President Obama Signs Bipartisan Medicare Law

Just a few days ago, President Obama signed H.R. 1845 (112th), the bipartisan Strengthening Medicare and Repaying Taxpayers (SMART) Act, which was introduced by Reps. Tim Murphy (R-PA) and Ron Kind (D-WI) in the House and Sens. Ron Wyden (D-OR), Rob Portman (R-OH), Ben Nelson (D-NE) and Richard Burr (R-NC) in the Senate.

The legislation was a bipartisan solution to streamline the Medicare Secondary Payer (MSP) system, to ensure that seniors and persons with disabilities get timely assistance and taxpayers are repaid millions of dollars every year.

The SMART Act is seen as a victory for senior advocates.

We will see how effective SMART is, as the Centers for Medicare and Medicaid Services (CMS) must still work to eliminate confusion and uncertainty by providing clear, efficient and definitive information to seniors.

Medicare Secondary Payer (MSP):

– The MSP process ensures Medicare is reimbursed for medical bills that are the responsibility of another party – such as an insurer or negligent party.

– A senior or person with disabilities who has been injured, and later obtains recourse through the legal system, often cannot access their settlement until Medicare is reimbursed for all medical cost

– The current MSP system is inefficient and slow to return dollars to the Medicare Trust Fund, which is funded by tax payer money

– It can take years for the Centers for Medicare and Medicaid Services (CMS) to report reimbursement amounts to beneficiaries and CMS can seek multiple reimbursement amounts over time, providing further delay and uncertainty

The SMART Act will:

  • Require CMS to maintain a secure web portal to access claims and reimbursement amounts in a timely fashion.

CMS must upload care payments they disperse within 15 days with the required information about the payment.

  • Streamline the process of obtaining reimbursement amounts.
  • Medicare beneficiaries must notify CMS they are anticipating a settlement no more than 120 days beforehand.
  • CMS then has 65 days to ensure the web portal is up-to-date, but may request an additional 30 days, if needed
  • Reimbursement amounts are reliable if downloaded from the web portal within three days of settlement.
  • Provide a process and timeline for discrepancies and appeals.

Medicare beneficiaries can provide documentation for discrepancies on the web portal to CMS. CMS has 11 days to respond to discrepancies.

– If CMS does not respond in 11 days, the amount calculated by the beneficiary is the correct amount.

– An additional appeal process must be established by CMS for reimbursements it attempts to collect from insurance plans.

– Create a threshold for collecting any payment amounts by CMS that are below the cost it incurs to collect an average claim.

– Readjust the penalty for reporting errors by insurers based on the violation.

– Ensure greater privacy for beneficiaries by no longer requiring use of full social security or health id claim numbers.

– Create a three year limit for CMS to seek any repayments beginning from when they were informed of an anticipated settlement.

!assisted-suicideAttorneys such as Margaret Dore in Seattle assert that Washington and Oregon laws that allow assisted suicide is a factor for increasing elder abuse. Ms. Dore explains that the Oregon and Washington assisted suicide acts have a formal application process. The acts allow an heir, who will benefit from the patient’s death, to play a large role in this process.

Once the lethal dose is issued by the pharmacy, no mechanism for oversight exists. That means that no one needs to witness the death. Without disinterested witnesses, Ms. Dore asserts, “[T]he opportunity is created for an heir, or for another person who will benefit from the patient’s death, to administer the lethal dose to the patient without his consent. One method would be by injection when the patient is sleeping. The drugs used in Oregon and Washington are water soluble and therefore injectable. If the patient woke up and struggled, who would know?”

In Washington and Oregon, the state health departments are required to collect some basic information for its annual reports. According to these reports, users of assisted-suicide are for the vast majority white and well-educated. Many have private insurance. Most are age 65 and older. People that fall into this demographic are seniors with money, which we have seen are commonly targeted and at a higher risk of financial abuse.

