Some Doctors Always Charge Medicare for the Most Expensive Office Visit

A joint investigation by ProPublica and the I-Team found hundreds of New York and New Jersey doctors who have billed Medicare exclusively for the most expensive type of office visit – even though most of their peers rarely charge the top rate.

Under Medicare billing rules, code “99215” is only to be used for the most complex office visits, when health care providers perform detailed patient examinations and make complicated medical decisions. While a simple office visit might involve diagnosing the flu or monitoring blood pressure problems, these more complex appointments require evaluations of multiple organ systems, complete medical histories or complicated medical diagnostics. Program rules describe code “99215” appointments as typically lasting 40 minutes or more.

Among the health care professionals with such a billing pattern is Dr. Alan Uliss, a Queens ophthalmologist who billed code “99215” for 100 percent of his Medicare office visits -- more than 1,900 times in 2012. That represents more than 22 percent of all the most expensive eye doctor appointments charged to Medicare in the entire state of New York that year.

The average cost of the simplest Medicare office visit is about $14. An office visit coded as "99215" costs taxpayers about $100 on average.

According to an analysis by ProPublica, Medicare paid more than $12 billion for office visits in 2012. Among those with at least 100 office visits, about 1,800 doctors billed Medicare for the most expensive code at least 90 percent of the time. In New York and New Jersey, the I-Team found 485 health providers who coded all of their returning patients' appointments at the top rate.

Nationwide, the average doctor codes 4 percent of office visits at the top rate.

Uliss, who is a retinal specialist, did not respond to repeated requests about his Medicare billing. The I-Team also inquired with the American Society of Retinal Specialists to determine how the group advises members to code Medicare office visits. No ASRS representative responded.

The fact that a health care provider bills for expensive office visits at a higher rate than his or her peers is not an indication of fraud or abuse. But critics of the Medicare program say administrators are not doing enough to flag doctors who have such billing practices.

“I think it absolutely deserved red-flagging in a situation like this,” said James Frogue, a lobbyist and author who has testified before Congress about health care fraud.

Frogue believes doctors who almost always bill for the most expensive codes should be routinely investigated for so-called upcoding, a practice whereby health care professionals charge taxpayers for services and time they don't provide.

“It’s a hard problem to solve because if patients aren’t seeing the bill, and physicians can code for whatever they want, little upcodes here and there will almost always go unnoticed,” Frogue said.

In 2012, the Health and Human Services inspector general found health providers across the country have been steadily increasing their use of the two most expensive Medicare office visit codes, from 24 percent of the time in 2001 to 41 percent of the time in 2010. The inspector general recommended the Centers for Medicare and Medicaid Services take efforts to better educate doctors and review health providers who have unusual billing patterns.

Medicare said in a statement that "CMS is working to ensure that physicians and health care providers appropriately bill for evaluation and management services."

Medicare program administrators would not comment specifically on the billing patterns of Uliss or any other physician, saying only, "it’s our assessment that it would be highly unusual for a provider to knowingly use the highest billing code (CPT 99215) for all or nearly all of his or her outpatient visits."

Source: NBCNewYork

Bronx criminal enterprise preys on HIV victims to exploit $16M of Medicaid funds

Raheel Pervez and his accomplices scraped in their dirty money by paying off hundreds of HIV patients not to fill their prescriptions, all the while billing the social health care program for millions, according to prosecutors

Pervez pled guilty last month to falsifying documents in a criminal enterprise involving pharmacies across greater New York City, Attorney General Eric Schneiderman said on Monday. Pervez will serve 1-3 years for that charge alone, Schneiderman said.

A Bronx pharmacist is facing up to 25 years behind bars for stealing $16 million of New York State’s Medicaid funds by preying on poor HIV patients.

Raheel Pervez and his cronies scraped in their dirty money by paying off hundreds of HIV patients not to fill their prescriptions, all the while billing the social health care program for millions, prosecutors said.

