The Ridgewood Blog Brings a Free Market Laissez-faire Point of View to Local, New Jersey State and National Issues.
There’s no denying that any type of vehicle accident is very stressful and can seriously impact both your physical and mental health. Unfortunately, one of the biggest concerns that victims have is related to the upcoming medical bills they will be forced to pay.
Continue reading Struggling To Afford Your Medical Bills After An Accident? Here Are Some Tips
from Hemant Bhatt
Ridgewood NJ, according to the Star Ledger, out of 544,000 people on average applying annually for green cards, 382,000 (More than 70%) fall into the categories that would be subject to review of restricting issue of Green Cards, if they use Medicaid, food stamps, housing vouchers or other forms of public assistance.
Continue reading 70% of All Those Applying for Green Cards would meet “Public Charge ” Criteria
the staff of the Ridgewood blog
TRENTON NJ, Attorney General Gurbir S. Grewal and the Office of the Insurance Fraud Prosecutor (“OIFP”) today announced charges against 19 individuals for their alleged participation in an $11 million “medicine-for-cash” insurance fraud scheme that was run by a Manhattan pharmacy owner and operated across New York and New Jersey.
As alleged in the charging documents, the scheme exploited the fact that pharmacies that purchase prescription drugs from wholesalers or distributors can return those drugs for a partial refund if the drugs expire before being sold. Pharmacies can recoup up to 85 percent of the price they paid for the drugs.
Continue reading AG Grewal Announces Charges Against 19 Individuals in $11 Million Medicine for-Cash Insurance Fraud Ring
the staff of the Ridgewood blog
Teaneck NJ, Attorney General Gurbir S. Grewal and the Office of the Insurance Fraud Prosecutor announced today that a Licensed Clinical Social Worker in Bergen County has been charged with second-degree health care claims fraud for allegedly billing the Medicaid program for mental health rehabilitation services never provided to at-risk children and adolescents under her professional care through a state-run program.
Gloria Andrade, 56, of Teaneck, was also charged with Medicaid fraud (3rd degree), theft by deception (3rd degree), and falsifying records (4th degree) in an indictment handed up by a state grand jury in Trenton on Monday.
June 29, 2017
the staff of the Ridgewood blog
Lakewood NJ, Ocean County Prosecutor Joseph D. Coronato and State Comptroller Philip James Degnan announced today the first of multiple ongoing arrests within Lakewood, New Jersey by the Ocean County Prosecutor’s Office for defrauding Medicaid and government assistance programs. The investigations initiated by the Federal Bureau of Investigation’s Red Bank Office and the New Jersey Office of the State Comptroller – Medicaid Fraud Division, were expanded to include the US Social Security Administration, New Jersey Department of the Treasury – Office of Criminal Investigation, and the Ocean County Prosecutor’s Office – Economic Crimes Unit. Today’s initial arrests include charges of collecting $1.3 million in illegal benefits.
Prosecutor Coronato stated, “Financial assistance programs are designed to alleviate family hardships for those truly in need. My office gave clear guidance and notice to the Lakewood community in 2015 of what is considered financial abuse of these programs. Those who choose to ignore those warnings by seeking to illegally profit on the backs of taxpayers will pay the punitive price of their actions.”
OCPO detectives/prosecutors, along with its collaborating agencies, began the first phase of the operation by arresting two married couples. Mordechai, 37, and Jocheved, 35, Breskin of Blue Jay Way in Lakewood, were arrested and charged with 2nd Degree Theft by Deception for wrongfully collecting approximately $585,662 in Medicaid, SNAP, HUD and SSI benefits between January 2009 thru December 2014. Zalmen, 39, and Tzipporah, 35, Sorotzkin of Olive Court collecting approximately $338,642 in Medicaid, SNAP, HUD and SSI benefits between January 2009 and April 2014. A Detention Hearing is scheduled for 1:30 pm today at Ocean County Superior Court.
The nature of the criminal events investigated and basic charges allege that the defendants misrepresented their income, declaring amounts that were low enough to receive the program’s benefits, when in fact their income was too high to qualify. The investigations revealed that the defendants’ received income from numerous sources that they failed to disclose on required program applications. As a result, they received benefits that they were not entitled to under these programs for themselves or family members.