The forms used to collect the statistical information do not ask about abuse. Moreover, not even law enforcement is allowed to access information about a particular case. Alicia Parkman a mortality research analyst at the Center for Health Statistics, Oregon Health Authority, wrote to Ms. Dore: “We have been contacted by law enforcement and legal representatives in the past, but have not provided identifying information of any type.“

Consumer Reports warns about financial elder abuse

KOMO News reported on the growing trend of financial elder abuse with focus on Consumer Reports recent investigations.

The message to the elderly: Even those you might trust the most–your family and friends–are the ones who are in the best position to drain bank accounts and take over real estate of vulnerable senior citizens.

Sadly, these are the types of crimes most difficult to spot, as it seems from most distant observers that someone’s family or caregiver is working in the best interest of the vulnerable elder.

Financial elder abuse is on the rise per Consumer Reports’ investigation..

Nevertheless, senior citizens are the most vulnerable for scams. From forging to pleas for a loan to abuses of power of attorney.  When someone has power of attorney, they have unfettered access to your accounts. Someone who misuses those powers can decimate financial accounts, leaving them with virtually nothing.

To help prevent elder abuse:

  • Have bank and investment statements sent to a person you trust to monitor accounts.
  • Arrange for direct deposit and automatic bill pay.
  • Consult a reputable elder law attorney for advice on wills and limiting power of attorney.

Consumer Reports says there are good places to get help if you or an elderly relative is concerned about financial abuse, including the National Center on Elder Abuse, which has links to help and hotlines.

You can also get help for elders dealing with Alzheimer’s Disease or other memory loss issues, from the local Alzheimer’s Association.

Over 50% of Elder Financial Abuse Cases Involve Own Family Member

In today’s MarketWatch Reality Q&A, the sad but true fact is underscored: Over half of thisElder Financial Abuse.jpg country’s elder abuse cases involve a family member, not shady “mortgage professionals.” The column indicates that sons are most likely to scam their parents or grandparents, more so than a fraudulent contractor/handyman or paramour.

This doesn’t mean that senior citizens should trust all lenders suddenly. Make sure that the senior that you’re concerned about understands the terms of the loan and the pros/cons of going through with the loan before s/he signs on the dotted line. Reverse mortgages rank as the 8th most prevalent scam targeting the elderly.

Fresno Woman Investigated for Ripping Off Senior Citizens

A woman in Fresno, CA, Sharon Harrelson, 55, is being investigated by local police for elder financial abuse. Elderly people, such as Michael Wyrick, trusted Ms. Harrelson and thought she was a friend, when depositing money directly into her account. She convinced these senrios that she could help them with their long term care by hiding their assets.

To qualify for Medi-Cal, these vulnerable adults entrusted her with tens of thousands of dollars. Police began investigating her in 2009, and alerted her employer about her possible criminal activities.

An investigator reported that Harrelson actually admitted to her employer that she had embezzled some money when they did an audit. She was fired soon thereafter.

Sadly, this type of situation is multiplying across the country, including in the Pacific Northwest.

Bring the "Silent Epidemic" to an End

Earlier this month, a group of Senators renewed their efforts to protect seniors from elder abuse with the Elder Protection and Abuse Prevention Act. Democratic Senators, Richard Blumenthal, Al Franken, Sheldon Whitehouse, and Robert Casey introduced this bill, to craft a range of comprehensive elder abuse prevention

The bill prods more third parties to stop elder abuse when they can do so. Federal definitions of elder abuse, neglect, and exploitation would be toughened. The definitions would be better aligned with the two prior bills that adressed this issue: the Elder Justice Act and the Older American Act. Those bills never defined elder financial abuse, which is a problem of epidemic proportions among seniors in our country,

Additionally, the bill requires better coordination of elder abuse justice programs nationwide and expands the National Adult Protective Services Resource Center to provide additional services and guidance to states. The measure would also require the development of best practices for elder abuse screening and increase support for state prevention, assessment, and response services.

Each of the senators who introduced the bill touched on the fact that the exploitation has gone on for decades will little notice from those in a position to stop it. Senator Casey noted that, “we must bring this largely silent epidemic of elder abuse to an end.

Population of 90+ Year Old Tripled Within 3 Decades, Will Quadruple by 2050.

