Dr. Mark Lachs: Addressing Capacity Assessment

Your elderly mother was just discharged from the hospital and needs a bevy of home care services if she’s not to bounce back like a bad check: visiting nurses, physical therapists, delivery of assistive equipment like a shower chair to make bathing safe. Yet the day after discharge, she curtly tells each of these well-meaning visitors to “get lost” when they knock on the door. When you politely remind her how much she hated being in the hospital and that these folks would likely prevent her from being readmitted, she tells you she understands but, “I just don’t like having strangers in my house and I’m willing to take that risk.” So what’s going on here?

On the one hand, Mom could have all her marbles and be making a decision consistent with the way she lived her life: as a rugged individualist who makes her own decisions and is willing to live with the consequences. She has capacity. It is also possible that because of any number of factors — new medications, leftover confusion from the hospital, early dementia — that she is incapacitated.

My good friend  Dr. Jason Karlawish is a pioneer in a field he calls neuroethics. He’s a geriatrician at the University of Pennsylvania who works closely with neurologists who care for and study patients with various degrees of memory loss and dementias like Alzheimer’s Disease. Last month, he gave a stunning presentation for attendees of the NYC Elder Abuse Confernce at the New School in New York City about the assessment of decision-making capacity of older adults with and without these disorders.

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Addressing Capacity Assessment

Brooklyn Doctor Accused of Massive Medicaid Fraud

Source: Brooklyn Doctor Accused of Massive Medicaid Fraud

NJ Doctor Accused of Unauthorized Medical Research on Disabled is Fired

The doctor accused of performing unauthorized medical research on intellectually disabled residents at a state institution in Union Township has been fired, a spokeswoman for the state Department of Human Services said today.
The doctor, Philip May, was let go last month after he refused to participate in an internal hearing on charges that he abused clients at the Hunterdon Developmental Center, engaged in inappropriate physical contact and falsified documents, the spokeswoman, Nicole Brossoie, said.

May’s lawyer, John A. Azzarello of Chatham, said in an e-mail message last night his client chose instead to challenge the dismissal by seeking a ruling before “a neutral arbiter.”

The department placed May on paid leave in December 2011, but did not bring administrative charges against him until last July 27 after an article in The Star-Ledger cited five sources who said they had direct knowledge of the investigation.

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N.J. Doctor Accused of Unauthorized Medical Research on Disabled is Fired

See Also:
Nurse Sues NJ Over Hunterdon Deverlopmental Center Investigation

Hunterdon Developmental Center Doctor Suspended Without Pay in Research Study Scandal

Three Hunderdon Developmental Center Managers Face Administrative Charges Over Bone Research Study

State Files Charges Against Hunderdon County Physician, Nurse

Hunderton Deverlopmental Center Pair Allegedly Performed Dangerous Tests on Disabled Residents

Doctor Sued in Huge Prescription Fraud Case

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.

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Doc Sued in Huge Prescription Fraud Case

Mount Prospect doctor charged in kickback scheme

A Mount Prospect doctor is one of nine defendants charged in a Medicare fraud scheme.

Masood Syed, 53, is facing five years in prison and a $250,000 fine if convicted.

He is accused of accepting nearly $5,000 in kickbacks from the owners of a Skokie home health care agency in exchange for referring Medicare patients, federal prosecutors said.

 

In addition to Syed, those charged include Dr. Emmanuel Nwaokocha of Skokie, two owners of Rosner Home Healthcare, Inc., a former employee of the agency, the operator of a referral agency, an office manager at a doctor’s office and two home health care marketers.

 

Prosecutors allege the kickbacks have been ongoing since 2008.

 

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Mount Prospect doctor charged in kickback scheme

TX: Biggest Medicare Fraud in History Busted in February, Says Feds

Federal officials say they have taken down the largest Medicare fraud scheme investigators have ever discovered: a $375 million dollar home healthcare scam operating in the Dallas, Texas area.