“This operation highlights the success of federal, state and county cooperation in New Jersey’s effort to combat Medicaid and other government benefits fraud,” State Comptroller Degnan said. “My office will continue to ensure that only individuals and families truly in need of benefits receive them, and that those who choose to steal from New Jersey taxpayers are referred for prosecution.”
The Ocean County Prosecutors Office is prosecuting the above arrested individuals at the state level. The Federal Bureau of Investigations arrested four additional individuals as a part of its’ role in the comprehensive review of financial assistance programs. Information regarding the FBI facilitated arrests continues below:
Rachel Sorotzkin, 32, and Mordechai Sorotzkin, 35, are charged by complaint with one count of conspiring to steal government funds. Yocheved Nussbaum, 40, and Shimon Nussbaum, 42, also of Lakewood, are charged in a separate complaint with one count of conspiring to steal government funds. The Sorotzkins and the Nussbaums, all of Lakewood, are expected to make their appearances this afternoon before U.S. Magistrate Judge Douglas E. Arpert in Trenton federal court.
According to the complaints:
From 2011 through 2014, Rachel and Mordechai Sorotzkin applied for and received Medicaid health insurance benefits for themselves and their children. After being approved for Medicaid benefits in August of 2011, the Sorotzkins received significant windfalls – including a lump sum payment of $1 million from Rachel Sorotzkin’s business in April of 2013 – which they failed to report to Medicaid officials. Despite earning in excess of $1 million in each of the 2012 and 2013 calendar years, the Sorotzkins continued to use their Medicaid cards, ultimately defrauding the government of approximately $96,000 in taxpayer-funded medical care.
In a separate scheme, Yocheved and Shimon Nussbaum applied for and received public benefits for themselves and their children from 2011 through 2014, despite their significant income. In the years prior to and during the conspiracy, the Nussbaums created a variety of companies that were nominally run by relatives but were actually controlled by the Nussbaums.
They opened various bank accounts in the names of these companies and used funds from these accounts to cover personal expenses.
In applying for Medicaid, Section 8 housing, and SNAP food benefits, the Nussbaums grossly underreporting their true income by failing to include the income from these business accounts. Despite annual income of up to as high as approximately $1.8 million in 2013, the Nussbaums continued to receive taxpayer-funded health, housing and food benefits through August of 2014, ultimately defrauding the government of approximately $178,000.
The conspiracy counts each carry a maximum potential penalty of up to five years in prison and a $250,000 fine, or twice the gross gain or loss from the offense.
Acting U.S. Attorney Fitzpatrick in his press release credited special agents with the FBI, under the direction of Special Agent in Charge Timothy Gallagher in Newark; the Ocean County Prosecutor’s Office, under the direction of Ocean County Prosecutor Joseph D. Coronato; the New Jersey Office of the State Comptroller, under the direction of State Comptroller Philip James Degnan; the New Jersey Department of the Treasury – Office of Criminal Investigation; under the direction of Special Agent in Charge Charles Giblin; Social Security Administration – Office of the Inspector General, under the direction of Special Agent in Charge John Grasso; and criminal investigators of the U.S. Attorney’s Office with the investigation leading to today’s arrests.
The government is represented by Assistant U.S. Attorney Molly S. Lorber of the U.S. Attorney’s Office Criminal Division in Trenton.
The investigation by all the participating agencies is continuing and additional arrests are forthcoming. OCPO and our prosecuting partners may add additional relevant charges (ie. Tax charges) as each case proceeds through the legal process. Anyone with any information is asked to contact Sergeant Mark Malinowski of the Ocean County Prosecutor’s Office at (732) 929-2027.
The media and the public are reminded that criminal charges are only allegations and that each defendant is presumed innocent unless and until proven guilty in court. See Photos below courtesy the Ocean County Jail:
BRESKIN, MORTECHAI DOVID
BRESKIN, JOCHEVED ALIZA
SOROTZKIN, ZALMEN
SOROTZKIN, TZIPPORAH
Ocean County Prosecutors office announced on June 28th that, along with its collaborating agencies, continued Monday’s operation by arresting the following three married couples. Hearings are scheduled for 1:30 pm today (6/28) at Ocean County Superior Court.
Yitzchock, 33, and Sora, 39, Kanarek of Brisk Lane – charged with 2nd Degree Theft by Deception for wrongfully collecting approximately $339,002.56 in Medicaid, SNAP, HUD, and SSI benefits between January 2009 and July 2014.
