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Even If Your Child Doesn’t Receive SSI Or Medicaid, You May Still Need To Set Up A Special Needs Trust

special needs trustSocial Security Disability Insurance (SSDI) is a federal program that typically provides cash stipends to people who have paid into the Social Security system and who can’t work due to disability.  (In some cases, it is possible to receive SSDI even if you haven’t worked.) In most cases, when someone has been eligible for SSDI benefits for two years, the individual also receives Medicare, even if he or she is under age 65.

From a special needs planning perspective, SSDI benefits are fairly easy to deal with because the program does not have an asset limit or a restriction on unearned income, like interest or dividends.  This means that a millionaire who meets the program’s requirements can receive SSDI benefits alongside a completely impoverished person. It also means that from a purely financial perspective, a person with resources doesn’t need to shelter her assets in a special needs trust in order to qualify for SSDI benefits as she would have to do if she were receiving means-tested government benefits like Supplemental Security Income (SSI) or Medicaid.

But this does not mean that SSDI beneficiaries should not have special needs trusts. In fact, there are many benefits to having a special needs trust that go far beyond the ability to maintain eligibility for SSI or Medicaid. For instance, a person with a mental illness may be unable to manage money. A special needs trust would allow that person’s funds to be invested and spent appropriately by a qualified trustee.  In another case, a person with special needs may be able to handle her personal finances but she might live in an environment where she is susceptible to mistreatment by others. In this situation, a special needs trust would provide an appropriate buffer between the beneficiary and the people who would otherwise take advantage of her.

When it comes to special needs planning, you never want to take anything for granted.  Just because an SSDI beneficiary might not need Medicaid and SSI now, it doesn’t mean she won’t qualify for, or require, services from those programs in the future. For instance, an SSDI beneficiary may rely on private health insurance and Medicare, but if she loses her insurance and Medicare doesn’t cover certain medications, it might be incredibly important for that beneficiary to receive Medicaid, which could make a special needs trust essential.

Finally, there is one particular type of special needs trust, called a first-party special needs trust, that is specifically designed to hold the beneficiary’s own assets. In most of the examples above, this is the type of special needs trust that would be required. Unfortunately, only a parent, grandparent, guardian or court can establish a first-party special needs trust for the beneficiary, even if she is completely competent to create a trust on her own. Therefore, if the parent or grandparent of a person who receives SSDI has the capability, it is probably a good idea for him to create the trust for his child or grandchild, on the off-chance that it will have to be used later, instead of relying on an expensive and time-consuming court process.

There are lots of reasons to have a special needs trust beyond merely qualifying for government benefits.  If you or a loved one receives SSDI and doesn’t have a special needs trust, our attorneys can help you determine the best estate planning option to meet your needs. Contact DJ Jeyaram at DJ@Jeylaw.com or 678.325.3872.

Credit Cards and Special Needs Trusts: How They Can Work Together

Credit Card Care A special needs trust is designed to supplement the income of an individual with special needs so that she can maintain access to government benefits without necessarily sacrificing her standard of living.

But government benefits like Supplemental Security Income (SSI) and Medicaid prohibit the trustee of a special needs trust from simply giving a beneficiary cash to pay for goods and services herself. Instead, a trustee must pay vendors directly.

Credit cards offer a way for the trustee of a special needs trust to avoid giving a beneficiary cash while at the same time not serving as the beneficiary’s designated shopper.

Because a credit card is technically a loan from the credit card company to the cardholder, the goods or services purchased by a trust beneficiary using a card are not income and do not affect his access to government benefits. If the special needs trust then pays off the balance of a beneficiary’s credit card bill, the payment is likewise not considered income.

Because of this special treatment, an SSI or Medicaid beneficiary who is capable of managing her own affairs can use a credit card to make small purchases, and a trustee of a special needs trust need not micromanage every transaction.

Several very important rules apply to the use of credit cards, however.

  • First, a trustee cannot pay for any charges on the credit card that are for food or shelter.
  • Second, a trustee of a first-party special needs trust that was established with the beneficiary’s own money cannot pay for any credit card charges that a beneficiary may have incurred paying for goods or services that were used by other people because first-party trusts can only be used for the sole benefit of the person with special needs.
  • Third, a trustee should never give a credit card to a beneficiary who is incapable of managing her own financial affairs, or who is involved with people who will take advantage of her.
  • Finally, the credit card rules apply only to credit cards; debit cards are considered cash and should never be used.

