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Someone You Love Have Alzheimer’s? Here’s Why They Need An Advance Medical Directive

Advance Medical Directive

Why An Advance Medical Directive Is Important

My wife’s grandfather (we call him Opa) has the last stages of Alzheimer’s. I remember meeting him more than a decade ago and he was vibrant, funny and loved to sing.

Now, at almost 90 years old, he does not remember me and spends his days in bed asking the same questions over and over and over.

Recently my wife called to check on Opa and he was crying hysterically. She asked him what was wrong and his sobbing reply was, “Didn’t they tell you? Your grandmother is gone. She’s gone.” And then he hung up the phone.

Of course, my wife called back immediately and her grandmother answered the phone. She had been standing next to Opa (my wife’s grandfather) the entire time and clearly she was alive and well. However, what was not well was Opa’s memory.

It was heartbreaking to say the least. My wife was visibly upset. She has traveled numerous times to help him when he became sick or was hospitalized. Her grandparents live about 2 1/2 hours away.

But with a young family of our own –  including a special needs child – it’s hard for her to get away. That’s where having an Advance Medical Directive in place has been extremely helpful. Even if my wife cannot be there in person, she can at least talk to the doctors and help make decisions on Opa’s behalf.

Thankfully, before Opa’s Alzheimer’s had progressed too much, he agreed for my wife to be his Healthcare Agent and give her the legal authority to make medical decisions on his behalf.

Advance Medical Directive – Why You & Loved Ones Need It 

An Advance Medical Directive is also known as a health care proxy, durable power of attorney, medical power of attorney, or healthcare agent. The purpose of an Advance Medical Directive is to legally enable an individual to make decisions on your behalf if you cannot speak for yourself or express your wishes about your health. It also helps those individuals and your healthcare providers know about your treatment preferences. Examples of being unable to make medical decisions for yourself include:

• Permanent illness like Alzheimer’s

• Incapacity

• A coma or persistent vegetative state

• If you are having an outpatient surgical procedure and are under general anesthesia

Hospitals, doctors and other health care providers must follow your Advance Medical Directive’s decisions as if they were your own but only if the Directive is properly executed.

By having an Advance Medical Directive, a doctor clearly knows whose direction is to be followed in the event your family disagrees as to what medical treatment you would want.

When Should You Set Up An Advanced Medical Directive?

Now. The unexpected in life happens. It happened to one of our good friends. Our friend received a call that her husband had been in a car accident and was unresponsive. He ended up being in a coma for three weeks. Thankfully there was not a dispute between our friend and her husband’s parents. However, if there had been a disagreement about his medical care, an Advance Medical Directive would have been critical.

Opa named my wife as his Healthcare Agent in his Advance Medical Directive during the early stages of his diagnosis. This is important. If he had signed the document during the final stages of Alzheimer’s, the legitimacy and legality of the Advance Medical Directive could be challenged in court if there was a disagreement within her family about his medical treatment. This is why putting documentation in place before you need it is very important.

How Do You Set Up An Advance Medical Directive?

All 50 states have forms online where you can establish an Advance Medical Directive. However, the state forms do not always address the important nuances of your healthcare decisions. For example, if you are incapacitated and unable to communicate, but not terminal, what do you want your life to look like? Do you want to be somewhere you can have a pet? A room with a view? NetFlix? By having an attorney help you set up an Advance Medical Directive, you ensure that your wishes are complete and clear to everyone involved.

Where Do You Start? 

Start having conversations with your loved ones about your medical wishes. These are not easy conversations, but they are important to ensure that your desires are enacted should you be unable to make decisions about your health.

And if someone you love has Alzheimer’s or other permanent or terminal illness, it’s important to put into place an Advance Medical Directive before their health significantly declines.

Contact Us

Our attorneys specialize in setting up an Advance Medical Directives. I have more than 20 years healthcare experience – working with medical professionals and individuals who need medical help. Further, we’ve personally been through the process with our own families. I can be reached at or 678.325.3872.