The Census Bureau reports some sobering statistics: The segment of our population that is 9!Cedar Village.jpg0 years old or older has tripled in the past three decades to 2 million. The number is projected to quadruple by 2050.

As the economy continues to limp along and the aging population jumps, an increasing number of elderly people are forced to turn to their younger relatives. Unfortunately, these family members don’t always have their vulnerable elders’ best interest in mind. This is one of the key reasons why elder financial abuse is growing at epidemic proportions.

A recent USA Today article addresses this troubling problem, reporting the opening of the first elder abuse shelter in Ohio. Despite the statistics that point to widespread abuse, the total number of elder abuse shelters in this country are in the single digits, Non profit groups fund all of them.

Word still needs to get out that our the elder abuse problem is cutting across socio-economic lines.

Holiday Season Sees Surge in Scams Preying on Seniors

This time of the year, many seniors are particularly vulnerable to elder abuse and scam artists who prey on our senior citizens.

! holiday phone scams.jpgThe following examples highlight scams regularly perpetrated against senior citizens. You are encouraged to share examples with all the senior citizens you know.

The Grandparent Scam

There are several versions of the “Grandparent” scam. In the most common version the victim will receive a call from an unknown person who will immediately say “Grandma” or “Grandpa” after the victim answers the phone. The victim will reply, “Johnny” or Janie” (the name of their grandson or granddaughter). The caller will reply, “Yes it’s your Grandson Johnny.” The caller will explain they are in trouble while visiting another country. The most common countries are Canada, Mexico, Jamaica, and Spain. The caller will claim to have been arrested and/or in jail, involved in a vehicle accident or experiencing a medical emergency and they need money wired to them urgently.

The caller will ask the victim not to contact other family members because they are embarrassed. The caller will ask for the money to be wired in the name of an unknown third-party. The amount to be wired can vary from $500.00 to $50,000.00. The largest amount wired from San Diego to China was $130,000.00. The caller said he needed emergency surgery. The hospital would not perform the procedure without a “bond” to cover the expense since the imposter did not have medical insurance in China.

What can I do? The victims in these scams have all sworn the caller sounded just like their loved one. The first thing you should do after receiving such a call is make a telephone call to a “good” phone number you have for your grandson or granddaughter. If you cannot reach them call your grandson or granddaughter’s parents to confirm they are indeed out of the country before you wire any money. Once the money has been wired and received, the money is gone!

The “International Lottery” Scam 

Another common telephone scam is the “International Lottery” scam. The caller will inform the victim they have won a substantial amount of money from the lottery of Jamaica or Canada. The victim will be instructed to wire money to cover the “taxes” associated with the prize.

The amount can range from $1,500.00 to $15,000.00. Usually the prize is worth anywhere from one to four million dollars. If money is sent, the victim will begin receiving multiple calls asking for more money to be sent to cover additional taxes, fees, and/or insurance. In reality, the victim has not won any prize and will never see any of their “winnings”. And just as the “grandparent” scam: once the money is wired and received, it’s gone!

What can I do? Before you send any money remember this, “If it sounds too good to be true, then it probably is.” Also, did you know it is against federal law to participate in an international lottery? The reason, the Federal Trade Commission says most foreign lotteries are likely to be scams and U.S. citizens send an estimated $120 million a year to foreign countries on the prospect of obtaining instant wealth. Scammers have turned to the telephone because federal law enforcement officials intercept and destroy millions of foreign lottery mailings every year.

Home Improvement Scams

There are several versions of the “home improvement” scam. An unknown and unsolicited building contractor / handyman will come to the victim’s door soliciting for work. In the most common version, this unknown person will explain they are working on a neighbor’s home and they ordered too much product for the job. They will also explain that he cannot return the materials, so they will offer to re-roof, paint, or fix cracks in the driveway of the victim’s home at a substantial savings.

The catch: the victim has to pay in cash. The amount can range from $500.00 to $5,000.00. The work on the victim’s home will look professional at first glance, but it will turn out to be substandard and it usually ends up costing the victim a substantial amount of money to repair.