Since the rules governing credit cards are complicated, it is imperative that you discuss the ongoing use of credit cards with a special needs planner prior to turning a card over to a beneficiary or paying a beneficiary’s bill.

Please contact DJ Jeyaram at DJ@Jeylaw.com or 678.325.3872 for assistance.

 

Jeyaram & Associate Medicaid Fraud Expert Interviewed On “Mostly Medicaid”

Medicaid FraudJeyaram & Associate attorney Kimberly Sheridan was interviewed about Medicaid fraud.

The segment originally aired today on the national site “Mostly Medicaid.”

To hear the interview, click here.

 

Medicare & Medicaid Deadline For Overpayment Clarified

60 Days Medicaid and Medicare RuleFederal Court Finds Sixty Day Rule Deadline Begins to Run When Put on Notice of Potential Overpayments

When the Affordable Care Act (ACA) was passed, a new requirement for reporting overpayments was created. This new obligation, often referred to as the ‘Sixty Day Rule’ requires providers who receive an overpayment of Medicare or Medicaid funds to “report and return” the overpayment to the government.

According to the statute, an overpayment must be reported and returned within sixty days of the “date on which the overpayment was identified.” Failing to do so is a violation of the False Claims Act.

Although Centers for Medicare and Medicaid Services (CMS) has provided some guidance on when an overpayment is “identified” within the context of Medicare, now a New York Federal Court has weighed in on the meaning and application of the ACA sixty-day rule as it applies to Medicaid.

In a case before a New York Federal Court, the U.S. Department of Justice asserted that a hospital improperly billed Medicaid in 2009 and 2010 and violated the FCA by delaying the return of overpayments. Such overpayments were the result of a billing system software glitch. The case was brought with the assistance of a former employee who had investigated the issue. Such employee had provided to hospital administrators a list of around 900 claims that were likely affected by the glitch which was subsequently ignored by the hospital.

The Court had to decide how to define the key term in the statute – “identified.” In the case, the former employee had not conclusively proven the identity of any overpayments. As it turned out, hundreds of the claims he listed had not actually been overpaid. However, he did recognize nearly five hundred claims that did in fact turn out to be overpaid as worthy of attention.

After looking at the legislative history and purpose, the Court concluded that the 60-day clock begins ticking when a provider is put on notice of a potential overpayment, rather than when the overpayment is conclusively ascertained. This holding is in line with CMS’s patchwork of guidance for Medicare overpayments.

As a result, providers facing a potential overpayment must take action immediately to meet the 60 day deadline and avoid False Claims liability. Every health care practice should have a protocol in place to ensure that possible overpayments are investigated in a timely manner and such investigation is documented appropriately. Failure to report overpayments within that time frame could subject providers to huge penalties.  

If you have any questions about the 60-day rule or need assistance with investigating and reporting a potential overpayment contact Danielle Hildebrand at dhildebrand@jeylaw.com.

Free Introductory Home Health Visits Don’t Violate Anti-Kickback Law

Anti-Kickback StatuteInspector General: No Kickback violation for free home health introductory visits

The Office of the Inspector General issued an advisory opinion clearing the way for home health providers who provide “introductory” home visits to individuals who eventually become their clients. The OIG advised that home healthcare providers who contact  patients after being selected by that patient and provide information to those patients about their services, do not violate the federal Anti-Kickback statute.

The Federal Anti-Kickback law makes it a criminal offense to knowingly and willfully offer, pay, solicit or receive anything of value in exchange for inducing or rewarding referrals of items or services reimbursable by a Federal health program

The OIG’s office stated that the “primary purpose of the Introductory Visit is to facilitate the patient’s transition to home health services in an effort to increase compliance with the post-acute treatment plan.” In addition, the OIG”s noted that during the “Introductory” visit, the health care provider ‘”does not provide any type of  any federally reimbursable diagnostic or therapeutic services during the Introductory Visits,” which occur where a patient is receiving care whether it’s a physician’s office, hospital or personal home. Further, the home health provider is not involved in any way in the patient’s selection process and “Introductory Visits” do not provide any actual or economic benefit to the patients. .