Chaim, 40, and Liatt, 39, Ehrman of Twin Oaks Drive – charged with 2nd Degree Theft by Deception for wrongfully collecting approximately $185,692.22 in Medicaid, SNAP, HEAP, and Sandy benefits between January 2011 and December 2015
William, 45, and Faigy, 40, Friedman of Leigh Drive – charged with 2nd Degree Theft by Deception for wrongfully collecting approximately $149,842.28 in Medicaid, SNAP, HEAP, and HUDbenefits between January 2011 and December 2015.
The media and public are reminded that criminal charges are merely accusations and the defendant is presumed innocent until proven guilty. Follow the Office of the Ocean County Prosecutor online at Twitter and Facebook. The social media links provided are for reference only. The OCPO does not endorse any non-governmental websites, companies or applications. For additional information visit our website at www.oceancountyprosecutor.org. Please send all press inquiries to Al Della Fave 732-288-7616 (OFFICE) 732-814-7347 (CELL) and adellafave@co.ocean.nj.us.
Since March of 2010, the American people have had to suffer under the incredible economic burden of the Affordable Care Act—Obamacare. This legislation, passed by totally partisan votes in the House and Senate and signed into law by the most divisive and partisan President in American history, has tragically but predictably resulted in runaway costs, websites that don’t work, greater rationing of care, higher premiums, less competition and fewer choices. Obamacare has raised the economic uncertainty of every single person residing in this country. As it appears Obamacare is certain to collapse of its own weight, the damage done by the Democrats and President Obama, and abetted by the Supreme Court, will be difficult to repair unless the next President and a Republican congress lead the effort to bring much-needed free market reforms to the healthcare industry.
But none of these positive reforms can be accomplished without Obamacare repeal. On day one of the Trump Administration, we will ask Congress to immediately deliver a full repeal of Obamacare.
However, it is not enough to simply repeal this terrible legislation. We will work with Congress to make sure we have a series of reforms ready for implementation that follow free market principles and that will restore economic freedom and certainty to everyone in this country. By following free market principles and working together to create sound public policy that will broaden healthcare access, make healthcare more affordable and improve the quality of the care available to all Americans.
Any reform effort must begin with Congress. Since Obamacare became law, conservative Republicans have been offering reforms that can be delivered individually or as part of more comprehensive reform efforts. In the remaining sections of this policy paper, several reforms will be offered that should be considered by Congress so that on the first day of the Trump Administration, we can start the process of restoring faith in government and economic liberty to the people.
Congress must act. Our elected representatives in the House and Senate must:
Completely repeal Obamacare. Our elected representatives must eliminate the individual mandate. No person should be required to buy insurance unless he or she wants to.
Modify existing law that inhibits the sale of health insurance across state lines. As long as the plan purchased complies with state requirements, any vendor ought to be able to offer insurance in any state. By allowing full competition in this market, insurance costs will go down and consumer satisfaction will go up.
Allow individuals to fully deduct health insurance premium payments from their tax returns under the current tax system. Businesses are allowed to take these deductions so why wouldn’t Congress allow individuals the same exemptions? As we allow the free market to provide insurance coverage opportunities to companies and individuals, we must also make sure that no one slips through the cracks simply because they cannot afford insurance. We must review basic options for Medicaid and work with states to ensure that those who want healthcare coverage can have it.
Allow individuals to use Health Savings Accounts (HSAs). Contributions into HSAs should be tax-free and should be allowed to accumulate. These accounts would become part of the estate of the individual and could be passed on to heirs without fear of any death penalty. These plans should be particularly attractive to young people who are healthy and can afford high-deductible insurance plans. These funds can be used by any member of a family without penalty. The flexibility and security provided by HSAs will be of great benefit to all who participate.
Require price transparency from all healthcare providers, especially doctors and healthcare organizations like clinics and hospitals. Individuals should be able to shop to find the best prices for procedures, exams or any other medical-related procedure.
Block-grant Medicaid to the states. Nearly every state already offers benefits beyond what is required in the current Medicaid structure. The state governments know their people best and can manage the administration of Medicaid far better without federal overhead. States will have the incentives to seek out and eliminate fraud, waste and abuse to preserve our precious resources.
