” said Jana Thorpe, a professional guardian who removed one of her wards from the company’s care in 2008. “They don’t care if they do anything for them.”

Full Article and Source:
Abuse of Brain Injured Americans Scandalizes U.S.

Also See:
Patients Tell of Beatings at Rehabilitation Center

NJ Nursing Home Rebel Makes Herself Heard

July 14, 2012

Anyone who thinks nursing home residents are helpless and unable to speak up for themselves never met Donna Parisi.

Her voice works fine. In fact, she’s hoping it will be heard all the way in Washington, where federal officials are reviewing sweeping changes proposed for New Jersey’s nursing home industry.

The former teacher, who uses a wheelchair, is leading the rebellion against the state’s plan to further privatize its Medicaid program. She has spent hours trying to enlist local politicians and citizens to join her cause. She hands letters about the issue to any visitor she spots at Preakness Healthcare Center in Wayne, where she lives. She’s managed to gather 11,000 electronic signatures on a petition.

“I ask everybody who comes in here if they want to sign the petition,” she said. “I’m not done fighting this even though it is going to take a miracle to stop it, mostly because nobody seems to be doing anything to try to stop it.”

The state’s plan — for which federal approval is expected soon — involves turning the long-term-care portion of the $5 billion Medicaid budget over to the four insurance companies that manage the rest of New Jersey’s healthcare program for the poor. Proponents say this will curb rising Medicaid costs in nursing homes while providing more funding for services and equipment for people who want to remain in their homes.

But Parisi has serious concerns about letting private companies rather than state regulators set the reimbursement rates for such care. She is worried that for-profit companies will slash reimbursements, forcing nursing homes to cut staff and reduce services.

“This is going to alter how we live here and how we’re cared for,” Parisi said.

Full Article and Source:
Nursing Home Rebel Makes Herself Heard

Medicaid Approved for Comatose Freddie Lempe

July 11, 2012

A Smithfield father fighting a Raleigh hospital to keep legal guardianship of his son has been able to secure Medicaid benefits to cover the teen’s treatment for a traumatic brain injury.

Freddie Lempe, 18, has been in a coma at WakeMed since a car wreck in March 2011.

His father, Fred Lempe, says Medicaid coverage for his son was dropped in December when he turned 18.

The hospital has said that the teen was denied coverage because his father failed to file the paperwork.

It wants the court to appoint a guardian for Freddie who would be legally authorized to make all medical decisions.

Full Article and Source:
Medicaid Approved for Smithfield Teen in Coma

See Also:
Smithfield Dad Battles WakeMed Over Son’s Guardianship

Medicaid fraud audits poor investment: GAO

July 9, 2012

Lawmakers blasted a Medicaid anti-fraud program that has cost taxpayers more than five times as much as it recovered.

Since 2008, more than $102 million was spent on the Medicaid audit effort, but only $20 million in overpayments were recovered, federal investigators revealed during a Senate hearing.

“I think Congress has been complicit in this far too long,” said Sen. Scott Brown (R-MA). The Government Accountability Office determined that nearly two-thirds of the audits of state spending were “unproductive.”

Full Article and Source:
Medicaid fraud audits poor investment: GAO