Tag Archives: Medicaid

Queens doctors charged in multimillion-dollar Brooklyn Medicaid fraud ring

| agiudice@ridgewoodtimes.com


Several Queens medical practitioners were among 23 people indicted in Brooklyn for allegedly scamming the Medicaid system out of nearly $7 million and offering free sneakers to low-income and homeless people in exchange for undergoing unnecessary medical tests and treatments, Brooklyn District Attorney Ken Thompson announced Tuesday.

The 199-count indictment alleges the defendants carried out a scheme in which Medicaid recipients from low-income neighborhoods, homeless shelters and welfare offices were recruited to undergo unnecessary medical tests, and the patients received free footwear such as sneakers, shoes and boots.

Participating patients were taken to a clinic and examined by a podiatrist. The physicians then supplied the patients, even though they did not have foot problems, with footwear and medical equipment such ankle braces, knee braces or orthotic insoles.

According to the indictment, the defendants then allegedly submitted more than $6.9 million in fraudulent claims to Medicaid, Medicaid-managed health care organizations and Medicare for the medical devices.

“These defendants allegedly exploited the most vulnerable members of our society and raked in millions of dollars by doing so,” Thompson said. “The many poor people who were allegedly targeted at homeless shelters, welfare offices and soup kitchens and referred to as ‘guinea pigs’ by the defendants were exploited for hours, if not days, just because they needed a pair of shoes. That so many doctors allegedly participated in this elaborate scheme to defraud a health care system designed to help the poor is truly disgraceful.”

Thompson identified Eric Vainer, 43, of Riverside Boulevard, as the alleged mastermind and leader of the scheme, and his mother, Polina Vainer, 66, of Keating Place, in Staten Island, as his second in command.

The Queens defendants are Susan Nutakor-Doh, 48, of Forest Hills; Taesoo Kim, 28, of Long Island City; Dr. Bennu Ogorek, DPM, 64, of Forest Hills; Dr. Avia Jackson, DPM, 43, of Jamaica; and Isaacs, DPM, 63, of Flushing.

Some of the defendants were arraigned on March 31 before Brooklyn Supreme Court Justice Danny Chun on various charges including enterprise corruption, first-degree money laundering, first-degree scheme to defraud, first-degree health care fraud, first-degree falsifying business records and first-degree offering a false instrument for filing, among several other charges.

The defendants were ordered to return to court on May 19; each faces up to 25 years in prison if convicted on the enterprise corruption count.

More charges may be forthcoming, as the U.S. Attorney’s Office for the Eastern District of New York reportedly obtained warrants to seize 13 bank accounts into which payments from the defrauded, federally funded programs could be traced.


Queens-based transportation company to pay $300K to settle overbilling allegations

By Queens Courier Staff | editorial@queenscourier.com


A Queens-based company has agreed to repay Medicaid $300,000 in overcharges for the transportation of mental health patients under a settlement announced Monday by Attorney General Eric Schneiderman.

Apple Transportation of New York Inc., which serves Medicaid recipients, billed the health care program unnecessarily between January 2004 and October 2008. The rides in question were for basic livery services that required no physical assistance for outpatients of mental health programs. But Apple charged Medicaid for Ambulette services, which do include physical assistance for patients and are billed at a  higher rate.

The case was investigated by Medical Fraud Control Unit Special Investigator Nancy Calo-Kenney, Auditor Investigator Kashmir Singh, and Medical Fraud Control Unit Acting Director Amy Held.

“Those who bill Medicaid for services they did not provide are stealing from taxpayers and depriving other New Yorkers of needed assistance,” Schneiderman said. “There has to be one set of rules for everyone, and my office will not allow Medicaid providers to siphon funds from the program by over-billing.”

As part of the settlement, Apple admitted “frequently” charging for the higher-priced ambulette service over the four-year period when it wasn’t necessary based on the patients’ needs, according to the attorney general’s office.



Predicting future Medicaid growth, WellPoint acquires Amerigroup

| ctumola@queenscourier.com

Health benefits company WellPoint announced that it reached a definitive agreement to acquire managed health care company Amerigroup. With the acquisition WellPoint said it will be able to better serve those looking for quality health care at an affordable price, particularly those with Medicaid, an area it predicts will grow in the future.

WellPoint will pay $92 per share in cash for all of the outstanding shares of Amerigroup, a value of about $4.9 billion. Following approval, the acquisition should close in the first quarter of 2013.