Remove barriers to entry into free markets for drug providers that offer safe, reliable and cheaper products. Congress will need the courage to step away from the special interests and do what is right for America. Though the pharmaceutical industry is in the private sector, drug companies provide a public service. Allowing consumers access to imported, safe and dependable drugs from overseas will bring more options to consumers.
The reforms outlined above will lower healthcare costs for all Americans. They are simply a place to start. There are other reforms that might be considered if they serve to lower costs, remove uncertainty and provide financial security for all Americans. And we must also take actions in other policy areas to lower healthcare costs and burdens. Enforcing immigration laws, eliminating fraud and waste and energizing our economy will relieve the economic pressures felt by every American. It is the moral responsibility of a nation’s government to do what is best for the people and what is in the interest of securing the future of the nation.
Providing healthcare to illegal immigrants costs us some $11 billion annually. If we were to simply enforce the current immigration laws and restrict the unbridled granting of visas to this country, we could relieve healthcare cost pressures on state and local governments.
To reduce the number of individuals needing access to programs like Medicaid and Children’s Health Insurance Program we will need to install programs that grow the economy and bring capital and jobs back to America. The best social program has always been a job – and taking care of our economy will go a long way towards reducing our dependence on public health programs.
Finally, we need to reform our mental health programs and institutions in this country. Families, without the ability to get the information needed to help those who are ailing, are too often not given the tools to help their loved ones. There are promising reforms being developed in Congress that should receive bi-partisan support.
To reform healthcare in America, we need a President who has the leadership skills, will and courage to engage the American people and convince Congress to do what is best for the country. These straightforward reforms, along with many others I have proposed throughout my campaign, will ensure that together we will Make America Great Again.
As Medicaid Rolls Swell, Cuts in Payments to Doctors Threaten Access to Care
WASHINGTON — Just as millions of people are gaining insurance through Medicaid, the program is poised to make deep cuts in payments to many doctors, prompting some physicians and consumer advocates to warn that the reductions could make it more difficult for Medicaid patients to obtain care.
The Affordable Care Act provided a big increase in Medicaid payments for primary care in 2013 and 2014. But the increase expires on Thursday — just weeks after the Obama administration told the Supreme Court that doctors and other providers had no legal right to challenge the adequacy of payments they received from Medicaid.
The impact will vary by state, but a study by the Urban Institute, a nonpartisan research organization, estimates that doctors who have been receiving the enhanced payments will see their fees for primary care cut by 43 percent, on average.
Stephen Zuckerman, a health economist at the Urban Institute and co-author of the report, said Medicaid payments for primary care services could drop by 50 percent or more in California, Florida, New York and Pennsylvania, among other states.
In his budget request in March, President Obama proposed a one-year extension of the higher Medicaid payments. Several Democratic members of Congress backed the idea, but the proposals languished, and such legislation would appear to face long odds in the new Congress, with Republicans controlling both houses.
https://www.nytimes.com/2014/12/28/us/obamacare-medicaid-fee-increases-expiring.html?_r=0
N.J. to allow Medicaid to cover in-home elder care
NOVEMBER 30, 2014 LAST UPDATED: SUNDAY, NOVEMBER 30, 2014, 1:21 AM
BY COLLEEN DISKIN
STAFF WRITER |
THE RECORD
In its latest move to promote alternatives to nursing homes, the Christie administration will enact a new funding measure on Monday that will allow more elderly and disabled people to apply for Medicaid assistance to pay for care at home or in non-institutional settings.
This newest amendment to the New Jersey’s Medicaid program will allow those who earn too much to qualify for full assistance — but who can’t afford the cost of the care they need — to receive help through the creation of a trust account at a bank.
Any income an elderly or disabled person receives above the Medicaid eligibility limit of $2,163 a month will be deposited into these irrevocable trust accounts, with withdrawals allowed for qualified living expenses as well as for the portion of their care that individuals can afford. Medicaid will then pick up the rest of the tab for their care, whether it’s in a nursing home or their own home.
The change is a response to years of lobbying from advocates who said old Medicaid rules were having the unintended effect of forcing people into nursing homes prematurely, because the state offered no help in paying for home health aides, adult day care programs or assisted living residences.
https://www.northjersey.com/news/health-news/n-j-to-allow-medicaid-for-in-home-elder-care-1.1143762
The Numbers You Need to Know About Obamacare
Ed Feulner / @EdFeulner / November 01, 2014 / 0 comments
Edwin J. Feulner’s 36 years of leadership as president of The Heritage Foundation transformed the think tank from a small policy shop into America’s powerhouse of conservative ideas.Read his research.
