Healthcare Reform: Don't Forget Billions in Medicare Fraud

As the Senate debates healthcare reform and how the additional coverages would be provided, why aren't they talking about the $90 billion that has been given away for free through Medicare fraud?

A private company would close their doors if all of their earnings were being stolen by clients.  Why does the government create programs which make it possible for fraud to easily take place? 

Those of us in the healthcare industry are aware of the stories which circulate about medical equipment companies who are billing improperly to Medicare (even the Scooter Store, which advertises heavily on television with infomercials, settled a lawsuit with the federal government after an employee blew the whistle on improper claims).  Part of the problem stems from government programs which make some reimbursements a bit too large, as compared to the profitability a company would earn in the private sector - but shouldn't government pay the same as the private sector pays for products (or less, if they are guaranteeing bulk orders)?

From the government's news release on the Scooter Store fraud:

"By representing to physicians that their patients wanted and needed power wheelchairs, The SCOOTER Store obtained thousands of “Certificates of Medical Necessity” from physicians who did not know about the company’s fraudulent practices. The SCOOTER Store then billed government and private health care insurers for power wheelchairs, which were far more costly than power scooters, and collected millions of Medicare and Medicaid dollars.

The SCOOTER Store received $5,000 to $7,000 in reimbursement for each power wheelchair it sold, more than twice the amount for a scooter, which sold for around $1,500 to $2,000. Many beneficiaries had no idea what kind of equipment they were getting, until it was delivered by The SCOOTER Store.

The government’s lawsuit also alleged that The SCOOTER Store knowingly sold used power mobility equipment to beneficiaries and billed Medicare as if the equipment were new, in violation of Medicare regulations. In addition, the U.S. alleged that The SCOOTER Store charged Medicare millions for unnecessary power mobility accessories."

If seems if the government could just cut out the programs that have a bit too much frosting and whipped cream on top for certain industries, and created efficient systems for reimbursement, the billions in fraud that are saved would more than pay for additional healthcare benefits.

Check out this 60 Minutes story which aired on October 25, 2009, and profiles the billions being stolen from Medicare via fraudulent claims.  It seems it would not be that difficult to set up a better system for checking out claims to avoid this fraud, especially when people aren't just stealing a million or two million, but million after million after million without being caught. 

Medicare does not pay for long-term care and because of this, many seniors must hire their own senior caregiver and the additional cost of providing health insurance for senior caregivers is not always covered by small businesses or when a caregiver is hired directly (or when a family member must quit their job to provide for the care). 

Meanwhile, studies show the most important factor in senior care is one-on-one care services by a caregiver.  Even Medicaid-funded nursing homes often do not staff more than 1 Certified Nursing Aide for each 12 residents, which often means this nursing aide cannot adequately provide care to each senior. 

It seems eliminating the extremely high Medicare reimbursements for some medical equipment would be the first easy fix to help pay for more health insurace benefits for Americans, including benefits for senior caregivers.




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Caregivers Provide Added Safety for Seniors with Memory Loss

Seniors with memory loss, and especially seniors who have been diagnosed with Alzheimer's disease, can benefit from having a part-time or full-time caregiver.  Senior home care agencies provide training and ongoing support for caregivers who are caring for clients with memory loss.  As every day can be different for the seniro with memory loss, and because sometimes the caregiver is the first person to be blamed for anything impacted by the senior's memory loss, having the full agency team proves valuable.

In Georgia this weekend, an 87-year-old woman with Alzheimer's disease left her home alone before dawn.  Fortunately, she did have a caregiver present, who discovered her missing at 6:00 a.m. Saturday morning.  The state police and sheriff's department began a search and found her just before 9:00 a.m. This is a reminder that confusion about time and place can lead to a senior with Alzheimer's Disease placing themself in harmful situations.  Providing a caregiver can help keep their daily schedule on track, along with keeping meals and medications consistent.

The Georgia senior's wandering incident is a reminder of the realities of the challenges and needs of a senior with memory loss. 

If you are a caregiver, find out if the senior you are caring for has had a mini-mental exam given by their doctor.  This is an easy way to catch memory loss early.