The purpose of the scam is not to perform substandard work for an inflated expense. The purpose of this scam is to steal cash, jewelry, or any other property from inside the victim’s home. The victim’s home will be burglarized while they are distracted by the workers.

What can I do? Do not allow unsolicited workers into your home. If someone is soliciting work in your neighborhood, make an appointment for them to return on another day to give you time to check the credentials of business. Check their rating on the “Better Business Bureau” for example.

Vehicle Repair Scams

There are several versions of this scam. In the most common version the victim will be approached by an unknown person after the victim parks their vehicle, usually in a mini-mall. In some cases the victim was followed home. The unknown person will tell victim they are a mechanic and noticed an unusual amount smoke coming from the rear of the victim’s vehicle.

The “mechanic” will ask the victim to open the hood so they can take a look at the engine. The “mechanic” will then pull the “O2” sensor or another small component that will disable the vehicle, not allowing it to start. The “mechanic” will now ask the victim to start their car. The “mechanic” will offer to fix the car for less money than a shop or dealership. The amount can range from $300.00 to $500.00. Why, because this is usually within the amount a person can withdraw from an ATM. The “mechanic” will offer to go to a parts store that is around the corner, pay for the part and replace the defective part. In reality, the “mechanic” will leave for twenty-minutes and return with the same part, re-install it and the victim’s vehicle starts no problem.

What can I do? Thank the “mechanic” for their concern, but you would rather call a tow truck or relative to assist you. Start to call someone you trust to come help you. Once you start to introduce someone else into the situation the “mechanic” will walk away. Remember, do not open your hood or let this unknown person in your vehicle. If you become afraid, call 9-1-1 to have an officer respond. The police would like to talk to this person and document who they are.

The Immigrant Scam

This scam usually targets Spanish-speaking women. The victim will be approached in a public area, commonly a clothing store by a Hispanic female. The female will claim to be an immigrant from the interior of Mexico. She will tell the victim a sad story about how she came to the United States looking for work. She lived with an American family as a housekeeper and the family mistreated her. She ran away because of the abuse and wants to return to Mexico, but does not have enough money.

She will show the victim a bar of gold, or a bar of silver, or a diamond she took from the American family to sell in an effort to return to Mexico. An unknown male will introduce himself during the story and say he “could not help but over hear” their conversation and offer to help. The male will explain that he has a friend who works at a jewelry store and he’ll offer to take the gold, silver, or diamond to have it appraised. The male will return and tell the victim the item is worth thousands of dollars and talk the victim into buying the item for a profit from the female. In the end the victim gives the female $1,000.00 to $5,000.00 for the bar of gold, or silver or the diamond and then cannot find the unknown male to sell the item for profit. As for the bar of gold, silver or diamond, it’s fake, usually a painted lead paperweight or Cubic Zirconia gem and not worth $100.00.

What do I do? Offer to refer the female to a church or other service for assistance. But, do not engage in a business deal with unknown people you’ve just met.

Remember – If it sounds too good to be true, it probably is.

National Phone Lines Established for General Finance, Medical & Financial Abuse Advice

As of Nov. 10th, a  new national hotline for seniors and adult children of the elderly is available to deal with one of America’s biggest fraud problems: The estimated 1 out of every 5 citizens over the age of 65 who are victimized by a financial swindle/fraud. Of particular concern are seniors with mild cognitive impairment (MCI) who can perform most daily functions, but have trouble or become confused when it comes to managing their finances.! Elder phone line.jpg

In collaboration with the National Adult Protective Services Association (NAPSA), the Financial Planning Association (FPA), and Baylor College of Medicine, the Investor Protection Trust (IPT) and Investor Protection Institute (IPI) are making available three separate call-in lines – covering general finance, medical, and financial abuse questions — from 9:00 a.m. to 6:00 p.m. EST on Thursday, November 10, 2011. (See call-in details below.) Kiplinger’s Personal Finance is also a partner in the November 10th hotline project.