Georgia Department of Community Health Approves $140 million Medicaid Rate Increase

Georgia MedicaidGeorgia doctors, nursing home operators and other healthcare providers will soon see an increase in Medicaid reimbursements. The Georgia Department of Community Health (DCH) approved a reimbursement rate increase earlier this month that will go into effect July 1, 2016.

The increase addresses concerns that low Medicaid reimbursement rates have made it difficult for practices with high volumes of Medicaid patients to be profitable. The rate increases will most likely have the biggest impact on providers in rural Georgia communities, which serve a high Medicaid population. For some providers, the Medicaid reimbursement rate will go up by more than 50% for some procedures.

The rate increases means $140 million in increased reimbursements for Georgia providers. The increase was funded by the General Assembly earlier this year, but the Department of Community Health did not approve the rate increase until the beginning of May. The total will be paid for in part out of the Georgia budget with about two thirds of the increase coming from the federal government.

Jeyaram & Associates is a full service healthcare law firm committed to helping doctors, nurses, hospitals, nursing homes, adult day care facilities, pharmacies, and Medicaid and healthcare providers. Contact DJ at or 678.325.3872.

Work In Healthcare? You Could Face Steep Fines Or Jail Time For Healthcare Fraud

Healthcare FraudNewly Released Health Care Fraud Report shows that HHS/DOJ Enforcement Efforts Remain Strong

The Department of Health and Human Services (HHS) and the Department of Justice (DOJ) recently released their annual joint report outlining the results of their healthcare fraud enforcement efforts throughout FY 2015.

The Report shows that during that period the DOJ opened 983 new criminal health care fraud investigations and over 800 new civil health care fraud investigations. Additionally, HHS investigations resulted in 800 criminal actions against individuals or entities that engaged in crimes related to Medicare and Medicaid, and 667 civil actions, CMP settlements, and administrative recoveries related to provider self-disclosure matters.

Over the course of the year, the government won or negotiated over $1.9 billion in health care fraud judgment and settlements.

High Number Of Fraud Convictions

The Report also highlights the activity of the Medicare Fraud Strike Force whose efforts resulted in over 300 guilty pleas and 48 defendant convictions throughout the year, and over 260 defendants going to jail. The Report summarizes several successful enforcement actions by the Strike Force including:

  • 2 physicians owners of a mental health clinic were each sentenced to 10+ years in prison for certifying that certain Medicare patients qualified for partial hospitalization services when they did not and paying kickbacks to group home operators and patient recruiters in exchange for referring Medicare patients;
  • An owner of a DME company was sentenced to 84 months in prison for paying kickbacks to medical clinics for fraudulent prescriptions for DME which the patients did not need; and
  • 2 home health directors were sentenced to over 10 years in prison and ordered to pay $18.6 million in restitution after pleading guilty to conspiracy to commit fraud and payment of kickbacks in exchange for Medicare referrals and home health service prescriptions.

You Could Personally Be Fined Or Go To Jail

The government is clearly cracking down and the healthcare industry should heed the warning. The Report indicates that any individual in the healthcare realm, whether physician or hospital CFO, could incur steep fines, penalties and even serve jail time for violating the Federal Anti-Kickback Statute, Stark Law and False Claims Act.

Jeyaram & Associates can help you assess and minimize your risk under these healthcare fraud and abuse laws. If you have any questions please contact Danielle Hildebrand at or 678.325.3872.

To review the Report it is available here.

Consider Creating A “Care Committee” For Your Special Needs Child

Special Needs TrustWhen setting up a special needs trust, we ask parents to designate someone to serve as their child’s trustee. The trustee’s job is to ensure the child receives the best possible care – without necessarily being the primary care giver.

The trustee oversees things like the child’s finances, overall health, housing, benefits and education. However, finding someone who is extremely knowledgeable in all of these areas and knows all of the members of your family and how they interact with one another – can be a challenge. As a result, we often recommend creating a Care Committee.

However, before we get to care committees, let’s do a quick refresher on special needs trusts. Special needs trusts are legal instruments specifically designed to hold property for a person with disabilities.