Once complete, the company will have the largest Medicaid enrollment base, with around 4.5 million members, and a Medicaid footprint in 19 states, said WellPoint’s chair, president and CEO Angela Braly during a July 9 conference call.

Both companies currently operate in New York, and will expand the areas in the state that they already serve.

In May, Amerigroup received final approval to acquire Health Plus, one of New York’s largest Medicaid managed care companies.

As one of the country’s top managed care companies, Amerigroup has the best Medicaid managed care platform, said Braly.

“We believe the partnership represents an opportunity to capitalize on the strengths of both companies and fundamentally meet the changing landscape in the health insurance industry,” said Maureen McDonnell, Amerigroup’s vice president of external communications.

Medicaid expansion is “unquestionable,” when looked at state-by-state, said Braly. WellPoint predicts that under managed care programs, Medicaid spending will increase by almost $100 billion by the end of 2014.

“First and foremost, there are significant growth opportunities ahead in the Medicaid marketplace, both resulting from economic, demographic, and budgetary issues, as well as health care reform,” she said.

The acquisition comes less than two weeks after the Supreme Court upheld the Affordable Care Act. Part of the decision allows for states to opt out of Medicaid, the government program that provides health care for the financially needy. But WellPoint believes that despite the court’s ruling on health care reform, Medicaid will still grow.


Benefits for Veterans

| rfatoullah@queenscourier.com

Veterans with limited income who are permanently and totally disabled or 65 years or older may receive an improved pension. To receipt this benefit, the veteran must have been discharged under other than dishonorable conditions and served 90 days or more of active duty, one day of which was during World War II, the Korean War, Vietnam War or Gulf War. A Veteran Administration’s improved pension has three levels: Basic Pension, Housebound Pension and Aid & Attendance.

The first level is the Basic Pension, for which veterans 65 and older are eligible. The Veterans Administration (“VA”) classifies any veteran who reaches the age of 65 as permanently and totally “disabled.” This classification entitles the veteran or his widow to a Basic Pension. A doctor’s assessment is not necessary to confirm disability.

In order to receive the Basic Pension, the veteran must be financially eligible for the pension after a review of income and assets. The VA must determine that the veteran’s assets, excluding his home, furnishings and vehicles, are not sufficient to support him for his lifetime. A commonly used measure is whether there is $80,000 or less in assets, regardless of whether the veteran is married or single. The current maximum monthly basic pension is approximately $1,201 monthly ($12,255 annually).

The second level of pension is the Housebound Pension. To be eligible for Housebound Pension, the individual need not require assistance with activities of daily living per se, but must require some assistance as confirmed by the veteran’s personal physician. The veteran must have a single permanent disability that is 100 percent disabling and be permanently confined to his premises or have a single permanent disability that is 100 percent disabling and another disability that is 60 percent or more disabling. The maximum housebound pension is $1,248 per month ($14,977 annually). The veteran cannot receive Aid and Attendance and Housebound benefits at the same time.

The highest level awarded is Aid & Attendance. Aid & Attendance is a benefit for veterans and surviving spouses who need assistance with activities of daily living, without which they would not be able to function independently. To qualify medically, a veteran or surviving spouse must need the assistance of another person to perform daily tasks, such as eating, dressing, undressing, taking care of the nature’s needs, etc. Being blind or in a nursing home for mental or physical incapacity, or residing in an assisted living facility also qualifies. The attending physician must certify that the individual’s physical limitations are such that he cannot live independently without assistance. The current maximum monthly Aid & attendance benefit is $1,703 ($20,446 annually).

If Medicaid is covering a nursing home resident’s care, the facility will receive the pension and Aid & Attendance and the resident will receive $90 monthly for his personal needs. Due to the complex nature of benefits for veterans, it is advisable to consult a professional who can provide advice regarding what benefits may be available, and to ensure that the Veteran has his legal house in order.

Ronald Fatoullah is a leading expert in the field of elder law. He is the founder and managing attorney of Ronald Fatoullah & Associates, a law firm concentrating in elder law, Medicaid eligibility, estate planning, special needs, trusts, guardianships, & probate. He is certified as an elder law attorney by the National Elder Law Foundation, and he is the current Legal Committee Chair of the Long Island Alzheimer’s Association. This article was written with the assistance of Yan Lian Kuang-Maoga, Esq. Ms. Kuang-Maoga speaks Mandarin and Cantonese and assists with the firm’s Chinese speaking clientele. The firm’s offices are conveniently located in: Long Island, Queens, Manhattan & Brooklyn and can be reached at: 1-877-Elder Law 1-877-Estates.