It’s important to reiterate, that healthcare providers should not contact the patient prior to receiving notification from the  patient that they have been selected nor can the “Introductory Visits” be a covered service under Medicare or Medicaid, or reimbursed by third-party payors. These actions could violate the Anti-Kickback statute.

To read the full opinion, click here.

For more information, please contact Kimberly Sheridan at 678-708-4703.

DCH’s “Engagement Process” Now Official

DCH Policy As of July 2015, the Department of Community’s Health’s “Engagement Process” became an official part of its Policy and Manual, section 402.5(b).

The “Engagement Process” offers providers an opportunity to discuss findings of an audit or other proposed adverse action and to possibly resolve the matter prior to any request for an Administrative Review during an Engagement Conference.

However, we strongly advise you to contact an attorney prior to requesting an Engagement Conference to help ensure the best possible outcome. 

Here is what you need to know:

  • PURPOSE: The purpose of the Engagement Conference is to discuss a proposed adverse action “with the goal of informally resolving the matter.”
  • WHO INITIATES: You. A provider may request an Engagement Conference following receipt of Initial Findings of Notice of Proposed Adverse Action letter
  • PROVIDER TIME DEADLINE: This request must be in writing within seven (7) calendar days of receipt; and submitted to Engagement@dch.ga.gov.
  • DCH TIME DEADLINE: The Engagement Conference must be held with twenty-one (21) calendar days of the receipt of the Request.
  • WAIVER: If you do not participate in the Engagement Conference and fail to provide the Department prior written notice of your absence, you waive your right to an Engagement Conference. Notice should be submitted to Engagement@dch.ga.gov. This waiver does not preclude you from requesting an Administrative Review.
  • SETTLEMENT:“The Engagement Conference is considered settlement talks, and therefore, is not admissible in any pending or future proceeding, including Administrative Review or Administrative Hearing.” This includes conduct during conferences, notes, and correspondence.
  • ACCEPTANCE/REJECTION: You have seven (7) calendar days from the date of the Conference to accept or reject the offer in writing.
    • Acceptance must be in writing and waives your right to an administrative review.
    • If you reject the offer, you have the Right to Request an Administrative Review pursuant to Policy and Procedures Manual Sections 402.6 and 505.

Remember to print a copy of any communication you have with DCH and always ask for a “read receipt” when you send an email to DCH.

If you have received a Proposed Adverse Action from the Department, please contact Kimberly Sheridan at ksheridan@jeylaw.com or 678-708-4703 for assistance.

ICD-10 Deadline Less Than 3 Months Away – Need Help?

CMS Announces Measures To Help Ease Transition

The countdown to the ICD-10 has begun in earnest, and the Centers for Medicaid & Medicare Services (CMS) has made it clear that it will not back down on the deadline of October 1, 2015. However, CMS announced on July 6, that it is adopting policies to help ease the transition to ICD-10.

The ICD-9 code sets used to report medical diagnoses and inpatient procedures will be replaced by ICD-10 code. ICD-10 will affect diagnosis and inpatient procedure coding for everyone covered by the Health Insurance Portability Accountability Act (HIPAA), not just those who submit Medicare or Medicaid claims.

Although the American Medical Association (AMA)  has long opposed the ICD-10 conversion, it issued a joint press release with CMS on July 6. The press release addresses some of the AMA’s concerns and offers some concessions by CMS. To assuage concerns from healthcare providers about inadvertent coding errors that could lead to audits and penalties, CMS has named a CMS ICD-10 Ombudsman to triage and answer questions about the submission of claims. The ICD-10 Ombudsman will be located at CMS’s ICD-10 Coordination Center. CMS has also released provider training videos and an outline of its implementation plan.

Additionally, CMS has announced that for one year past the Oct. 1, 2015, deadline, it will reimburse for incorrectly coded claims as long as that erroneous code is in the same broad family as the right one.

Providers should note that claims for services provided on or after the compliance date will need to be submitted with ICD-10 diagnosis codes; but claims for services provided prior to the compliance date should be submitted with ICD-9 diagnosis codes.

It is important for providers to have their practices ready to implement ICD-10 on October 1, 2015. If you need help with the ICD-10 transition and implementation, call Jeyaram & Associates’ Kimberly Sheridan at 678-708-4703.