The alleged “mastermind” of the fraud, Dr. Jacques Roy, is charged with certifying hundreds of fraudulent claims for Medicare reimbursement, and pocketing millions in payments for services not needed, or never delivered. Prosecutors say the 54-year-old Dr. Roy, who was arrested today and could be sentenced to life in prison, operated a “boiler room” to churn out thousands of phony Medicare claims and recruited homeless people as fake patients

“Today, the Medicare Fraud Strike Force is taking aim at the largest alleged home health fraud scheme ever committed,” said Assistant Attorney General Lanny Breuer. “According to the indictment, Dr. Roy and his co-conspirators, for years, ran a well-oiled fraudulent enterprise in the Dallas area, making millions by recruiting thousands of patients for unnecessary services, and billing Medicare for those services.”

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Biggest Medicare Fraud in History Busted, Says Feds

See Also:
NASGA’s Open Letter to Congress: The Fleecing of Medicaid and the Taxpayer

Houston Hospital Pulls Life-Preserving Treatment Against Family’s Wishes

A hospital is now actively killing a patient whose family called me at the 11th hour yesterday, pleading to save their father’s life.

Despite the family’s desperation to protect their father’s life, and everything Texas Right to Life did for them, the hospital’s death panel declared his life futile and moved with steps to kill him.

I could not protect him, and I want to tell you what happened.

His family calls him Willie.

A few weeks ago, he was making plans to travel with his family for a vacation in Europe, but he had chest pains and went to the hospital to check what’s wrong. To his surprise, they discovered pneumonia and, shockingly, leukemia.

His doctors suggested surgery and chemo. Willie didn’t want to die. Before sedation, his daughter told me that he looked lovingly into her eyes and said, “Fight for me, baby; I ain’t done living.”

His family — armed with a medical power of attorney — obeyed his wishes and told the doctors to continue his medical care and treatment.

But his doctors disagreed. They had other plans.

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Houston Hospital Pulls Life-Preserving Treatment Against Family’s Wishes

Note: This article was written on March 20, and the author says Willie died that same afternoon.

GA Doctor Sentenced to Prison for Bilking Medicaid/Medicare

Dr. ROBERT WILLIAMS, 77, of Atlanta, Georgia, was sentenced to prison by United States District Judge Richard W. Story on federal health care fraud charges.

United States Attorney Sally Quillian Yates said, “This doctor attempted to bilk Medicare and Medicaid for over $2 million for psychological services he never provided to elderly nursing home patients. Some of the patients were dead at the time he claimed he provided services; others never received treatment. Now he’s headed to prison.”

“Many of Georgia’s neediest citizens rely on Medicaid for access to health care. The Attorney General’s office is committed to weeding out fraud so that every dollar is spent on those who need this vital assistance,” said Georgia Attorney General Sam Olens.

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Doctor Sentenced to Prison for Submitting Fraudulent Bills to Medicare and Medicaid

>Doctor’s Involvement Encouraged in Elder Investment Fraud and Financial Exploitation Program

>We have a special relationship with our doctors. We trust them and tell them intimate details about our lives. And doctors who see us regularly are likely to notice changes from visit to visit that might signal that all is not well.

That’s why some regulators and advocates for the elderly are reaching out to primary-care physicians, hoping they will use their unique position to help spot when older patients — particularly those with mild cognitive impairment — are victims of financial fraud.

About half the states so far have signed on to the Elder Investment Fraud and Financial Exploitation program that aims to train doctors on the red flags of financial exploitation and gives them the information they need to refer patients for help.

The program is run by the nonprofit Investor Protection Institute and the Baylor College of Medicine.

Diagnosing financial fraud may seem an unlikely role for busy doctors. But finances are a health issue, say regulators and geriatric specialists. Elderly patients bilked out of their savings can be under heavy stress that causes their health to deteriorate or leaves them unable to afford medicine and regular visits to the doctor.

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Doctors Asked to Keep Eye Out for Elder Fraud

>Doctor Could Get Millions For Blowing the Whistle

>A Manhattan doctor could reap a huge paycheck for exposing Medicaid fraud.

Federal prosecutors say Dr. Gabriel Feldman helped uncover New York City’s attempt to bilk taxpayers out of more than $60 million by overbilling Medicaid. If prosecutors are successful in their attempt to recover the cash, Feldman stands to get a 15% to 20% cut of the money because of the city’s whistleblower tax.

That means Feldman could receive $9 to $12 million for exposing fraud.

The feds say the city improperly approved 24-hour home care for thousands of low-income, elderly patients, even against the recommendations of doctors paid to review the cases.

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Doctor Could Get Millions for Blowing the Whistle on Medicaid Fraud