The toll-free hotlines will address questions and offer free advice in the following key areas:

General Finance Questions 888-227-1776. Callers are encouraged to dial into this number to speak with an expert from the Financial Planning Association about their family financial security. Callers will get answers to general financial questions, help identifying financial professionals that put your interests first and learn how to protect themselves and their loved ones from financial fraud. FPA professionals can also help initiate a conversation about money with adult children of older parents in order to help prevent elder investment fraud and financial exploitation.

Medical Questions 888-303-0430. Callers to this number can get advice from health care professionals about medical issues such as mild cognitive impairment that can impact an older person’s ability to make wise and safe financial decisions and can increase their vulnerability to elder financial abuse and exploitation. The health care professionals can help callers recognize the warning signs of vulnerability to financial abuse in themselves or loved ones and suggest referral routes for further medical screening.

Financial Abuse Questions 888-303-3297. Callers to this number will speak with an adult protective services (APS) professional about elder financial abuse and strategies for keeping themselves or older loved ones independent. Callers can get information on how to recognize the most common ways that older adults are financially exploited and methods for preventing elder financial abuse. APS professionals will also help callers take the proper steps if they suspect that a loved one is currently being financially abused or exploited.

Elder Abuse Results in $2.9 Billion Loss Per 2011 Report

A June 2011 by the MetLife Mature Market Institute (MMMI) reports that older Americans lost $2.9 billion as the result of elder abuse. This is a whopping 12% increase from the previous year. Financial Elder Abuse.jpg

A common practice among banks is to allow older customers to use signature stamps (especially for those clients who find it more difficult to sign their names on forms, etc.)

The MMMI report is a sobering reminder that elder abuse comes in many forms–not only physical and emotional, but also financial. However, if a signature stamp fall in the wrong hands, it can do much more than wreak more than a little havoc to one’s finances. Case in point: Ms. Isenberg.

Ms. Isenberg’s daughter, Liz Sanders, hired a caregiver for her bedridden mother. This caregiver, Ms. Wofford, slowly drained over 3/4 of $1 million from Ms. Isenberg’s accounts. Wofford wrote herself checks and withdrew from Wofford’s life insurance. In addition to racking up tens of thousands of dollars in debt at various department stores, Ms. Wofford treated herself to a Mercedes courtesy of Ms. Isenberg–unbeknownst to Ms. Isenberg and her daughter.

When Liz Sanders found out about how Wofford had victimized Ms. Isenberg, she also learned that restitution was not a reality. However, she was determined to make it less easy for such financial abuse to occur to other elderly Californians. She went to her state senator, Fran Pavley (D-Agoura Hills), and put together California Senate Bill 586, which would have doubled the penalties for elder and dependent adult abuse in California. It added new provisions for the issuing of signature stamps by state-organized banks and credit unions.

The legislation passed easily, backed by the AARP along with other advocates for seniors and the CA Senior Legislature. Yet, Gov. Jerry Brown vetoed the bill last week. His message with the veto was that he did not believe that the bill would prevent fraudulent use of stamps. Brown pointed to another bill that increases penalties for elder abuse embezzlement, forgery, and identity theft as sufficient.

Liz Sanders says she pursued the legislation to find justice for her mother, and also to protect other seniors who might be at risk. The process helped spread the word about this problem throughout California and the United States.

Please heed Sanders’ plight and stay mindful of common signs of financial elder abuse:

  • Unusual financial activity, abnormal purchases, unpaid bills
  • An individual seems neglected physically or his/her home seems neglected
  • An elderly person asks to add a new name to bank accounts or seeks other co-signing arrangements
  • An individaul is granted power of attorney, although the senior may not have known that person for a long period of time
  • Increasing isolation of a senior along with decreasing contact with family members/friends
  • The emergence of a sudden “new best friend,” especially of someone who is much younger than the senior.

Better to err on the side of caution and report any suspicions to local authorities, which often have a division that focuses on assisting seniors.

About Kevin

Kevin Coluccio was recently named one of the Top 10 Super Lawyers in Washington State. He has long history of successful elder abuse/neglect cases and has a stellar reputation for getting results for his injury clients in serious car crashes, pedestrian accidents, trucking accidents, maritime claims, and asbestos injury cases.