Posts Tagged ‘Administration on Aging’

Federal Initiative Combats Medicare and Medicaid Fraud

NOVEMBER 1, 1999 VOLUME 7, NUMBER 18

Two programs—Medicare and Medicaid—provide the majority of acute medical and long-term nursing care for America’s senior citizens. In fact, those two programs provide over one third of all medical care for Americans of all ages. With the total cost of those two programs approaching $400 billion per year, efforts have intensified to cut the cost of medical care for the poor and elderly.

Health care rhetoric frequently focuses on fraud in the Medicare and Medicaid programs. Estimates of the extent and cost of fraud are difficult to come by, but range as high as $33 billion per year (see, for example, the National Center for Policy Analysis website at www.ncpa.org/health/pdh5.html).

In response to concerns about fraud in federal health care programs, the Administration in 1995 announced the formation of a program to find and eliminate fraud. Named “Operation Restore Trust,” the initiative claimed almost $25 million in returned program dollars in its first year of operation. Originally focused on the five most populous states, the program was soon expanded into smaller states, including Arizona. Other states and agencies have also begun concerted anti-fraud efforts.

The State of New Mexico, for example, recovered almost $2 million over a six-year period from a program focusing on criminal investigations and prosecutions. A single nursing home prosecution in 1997 returned over $100,000.

Much of the fraud uncovered by federal and state investigators is subtle. Earlier this year, for example, federal prosecutors in Florida indicted Jack Campo and five other men for allegedly participating in an illegal “kickback” scheme. Doctors are accused of accepting fees for referring patients for unnecessary tests and procedures; the total loss from the actions of the defendants is alleged to be over $1 million.

Fraud in Medicare and Medicaid is not always subtle. Operation Restore Trust has unearthed instances such as a van service billing $62,000 to transport a single patient 240 times in a sixteen-month period. In another case, a single psychiatrist billed an average of 26 sessions per day, each lasting 45 to 50 minutes.

This year, Operation Restore Trust will turn its focus to fraud in nursing home care. Four years of publicity and prosecutions may have caught some of the most flagrant instances of abuse, and deterred others who now fear the possibility of public exposure and prosecution.

For more information on fraud in the Medicare and Medicaid programs, visit the Health Care Financing Administration’s internet website at www.hcfa.gov/medicaid/mbfraud.htm or the Administration on Aging’s site at pr.aoa.dhhs.gov/ort/ (the AoA is a division of the Department of Health and Human Services).

Voting Rights and Guardianship

SEPTEMBER 26, 1994 VOLUME 2, NUMBER 12

Court in Phoenix challenging Arizona’s voting laws. The challenged provisions prevent people for whom guardians have been appointed from voting in state, local or federal elections.

Arizona’s Constitution provides, in Article VII, Section 2, that “[n]o person under guardianship, non compos mentis, or insane, shall be qualified to vote at any election….” Statutes adopted to implement that provision require the Superior Court Clerk to notify the County Recorder whenever a person has been “declared insane” or had a “guardian of the person and estate” appointed. Perhaps because of the archaic language of the statute, few (if any)of Arizona’s counties comply with this requirement.

Carl Pierson, a 37-year-old Globe resident, is the plaintiff in the Center’s lawsuit. Mr. Pierson is mildly retarded, and the Gila County Public Fiduciary has been appointed as his guardian. Although he registered to vote last May, his name was removed from the voter lists this month.

The lawsuit claims that denial of the right to vote to all wards in guardianship proceedings violates the 14th Amendment to the U.S. Constitution, which guarantees “equal protection” of the law to all citizens. The suit also alleges that the Arizona provisions violate the Americans with Disabilities Act, which was adopted by Congress last year, and the Voting Rights Act.

If the lawsuit is successful, the result would probably be that guardianship wards will be permitted to vote unless someone specifically challenges their capacity to understand the voting process. Estimates indicate that over 3,000 Arizona residents are under guardianship or conservatorship.

Federal Study of Abuse

The U.S. Department of Health and Human Services has announced that it will spend a million dollars on a three-year investigation of abuse, neglect and exploitation of older Americans. Funds will come from the Administration on Aging and the Administration for Children and Families; the study will be conducted by the National Center on Elder Abuse in Washington.

Fernando Torres-Gil, assistant secretary for aging of the Department, announced the study last week. He described previous studies which indicate that as many as 1.5 million senior Americans (approximately one in 20) may be victims of abuse, and speculated that the actual numbers may be much higher.

Reasons for suspected under-reporting of abuse include the shame frequently felt by victims, as well as the fact that police and prosecutors are ill-equipped to work with the elderly. Torres-Gil described elder abuse as “the hidden shame of the American family.”

Editorial

A larger question posed by Carl Pierson’s case may go unanswered. If Mr. Pierson is able to exercise the discretion involved in voting (and all indications are that he is), why does he have a guardian? If a guardian has been appointed because Division of Developmental Disabilities rules require a guardianship proceeding as a condition of providing services, shouldn’t that law be challenged first?

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