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Caregiverlist's Estate Expert on Good Morning America

Caregiverlist's "Ask the Expert" section allows you to submit your senior care questions to industry experts, including Alexis Martin Neely, an attorney specializing in family law.  Alexis was a guest on Good Morning America today, discussing her recent book "Wear Clean Underwear", along with estate planning.

She also talks about 5 legal documents every family should have on Good Morning America today. 

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Sample Nursing Aide Test

Are you a family caregiver or professional caregiving looking to learn more caregiving skills to better provide care?

Anyone who has completed a caregiver training program knows the difference it can make to know how to safely transfer a patient or speak to someone with Alzheimer's Disease (use their name often, give them eye contact and don't ask too many open-ended questions).

Caregiverlist's Sample Nursing Aide Test is provided by the company who officially administers the nursing aide tests for the department of health in many states nationwide (for final certification, nursing aides must pass the state exam).

Test your caregiving skills or find out what types of questions would be on the nursing aide exam by taking our sample test (just scroll to the bottom of our Career Center) and if you really want to test your skills, take the nursing aide Practice test.

You can also read about senior care training and learn about caregiving for specific age-related illnesses in our training center and print out our senior care briefs.

Certified Nursing Aides have the ability to earn a couple dollars more per hour than caregivers without formal certification and you may also find nursing aide schools and programs on Caregiverlist, including costs and admission requirements.


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Caregiver Employment Continues to Rise

The Rising Number of Childless Seniors Spells Opportunity for Caregivers

Caregivers have another reason to celebrate their career choice, according to a report issued this week, which forecasts a growing demand for full-time care professionals.

The U.S. Census Bureau report, An Aging World: 2008, explores trends in aging across the globe, revealing that the proportion of older people will double from 7 percent to 14 percent of the total world population in just over 30 years. This translates to long-term job security for caregivers.

“The average age of the world’s population is increasing at an unprecedented rate,” according to a U.S. Census Bureau release. “The number of people worldwide 65 and older is estimated at 506 million as of midyear 2008; by 2040, that number will hit 1.3 billion.”

Caregivers might not be surprised by the staggering projections for a growing senior population, but there’s a new twist. Many U.S. citizens who are approaching their senior years do not have children to call on to provide care.

“Twenty percent of women (ages) 40 to 44 in the United States in 2006 had no biologic children,” according to the release, which raises questions about who will one day care for this sizable group of citizens.

Seniors will increasingly count on caregiving professionals in the next 20 to 30 years. Check out the senior caregiver job description, take a practice
C.N.A. test and apply for a caregiving position in your area.

Both part-time and full-time positions are available in senior care and as some seniors need around-the-clock care, many times part-time and back-up caregivers are needed for weekends and evening.


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Certified Nursing Aide Test Questions

Many senior caregivers are Certified Nursing Aides, Certified Home Health Aides or Certified Personal Care Assistants (the Department of Health in each state establishes the guidelines for caregivers staffed by licensed nursing homes, assisted living companies and senior home care agencies).

The training requirements for certification allow the hiring senior care companies to know the person will understand how to interact and care for seniors appropriately, both physical care and emotional care.  If you are a caregiver interested in obtaining certification or already have certification status in your test (you must complete a certification course at an accredited school, complete clinical assignments in the field and then pass the state exam), you may take answer Caregiverlist's "Question of the Day", take the 10-Question Sample Nursing Aide test or take the full Certified Nursing Aide Practice Test.

What kinds of questions are asked on the Certified Nursing Aide test?  You will find questions about what temperature bath water should be, use of a catheter and feeding tube, memory loss, range-of-motion exercises, bed sores, taking someone's temperature, managing for bed sores and questions about how to properly report certain items to managers and interacting with difficult clients.

Take our Sample Certified Nursing Aide test - it is free and you'll probably learn something and even if you know all the answers, being told you are "brilliant" is kind of nice!




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What is the Veteran's Caregiving Benefit?

