Feds recover record $4 billion from fraudulent healthcare claims - McKnight's Long Term Care News

In case you were wondering if the new enforcement techniques were a flash in the pan, take a look at this:

Feds recover record $4 billion from fraudulent healthcare claims - McKnight's Long Term Care News

The Federal Government is and will be using HEAT, Whistle blowers, Qui Tam, RACs, MICs, ZPICs and MACs to recover "overpayments" and money "stolen" from the Federally Funded programs. The $4 billion dollars referenced in the article is just the tip of the ice burg. As Health Care reform rolls out, we are expecting even more activity this year.

Sexy Fork Party a Great Success!

Wow! Thank you all so much for making our Sexy Fork networking event a huge success. It was such a privilege to share the room and enjoy the evening with such interesting and accomplished women. And you all looked fabulous!!!

Thanks especially to Mary Wills of the Good Fork. The food was just wonderful and we all enjoyed the presentation.

I will be posting more pictures on my facebook page. Please friend me on facebook or link in on LinkedIn. We should absolutely stay in touch so that we can plan another get together soon.

Thanks again for a great evening.

Mary Louisa

Ohio Chautauqua coming to Hudson

I am so excited that Hudson will be hosting a Chautauqua presentation, bringing the lives of six 1930s personalities to life under the big tent! From July 6 - 10, we have the opportunity to interact with trained scholars who assume the costume and character of historical figures including W.C. Fields, Paul Robeson, Eleanor Roosevlet and Orson Welles. The event will take place on the Hudson High School Grounds, and there will also be programs at the Hudson Library each day.

I hope to see you there!

New Proposal for testing Independent Contractor Status

Ohio will be cracking down on the misclassification of workers as independent contractors. Ohio Attorney General Richard Cordray estimates that Ohio has lost hundreds of millions of dollars in potential unemployment compensation and workers' compensation premiums and in state income.

Recent legislation has been introduced to create a uniform definition of "employee." If passed, it would replace the current independent contractor analysis with a statutory, seven-point test to determine whether a worker is an employee. Under the proposal, independent contractor status can be established only by meeting all of the following factors:

1. The individual has been and continues to be free from control and direction in connection with the performance of the service.

2. The individual customarily is engaged in an independently established trade, occupation, profession, or business of the same nature as the trade, occupation, profession, or business involved in the service performed.

3. The individual is a separate and distinct business entity from the entity for which the service is being performed or, if the individual is providing construction services and is a sole proprietorship or partnership, the individual is a legitimate sole proprietorship or a partner in a legitimate partnership.

4. The individual incurs the primary expenses and has continuing or recurring business liabilities related to the service performed.

5. The individual is liable for breach of contract for failure to complete the service in the time and manner prescribed.

6. An agreement, written or oral, express or implied, exists describing the service to be performed, the payment the individual will receive for performance of the service, and the time frame for completion of the service.

7. The service performed by the individual is outside of the usual course of business of the employer.

This test will certainly change the independent contractor landscape. Even if the new law does not pass, it is clear that the Attorney General is ready to challenge the status.

Is is time to review your independent contractor agreement?

High Risk Pools Set to Start

5,000 Ohioans May Benefit From High-Risk Pool.

In a June 26th article, the Cleveland Plain-Dealer reported "Health coverage could be a step closer in Ohio for more than 5,000 people whose pre-existing medical conditions or diseases made insurance unavailable or highly unaffordable. While this will help Ohio reduce its uninsured, it still could represent only a fraction of the state's eligible population."

But, "in serving about 5,000 residents, it will do so without incurring any state debt, because it will rely entirely on new federal health care reform money, officials said." Ohio "has picked Medical Mutual of Ohio to run the temporary program, called a high-risk insurance pool."

Law for the Masses: the Estate Plan

Today I spent some time with my partner, Scott Geneva, and I learned that everyone should be reviewing their estate planning documents this year. Typically, attorneys recommend that you should, at the very least, review your plan every 3-5 years. But this last year has seen some major changes in both Federal Estate Tax Law and in Ohio Law. Because it was so painful to go through the process the first time (not with Scott!), I told him I needed a tangible example to force me to move on this. So, he told me about a plan he reviewed last week.

As it turns out, most estate planning documents use formulas, not dollar figures when describing what money will go to whom. Instead of saying: "Leave $500,000 to my kids' trust, and the remainder of my property to my husband," the plan document Scott reviewed said: "Leave whatever can pass tax free to my kids’ trust, and the remainder to my husband." Since the client signed the plan ten years ago, the law has gone through a number of changes.

Ten years ago, a person could pass about $675,000 dollars tax free. But since then, the amount has steadily increased to 3.5 million dollars. This year a person may pass an unlimited amount of money tax free (at least under the current law). So, under the plan above, the client left "whatever would pass tax free" to her children (now an unlimited amount), and in the process, she has disinherited her husband.

Thankfully, it is a quick fix. But only if you have someone look at the documents!

Dr. Berwick nominated as Administrator for CMS

On Monday, President Obama nominated Dr. Donald Berwick for administrator of the Centers for Medicare & Medicaid Services.

If confirmed by the Senate, Berwick, president and CEO of the Institute for Healthcare Improvement, will succeed Dr. Mark McClellan. Since McClellan stepped down, there have been interim appointees. Charlene Frizzera is the current interim administrator.