Pervez, 41, of Dix Hills, N.Y., already pled guilty last month to falsifying documents in a criminal enterprise involving pharmacies across greater New York City, Attorney General Eric Schneiderman said on Monday. Pervez will serve 1-3 years for that charge alone, Schneiderman said.

National HIV/AIDS activists were sickened by the scam.
“He is killing these people,” Jessica Schilling, the operations officer for the National AIDS Treatment Advocacy Project said of Pervez, noting that any extended break from an HIV medication regimen can cause fatal intolerance to the life-saving drugs. “Medication is the only thing standing between people living with HIV and dying from HIV.”

Perez and his associates operated 11 pharmacies across New York City and Long Island, including Super Value Pharmacy in Williamsbridge, Big Value Pharmacy in Melrose and Mott Haven’s Big Mart Pharmacy, where approximately 70% of HIV patients did not receive their treatment, according to the indictment.

“Pervez not only scammed taxpayers and the state’s Medicaid system, but he put the lives of poor people living with HIV at risk by convincing them to exchange prescriptions for desperately needed money, said Sean Barry, the executive director of Vocal NY.

Pervez and four associates were indicted in Bronx Supreme Court Monday. Pervez’s father, Mujahid (Peter) Pervez, also faces related indictments for corruption and grand larceny, but fled to his native Pakistan. Schneiderman’s office is seeking to extradite him back to New York.

Source: NYDailyNews

Have You Been the Victim of a Wrongful Termination?

In New York, an employer may fire an employee for any reason or even no reason at all. This is the “at-will” employment relationship. Additionally, since employment is “at-will”, the employer is free to change the terms of the relationship without any notice. This means that the employer can potentially take away your paid time off, wages, or benefits. Similarly, you are also free to leave your job at any time. 

There are laws currently in place that guarantee protection for an employee. For instance, an employer cannot fire you for discriminatory reasons. These reasons include any of the following: race, sex, color, religion, age, disabilities, national origin, and veteran status. The New York State Division of Human Rights offers protection for any employee terminated as a result of discrimination. However, certain things do give an employer the right to terminate, namely stealing from the business, engaging in sexual harassment, excessive absences or lateness, physical violence or poor job performance. 

An employer is also unable to fire an employee for being a “whistleblower.” For example, if an employee notices wrongdoing in the workplace, the employer cannot use his or her job security as leverage for silence. This is known as retaliation and it is not allowed. 

            If you have been performing your job diligently and to the best of your abilities, yet feel that your job is on the line or that the employer is treating you unfairly, don’t handle this matter alone. It is incredibly important that you speak with a knowledgeable employment law attorney to review the facts and circumstances of your situation. Attorney Inna Fershteyn is an experienced employment law attorney and can assist you in protecting your rights and keeping your job. If there are any questions, feel free to contact her with the information below.

Law Office of Inna Fershteyn and Associates, P.C.
(718) 333-2394
www.BrooklynTrustAndWill.com
1517 Voorhies Avenue, Suite 4
Brooklyn, NY 11235

Estate Planning Tips: Planning For Children with Disabilities

Planning ahead as a parent is essential when you have a disabled child. Executing a Special Needs Trust can be one of the many ways a disabled child will be taken care of. Attorney Inna Fershteyn can help you with this process. The following highlights some areas of the Special Needs Trust an individual should be thinking about:

• A parent may create a Special Needs Trust for a child with a disability that is designed to coexist with the eligibility of the government supplemental programs such as Medicaid.
• A Special Needs Trust is only available to individuals who are disabled and under the age of sixty-five.
• The trust may be funded with the assets of the individual who is disabled and must be created for his or her benefit by a parent, a grandparent, or a legal guardian of the individual or a court.
• Once the trust is created; a Trustee will be appointed and will be responsible for maintaining the trust. The Trustee has to maintain the trust because it is used to provide care for the disabled individual.