The current administration is lobbying for better benefits for our veterans - especially with more and more servicemen surviving injuries in Iraq, while living with the loss of limbs and with ongoing needs for medical assistance and caregiving.  It seems the least we can do for these servicemen is provide for their care needs when they return home.  I know I am grateful I live in a country where, as a woman, I can wear what I want, and earn a living and grateful for the servicemen who protect us and provide for our freedoms.....I wish we could air-drop bikinis to the women in Afghanistan....but back to caregiving for the American veterans.

A question we are frequently asked is what benefits are available for retired veterans.  Here is the answer:

Veteran's of qualifying foreign wars do qualify for in-home senior caregiving services, with preapproval from a doctor and the proper documents submitted (doctors at a Veteran's hospital are your best bet for assisting with quick approval or you can also secure this benefit quickly upon discharge from a hospital with the assistance of the hospital social worker).

The veteran and their spouse, with financial assets of $80,000 or less (excluding home and cars) qualify for caregiving services in these amounts:

  • Up to $1,519 per month for a Veteran
  • Up to $976 per month for a Veteran's Spouse, even if the Veteran is deceased
  • Up to $1,801 per month for a Couple

    Any licensed senior home care agency that hires caregivers as employees and provides for all of their payroll taxes and insurances will qualify to provide for the care. 

    You may learn more about the Veteran's benefit, along with the forms to file, on this page of Caregiverlist.


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  • Coping with Caregiver Burnout

    Enjoy Summer Fun By Managing Caregiver Stress

    Summer is finally here. While many people are firing up their grills, going fishing and pulling down their beach towels, it’s common for caregivers to feel exhausted and lack the desire to be social.

    Think you might be suffering from caregiver burnout? Read on to identify the symptoms, and discover tips to help you unwind and enjoy the season.

    Here’s ten ways to tell if caregiving is putting too much stress on you, according to the U.S. Department of Health and Human Services: 

    • feeling overwhelmed
    • sleeping too much or too little
    • gaining or losing a lot of weight
    • feeling tired most of the time
    • loss of interest in activities you formerly enjoyed
    • becoming easily irritated or angered
    • feeling constantly worried
    • often feeling sad
    • frequent headaches, body pain, or other physical problems
    • abuse of alcohol or drugs, including prescription drugs

    Here are the Health and Human Services Department recommendations for reducing caregiver stress, so you can get back to enjoying the summer: 

    • Find out about caregiving resources in your community.
    • Ask for and accept help. Be prepared with a mental list of ways that others can help you, and let the helper choose what she would like to do. For instance, one person might be happy to take the person you care for on a walk a couple times a week. Someone else might be glad to pick up some groceries for you.
    • If you need financial help taking care of a senior relative, don't be afraid to ask family members to contribute their fair share.
    • Say "no" to requests that are draining, such as hosting holiday meals.
    • Don't feel guilty that you are not a "perfect" caregiver. Just as there is no "perfect parent," there is no such thing as a "perfect caregiver." You're doing the best you can.
    • Identify what you can and cannot change. You may not be able to change someone else's behavior, but you can change the way that you react to it.
    • Set realistic goals. Caregivers can break large tasks into smaller steps that you can do one at a time.
    • Prioritize, make lists, and establish a daily routine.
    • Stay in touch with family and friends.
    • Join a support group for caregivers in your situation, such as caring for someone with dementia. Besides being a great way to make new friends, you can also pick up some caregiving tips from others who are facing the same problems you are.
    • Make time each week to do something that you want to do, such as go to a movie.
    • Try to find time to be physically active on most days of the week, eat a healthy diet and get enough sleep.
    • See your doctor for a checkup. Tell her that you are a caregiver and tell her about any symptoms of depression or sickness you may be having.
    • Try to keep your sense of humor.

    Caregiverlist offers a wealth of resources for caregivers. Caregiverlist's Community section provides an opportunity for caregivers to share their story, and become inspired by stories submitted by other caregivers.