Physicians Need To Be Prepared For Increased Medicare & Medicaid Fraud Scrutiny

doctor-in-handcuffs-caption-1HHS increases resources to root out and penalize fraud:  Review existing financial arrangements NOW

On June 30th the federal Department of Health and Human Services Office of the Inspector General announced that it has created a specialized unit comprised of attorneys focused on Medicare and Medicaid fraud. This announcement comes on the heels of the OIG Special Fraud Alert reminding physicians of anti-kickback liability for illegal compensation related to arrangements with healthcare institutions.

Physicians should be prepared for increased scrutiny and an uptick in enforcement actions for kickback violations. According to OIG official Lisa Re, the new unit will be targeting kickback cases and will be going after not only the individual or organization paying the kickbacks but also the recipient of the kickbacks, e.g., the physicians.

Physicians who have financial arrangements that violate the Federal Anti-Kickback Statute would not only be subject to fines in the form of Civil Money Penalties, but could also be excluded from the Medicare and Medicaid programs.

Now is the time for physicians to review existing or proposed financial arrangements to ensure that they do not pose any risk of violating the Anti-Kickback Statute.

If you have any questions about a particular arrangement our attorneys can help. Please call Danielle Hildebrand or DJ Jeyaram at 678-325-3872 for legal counsel.

Increase In Medicare Part D Fraud Investigations

medicare-fraud1On June 18th, the U.S. Department of Health and Human Services announced a nationwide sweep by the Medicare Fraud Strike Force in 17 districts. This sweep represents the largest criminal healthcare fraud takedown in the history of the Department of Justice.

The investigations led to charges against 243 individuals, including 46 doctors and 197 other medical personnel. These individual are charged with participating in Medicare fraud schemes, including prescription drug fraud, totaling approximately $712 million in false billings.

On the heels of this announcement, the Office of Inspector General issued two new reports citing its findings of numerous nationwide violations of Medicare part D, Medicare’s drug benefit program. The reports show that more than 1,400 pharmacies submitted questionable billings for opioid drugs and also point to questionable billing practices in 1,432 retail pharmacies. The OIG is calling for more action from the Centers for Medicare and Medicaid Services to implement a greater number of its recommendations for fighting fraud and abuse in Part D.

The timing of these reports signals that the prescription drug benefit in Medicare part D will continue to be on the radar for investigation and enforcement actions.

To best protect against facing investigation for violations of federal and state healthcare regulations, providers must create, consistently practice and enforce strong internal compliance programs. If you need assistance with developing a compliance program or have any questions about healthcare fraud, please call or email Kimberly Sheridan at 678-708-4702.

 

OIG Reports

https://oig.hhs.gov/oei/reports/oei-02-15-00190.pdf

https://oig.hhs.gov/oei/reports/oei-03-15-00180.pdf

 

Former DCH Attorney Joins Jeyaram & Associates

Screen shot 2015-06-26 at 2.55.32 PMMr. Harrison Kohler joins Jeyaram & Associates as counsel. Mr. Kohler brings extensive criminal defense and administrative hearing experience to the firm. He represented the Department of Community Health (DCH) for nine years in both administrative hearings and negotiations with attorneys for Medicaid providers.

Prior to joining DCH, Mr. Kohler served as an Assistant Attorney General, which included 10 years as a prosecutor in the Medicaid Fraud Control Unit. During that time, he had 90 jury trials, including both criminal and civil, in 15 different superior courts and two federal districts in Georgia.

Further, Mr. Kohler has orally argued approximately 50 appellate cases. He successfully argued Georgia v. McCollum, 505 U.S. 42 (1992), in the United States Supreme Court. In 1996 the Supreme Court Historical Society named Georgia v. McCollum as one of the most significant oral arguments heard by the United States Supreme Court between the years 1955 and 1993.

Prior to pursuing a legal career, Mr. Kohler  served three years in the United States Army, including a year in Vietnam. He was awarded the combat medical badge and the Army Commendation Medal with Oak Leaf Cluster. Mr. Kohler has also been recognized by his peers as he’s earned the AV Peer Review Rating, which identifies a lawyer with “very high to preeminent legal ability, is a reflection of the firm’s expertise, experience, integrity and overall professional excellence.”

Please help us welcome Harrison to the firm!