When a Special Needs Trust is appropriately drafted, the terms will prohibit the Trustee from using the trust assets to pay for items or services that are not provided by the public benefit system. The Special Needs Trust acts with government public benefits, filling in gaps and providing supplementary care that might otherwise not be accessible.

A Special Needs Trust is essential if your child is dependent on you for financial or caring needs. It is never too late to start planning for your child. If you are seeking to establish a Special Needs Trust or require some insight on Planning for your Child with Special Needs, seek an Attorney who has experience in working with families with Special Needs. Contact Attorney Inna Fershteyn today for assistance in Planning your Special Needs Trust.

Law Office of Inna Fershteyn & Associates, P.C.
(718) 333-2394
www.BrooklynTrustAndWill.com
1517 Voorhies Avenue, Suite 4
Brooklyn, NY 11235

Four Estate-Planning Documents Everyone Should Have

There's no time like the present to make sure all your estate-planning ducks are in a row.

For many people, the words "estate planning" may conjure up thoughts of large inheritances and tax shelters. But planning "isn't just about death and taxes; it's also about what happens if you get very sick and live," says G. Mark Shalloway, a West Palm Beach, Fla., attorney who specializes in elder law.

Here's are the four estate-planning documents everyone needs:

1 A will.

 

Many people think they don't need a will. But sitting down with a lawyer and completing a will is the best way to ensure your wishes will be fulfilled—and to avoid leaving anything up to the courts.

"It's often best to do a very simple will directing where things go," says Philip Bouklas, an attorney in New York. That's especially the case if there are multiple children where it's critical to name guardians for minors, he says.

An important part of the will is naming the executor who is in charge of managing an estate, including paying bills. While you don't need to tell anyone what is in your will, it's important to let your designated executor know he or she has been chosen to do that job, and it might be a good idea to inform other family members, too.

Mr. Bouklas also suggests having discussions with family members about how personal effects or family heirlooms are handled. 

"You can't just stick your head in the sand and say 'they'll figure it out,' " he says. 

There may be a temptation to do a will on the cheap, using online resources. Tread warily. Small details can end up invalidating wills or leaving your wishes unfulfilled.

2 Durable power of attorney.

 

A power of attorney can give someone else the authority to act as your "agent" and make legal and financial decisions should you become incapacitated.

Don't take this decision lightly. Unlike an executor, this could be a continuing role. "People don't give enough thought to whom they are giving power of attorney," says Michael Kirtland, a Colorado Springs, Colo., estate-planning and elder-law attorney.

Mr. Shalloway says it's important to consider that this person will be managing your finances. "You may have someone who is devoted to you, but doesn't have the skill sets for managing money," he says. 

Finally, always name a backup. Many people will name their spouse, says Mr. Kirtland. "But what happens if both are injured in a car wreck or both develop signs of dementia?"

3 Medical power of attorney.

 

This document—also known as a health-care proxy—enables any adult you designate to make medical decisions on your behalf should you be unable to make them yourself.

"Pick the person who you think is going to stay calm in a crisis," says Mr. Kirtland. "Mom was in an auto accident...and that person is being asked to make medical decisions under the stress of 'Mom is dying.' "

4 A living will.

 

A living will—sometimes known as an advanced health-care directive—specifies in writing your wishes for end-of-life care. That includes such things as whether you want to be resuscitated if your breathing or heartbeat stops, or whether you want to be kept alive through artificial respiration or feeding.

When it comes both to the medical power of attorney and living will, sit down and have a conversation with loved ones about your wishes. It may not be easy, but will help later in what will be a difficult time for your family.

Lastly, make things easier for everyone by keeping your important documents, financial records and even information about doctors and medication updated and in one place. (Just not in a safe-deposit box, which will require a power of attorney to access.)

Mr. Bouklas says he has clients who once a year or so provide him with an updated list of their bank and investment accounts, and any other important information, which he then holds in their file.

"It helps keep things a lot more orderly," he says. 

Source: The Wall Street Journal