Every special needs trust has a trustee – the person responsible for managing the trust’s assets for the benefit of the person with the disability. A special needs trust gives the trustee very broad authority to use the trust funds in whatever way she thinks will best help the trust beneficiary given the beneficiary’s current and future needs and other resources.

Because the trustee of a special needs trust has these discretionary powers and cannot typically be forced to make distributions to the beneficiary, the funds in the trust do not harm the beneficiary’s ability to qualify for government benefits like Medicaid or Supplemental Security Income (SSI).

This brings us back to Care Committees. Since the trustee of the special needs trust cannot always be expected to know everything about the beneficiary’s care and needs, parents may decide to name several knowledgeable people to serve as a formal advisory committee.

The Committee can include any number of people, but it is typically composed of a small group that parents select because they understand the beneficiary’s needs. Committees are often made up of caregivers, doctors, social workers, family members, lawyers and other advocates. The Committee members are supposed to advise the trustee about the best way to utilize the trust assets, even though the trustee usually retains the ultimate authority over the disposition of the trust.

However, in some cases the trust will mandate that the trustee must follow the committee’s advice unless it is clearly against the beneficiary’s best interests.

The Care Committee also facilitates a conversation between the trustee and the beneficiary. Since this relationship can sometimes be difficult, especially if the trust beneficiary is fully competent and resents the trustee’s control over the assets, the Care Committee can advocate for the beneficiary’s needs without antagonizing the trustee.

The Committee can also take some of the pressure off of the trustee, because she will have help making difficult decisions that a lone trustee may agonize over.

Not all parents feel the need to create a Care Committee for a special needs trust, but if you are interested in establishing one, we can help you design the right committee for your family. Contact DJ Jeyaram at or 678-325.3872.

Avoid Being A Target Of HIPAA Audits | Here’s How

HIPAA AuditPhase 2 OCR HIPAA Audits Are Here – What Providers Should Do to Prepare

The Office of Civil Rights (OCR) has taken the first step in the next round of HIPAA audits.

OCR has begun to send out surveys in order to collect information from providers, health plans, and clearinghouses in preparation for phase 2 of their HIPAA audits. From the hundreds of entities receiving surveys, OCR will select over 200 providers and over 100 health plans to be audited.

It is more important than ever to make sure that you have complied with the HIPAA Rules. Here are the top 3 areas every provider should address:

1. When was the last time you conducted a Risk Assessment? If it has been more than a year or two, you should conduct a comprehensive Risk Assessment now.

If you are a small to medium sized office you can take advantage of HHS’s security risk assessment tool available on their website: SRA Tool

2. Have you recently reviewed your HIPAA policies and procedures to ensure that they are up to date and are being followed? There are three main areas that need to be addressed in your policies: Security Standards, Privacy Standards and Breach Notification Standards.

    • Security Standards – focus on how you keep Protected Health Information (PHI) secure, whether it is stored and/transmitted electronically or in some other form. Your practice must have appropriate safeguards in place (for example, requiring the use of secure passwords to access electronic health records and encrypting all devices that might contain e-PHI).
    • Privacy Standards – do you conduct periodic trainings for personnel regarding privacy practices? Do you have records that such trainings have been completed by all personnel? Is your Notice of Privacy Practices current and made available to your patients?
    • Breach Notification Standards – do you have a policy in place that outlines the steps for identifying and reporting a breach? Such a policy should address steps to take to investigate and contain the problem, as well as a means for identifying how many people were affected, who those individuals are, and how to send out breach notices. Keep in mind that under the Breach Notification Rule, providers must provide notice of a breach within a certain time frame. Your procedures for responding to a breach should allow for adequate time to meet this deadline.

3. Keeping track of your Business Associates and Business Associate Agreements – During the audit process OCR might ask for a list of business associates and their contact information. All providers should have this readily available. It is also important to have written Business Associate Agreements that are up to date and can be made available to OCR upon request.

If you have any questions about any HIPAA requirements or the approaching OCR audits our attorneys can help. Please contact Danielle Hildebrand at


The information on this site should not be construed as formal legal advice and is not intended to create or constitute a lawyer-client relationship.


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.