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    Home Care Workers Exempt from Overtime for Live-in Caregiving

    We are often asked about caregiver pay and the difference between hourly and live-in care.  Senior home care agencies employ caregivers and provide for all of their payroll taxes and worker's compensation insurance, as required by law.  This protects both the caregiver and the senior client they are caring for in the event of an on-the-job injury as worker's compensation will provide for the caregiver's needs and the client will not be responsible.  The payroll taxes also provide for the caregiver's retirement benefits through Social Security when they retire.  In addition, senior home care agencies have policies in place to protect the caregivers and to make sure the plan of care can be successfully implemented.

    Hourly caregivers work a set schedule of hours each week and are paid an hourly rate.  Live-in caregivers stay with a client for a few days at a time, sleeping at the client's home each night and are paid a flat daily rate for their work.  Usually live-in caregivers will receive meals and their own room to sleep in.

    Senior home care agencies do pay for overtime pay for employees who work more than 40 hours per week as hourly employees, as required by law.  However, live-in care is not considered hourly work and is paid at a daily rate and because of this, overtime pay is not provided on an hourly work week for live-in caregivers.

    The Fair Labor Standards Act (FLSA) imposes minimum wage and overtime requirements on employers and specifically exempts from overtime any employee employed in domestic service employment to provide companionship services to individuals who, because of age or infirmity are unable to care for themselves.  Live-in caregivers meet this requirement.  The Department of Labor created a controversy with respect to this exemption several years ago when it adopted seemingly conflicting regulations.  One regulation refers to persons who provide services "in or about a private home of the person by whom he or she is employed."  You have to love the legal language - they always seem to take the long way around to get to the point, or maybe they just want to make sure lawyers will always have jobs in order to translate this stuff for us.

    The other regulation, which helped confuse matters, expands the coverage to persons who are "employed by an employer or agency other than the family or households using their services."  Legal challenges to this have been made over the years, based on the argument that it is inconsistent to the first regulation.

    Then Evelyn Coke, a 73-year-old immigrant from Jamaica, sued New York based Long Island Care at Home for failure to pay her for overtime.  A federal court of appeals ruled in her favor, overturning the Department of Labor regulation, determining that it conflicted with congressional intent.  Then the Supreme Court reversed this, taking us back to where we started:  no overtime pay for companion care services.

    It is important to remember that each state maintains their own minimum wage laws and their overtime requirements, and some of these laws are specific to home care workers (this is the the term they use, rather than "caregivers").

    The basic rule you can follow is that "companionship services" are exempt from overtime when the care is not hourly.  Companionship services include household work for aged or infirm persons, meal preparation, bed making, laundry and other similar personal services.  General household work is also included, as long as it does not exceed 20 percent of the total weekly hours worked by the companion. 

    Most senior home care agencies have policies in place which require live-in caregivers to sleep at least 8 hours at night, with a minimum of getting up twice to assist the client, along with a couple of hours of downtime each evening.  At the point when a senior client needs a caregiver to get up repeatedly at night, which would not allow the caregiver to receive adequate sleep, it is time for the client to switch to hourly care.

    Note:  most senior home care agencies do pay for overtime hours at time-and-a-half for hourly caregivers who go past the 40 hour work week, even though depending on the state and the type of care assignment, they may not be required to do so.







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    Early Warning Signs for Alzheimer's Disease

    Senior caregivers know the difficulties of caring for someone with memory loss.  But sometimes when you see someone daily, you do not as easily notice some of the early warning signs for memory loss in the form of Alzheimer's Disease.  The Alzheimer's Association has been promoting their new "Know the 10 Signs" for early detection and early diagnosis of Alzheimer's Disease.

     These 10 signs include:


    1) Memory changes that disrupt daily life


    2) Challenges in planning or solving problems


    3) Difficulty completing familiar tasks at home, at work or at leisure


    4) Confusion with time or place


    5) Trouble understanding visual images and spatial relationships


    6) New problems with words in speaking or writing


    7) Misplacing things and losing the ability to retrace steps


    8) Decreased or poor judgment


    9) Withdrawal from work or social activities


    10) Changes in mood and personality

    As soon as you notice signs of memory loss, it is a good time to make sure the senior has an estate plan in place and to understand the ways to pay for senior care as many years of caregiving are often necessary for those living with memory loss.


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