Responsibilities of A Special Needs Trustee

By Queens Courier Staff | editorial@queenscourier.com

A supplemental needs trust (SNT) is a vehicle through which an individual can provide for the needs of a chronically and severely disabled beneficiary by supplementing the beneficiary’s government benefits, rather than diminishing such benefits. Many government benefit programs, including Medicaid, count the assets and income of an individual for purposes of determining eligibility for assistance. With a supplemental needs trust, however, a person such as a parent or relative may establish and fund a trust for a disabled individual without jeopardizing the beneficiary’s eligibility for Medicaid and Supplemental Security Income (SSI).

The trustee of an SNT has all the same duties of any trustee, plus the specific added responsibilities due to the special needs of the beneficiary. All trustees are responsible for the prudent investing of trust property, bookkeeping and accounting of trust activities, communicating with trust beneficiaries, tax reporting for the trust and appropriately distributing trust property to the beneficiary or beneficiaries – taking into account both current and future needs. In addition to these responsibilities, the trustee of an SNT must also inquire into the needs of the trust beneficiary, ensure that the beneficiary maintains their eligibility for public benefit programs, report to the agency or agencies administering these programs and work with the family members, social workers or other individuals providing support for the trust beneficiary.

Due to these demands, many families find that a professional trustee is better equipped to serve as trustee or as co-trustee with a family member. Professional trustees, such as banks, trust companies and some attorneys, are prepared to handle details like establishing accounts for the management of trust assets, handling trust recordkeeping, hiring and overseeing the activities of any service providers, making distribution decisions and investing trust assets.

With respect to the taxation of the trust, the trustee is responsible for notifying the IRS that the SNT has been created and requesting that the IRS issue an employer identification number. This number is necessary for opening any account in the name of the trust and is also used on the trust’s tax returns.  The trustee is also required to prepare and file annual federal and state fiduciary income tax returns and reporting any income that the trust earns.  It is critical for the trustee to know when potential tax reductions may warrant making distributions to or on behalf of the trust beneficiary.

The trustee also has sole responsibility for distribution decisions. To avoid compromising a beneficiary’s eligibility for public benefits, distributions generally should be made directly to providers of goods or services, rather than to the beneficiary. When a beneficiary receives a distribution that exceeds their allowable monthly limit, it is considered unearned income and SSI benefits are reduced on a dollar for dollar basis. If the trust beneficiary is a recipient of SSI benefits, the trustee must be aware of the income distribution guidelines so as not to jeopardize the beneficiary’s eligibility. Further, the trustee must also adhere to the guidelines posted in the trust by the grantor.

The trustee is required to look at the big picture when it comes to a request by the beneficiary for a trust distribution. A trust often initially appears to hold an excessive sum of money. However, when taking into consideration the life expectancy of the beneficiary and the anticipated use of the funds, the funds in the trust may have to be used sparingly.Accordingly, the trustee may have to deny the beneficiary a distribution if the trustee is concerned about depleting the trust assets.  It can often be easier for an independent, professional trustee to deny a beneficiary’s request rather than a family member.

Finally, the trustee has a fiduciary responsibility for the management of trust assets, even if the trustee chooses to hire professional investment managers to make day-to-day investment decisions.

SNTS are a unique and helpful tool in elder law and special needs planning. Consulting with an attorney who specializes in these fields is helpful in determining when the creation of such a trust should be utilized.

Ronald A. Fatoullah, Esq. is the principal of Ronald Fatoullah & Associates, a law firm that concentrates in elder law, estate planning, Medicaid planning, guardianships, estate administration, trusts, wills and VA benefits. The firm has offices in Forest Hills, Great Neck, Manhattan, Brooklyn and Cedarhurst, NY. Mr. Fatoullah has been named a “fellow” of the NationalAcademy of Elder Law Attorneys and is a former member of its Board of Directors. Mr. Fatoullah has been certified as an Elder Law Attorney by the National Elder Law Foundation, and he is a co-founder of Senior Umbrella Network of Queens. We wish to thank Special Needs Answers for their contribution to this article.This article was written with the assistance of Debby Rosenfeld, Esq., a senior staff attorney at the firm. Ronald Fatoullah & Associates can be reached by calling (718) 261-1700, 516-466-4422, or toll free at 1-877-ELDER-LAW or 1-877-ESTATES.