Massive Medicare Fraud Alleged

Every few years it seems the federal government needs to do something to fix Medicare or risk running out of available funds for the program. One attempt to fix Medicare was undertaken in the early 2000s. It is now known as Medicare Advantage.

The program privatized parts of Medicare by turning things over to insurance companies. The idea was that insurers would do a better job of controlling costs in the program than the government.

Instead of doing that, however, a whistle-blower alleges that insurers have used the program to make billions of dollars from Medicare they are not entitled to, as The New York Times reports in “A Whistle-Blower Tells of Health Insurers Bilking Medicare.”

The alleged fraud is a relatively simple one.

Insurers are said to have used the medical coding system to make patients look sicker than they really are. As a result, the insurers easily collect more money from the government than they actually should.

The government has already announced plans to sue one insurer based on these allegations and more lawsuits against other companies are expected.

It is important for the government to stop this fraud, if true, and any other Medicare fraud.
The Medicare system is yet again close to running out of funds and in need of a fix. The government cannot afford to lose billions to fraud.

Reference: New York Times (May 15, 2017) “A Whistle-Blower Tells of Health Insurers Bilking Medicare.”

Forced to Pay for Your Parents

It is well-known and accepted that parents are required to provide care and support for their minor children. What is less well-known, is that in over half the states, adult children can be required to provide care and support for their elderly parents.

There are many laws on the books that receive very little attention because they are very rarely used. If few ever bother to attempt to enforce a law, then there is usually no reason for people to bring it up.

However, sometimes those laws do eventually become important, because of a general change in circumstances that sees those laws starting to be used more frequently.

An example of this is filial-responsibility laws.

These are laws that have been passed in 28 states that require adult children to provide financial support for their elderly parents, if the parents are unable to pay their own bills, as the Wills, Trusts & Estates Prof Blog discusses in “Filial-Responsibility Laws Could Cost You.”

These laws were not used much in the past because government programs for the elderly such as Social Security, Medicare and Medicaid provide financial support for the elderly.

Today, with people saving less and living longer, many elderly people are not able to afford the costs of their own care, which is increasing.

Nursing homes in states with filial-responsibility laws are increasingly looking to enforce them against children with parents who do not pay their bills.

This is yet another reason to make sure that you plan for your retirement and estate. If you do not, your children might be required to pay for you.

Reference: Wills, Trusts & Estates Prof Blog (May 3, 2017) “Filial-Responsibility Laws Could Cost You.”

Counting on Medicaid

People who plan to rely on Medicaid, if they ever need long-term care in a nursing home, often make a very big mistake.

Nursing home care is one of the most expensive things facing elderly people. It costs a lot of money to get long-term care in a nursing home.

Many older people do not have the money for it and do not have a realistic way of getting that money.

As a result, they look to the government to pay for that care. The government will step up through Medicaid, but only if the elderly person, who is in need of nursing home care, has no assets.

When seeking to qualify for Medicaid, however, many people make a big, big mistake.

This mistake is discussed in the Pauls Valley Daily Democrat article titled “Misunderstandings create traps in planning.”

The mistake is a simple one to explain, but it is important to make sure you understand it so you will not make it. You cannot give your assets to your children, just before you go into a nursing home, at Medicaid’s expense.

Unfortunately, that is just what many people are planning to do and it will not work.

What is the problem?

Medicaid has a five-year lookback window, which means that the program will look at any asset transfers the applicant (or anyone on his or her behalf) made within five years of needing long-term care.

If those transfers were not made at market value, then Medicaid will not pay for care until the expenses start to exceed the value of the transferred assets. There is a formula to calculate the “penalty period” that will be applied.

This simple mistake is a big source of problems for the elderly. Make sure that you understand it and ask an elder law attorney, if you have any questions about it.

Reference: Pauls Valley Daily Democrat (March 8, 2017) “Misunderstandings create traps in planning.”

Millennials Should Pay Attention to Elder Law

The Millennial generation might still have a long way to go before they reach retirement age, but they should be paying attention to elder law issues that will affect them in the future.

People of all generations tend to pay the most attention to the issues that affect them directly and immediately.

Most senior citizens do not think a lot about the cost of a college education and the availability of entry level jobs. Conversely, younger people do not think much about Social Security and Medicare. Each group has more pressing concerns that hold their attention.

However, the younger Millennial generation should pay attention to Social Security and Medicare.

Some people believe that stock markets will be bearish in the next few years. As a result, Millennials should save 25% of their current income to make sure that their retirement nest eggs grow at the appropriate rate, according to Wealth Management in “Should Millennials Double Retirement Savings Rates?”

Many Millennials will quickly point out that due to other economic factors beyond their control, they cannot afford to save 25% of their incomes, or even the traditional 10-15%.

As a result, people in that age group will be reliant to some extent on Social Security and Medicare when they retire. Since both of those programs face impending financial problems, Millennials need to pay attention to how these programs might change.

They should not consider it just an issue for older people. It will be their issue one day.

Reference: Wealth Management (Jan. 11, 2017) “Ken Thompson’s mother says she was cut out of will by late Brooklyn DA’s wife.”

The Future of Medicare

President-elect Donald Trump’s nominee to be Secretary of Health and Human Services has many worried that Medicare could undergo severe changes and cuts. However, there might be some opportunity for positive changes as well.

It is no secret that U.S. Rep. Tom Price is not a fan of Medicare or any form of federal government health coverage. Since he has been in Congress, the legislator has sought to make drastic changes to Medicare and to reduce its funding. This has many seniors and elder law advocates rightfully worried.

If he is confirmed as the next Secretary of Health and Human Services, the future of Medicare is in doubt, as Price would be in charge of overseeing the program.

However, as recently argued in “Make lemonade out of possible Medicare lemon,” there might be an opportunity for positive changes to the program.

One thing Price might do as secretary is to end Medicare at the federal level and instead give each state a block grant to administer its own replacement program. That could leave open the possibility that individual states could seek to negotiate prescription drug prices with manufacturers, which the federal government is currently prohibited from doing.

While negotiating at the state level would not be as effective at lowering prices as it would be at the federal level, it would still be helpful and Medicare patients could see their drug prices reduced.

Reference: (Dec. 26, 2016) “Make lemonade out of possible Medicare lemon.”