“Is the Affordable Care Act Working?” reads a recent headline in The New York Times. The editors then consider a series of questions, the first of which is pretty basic: “Has the percentage of uninsured people been reduced?”
Their answer: yes. So, problem solved, right? Not quite.
The devil, as they say, is in the details. And the details show that it’s not as simple as getting more people insured. A new report from health care expert Ed Haislmaier — one based on actual enrollment data, not surveys — illustrates two facts that should give us pause.
One is that the decline in the number of people who are uninsured isn’t as high as it may seem at first glance. The other is that more than two-thirds of the gain in coverage is a result of an increase in the number of people in Medicaid, the federal government’s health care program for the vulnerable poor.
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This isn’t exactly what Americans were led to believe would happen when the Patient Protection and Affordable Care Act, often referred to as Obamacare, became law.
Let’s look a little closer at the first point. Why isn’t the number of newly insured people as high as it might seem?
Proponents of Obamacare, after all, can point to the 6.2 million Americans who have been enrolled in individual-market coverage since Obamacare took effect. You have to take into account, though, the 3.8 million who lost their employer-based coverage during the same period. As a result, the number of Americans who gained private health insurance increased by a bit less than 2.5 million in the first half of 2014.
In short, Mr. Haislmaier shows, decline in employment-based coverage offset 61 percent of the increase in individual-market coverage.
Why would so many people be losing employer-based coverage? Because of the negative incentives built into Obamacare. It’s cheaper for many employers (who might otherwise face steep rises in coverage costs or fines from Washington) to stop offering coverage altogether and let their employees fall into government-run programs.
Now let’s consider the second point. During this same period, enrollment in Medicaid and the Children’s Health Insurance Program increased by almost 6.1 million individuals. Of the 8.5 million total individuals who gained health insurance coverage, 71 percent of that net coverage gain was due to Obamacare’s expansion of Medicaid to able-bodied, working-age adults.
“The inescapable conclusion,” writes Mr. Haislmaier, “is that, when it comes to covering the uninsured, Obamacare so far is mainly an expansion of Medicaid.”
This is hardly what Americans were promised. Or what they expected when President Obama last year said that Obamacare is “doing what it’s designed to do — deliver more choices, better benefits, a check on rising costs.”
Today, the president touts the millions of Americans who have gained coverage. However, we don’t hear much in the way of context. Left unsaid is that a large number of the 6.2 million cited above already had individual or employer-based coverage but were forced by Obamacare to get new coverage.
Also unmentioned is the fact that the 6.1 million new Medicaid enrollees include able-bodied, working-age adults who are being given substandard government coverage in lieu of what they really need: a job.
We certainly don’t hear much to contradict the much-hyped “check on rising costs.”
“In eleven states, premiums for twenty-seven-year-olds have more than doubled since 2013; in thirteen states, premiums for fifty-year-olds have increased more than 50 percent,” writes health care expert Robert Moffit in a new report.
It doesn’t take a medical degree to see that Obamacare is ailing. The sooner it’s repealed, the better.
Originally appeared in the Washington Times.
71% of Obamacare Signups Traced to Government’s Expansion of Medicaid
Melissa Quinn / @MelissaQuinn97 / October 22, 2014
The vast majority of Americans gaining health coverage under Obamacare actually qualified for Medicaid because of loosened eligibility —and that’s what boosted enrollment among those previously uninsured, a new report from The Heritage Foundation.
The Obama administration has boasted that the Affordable Care Act, popularly known as Obamacare, would allow those previously uninsured to purchase quality, affordable health care.
“The inescapable conclusion is that, when it comes to covering the uninsured, Obamacare so far is an expansion of Medicaid,” Heritage Foundation health policy experts Edmund F. Haislmaier and Drew Gonshorowski write in a research paper scheduled for release today.
Officials announced in May that more than 8 million Americans had picked a health plan on the Obamacare website, HealthCare.gov.
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Haislmaier and Gonshorowski conclude that 8.5 million Americans gained coverage through Obamacare from January to July.
Commentary: The Real Story on How Much Obamacare Increased Coverage
However, their paper says, more than 70 percent of those signups can be traced to the expansion of Medicaid eligibility in 24 states:
Of the 8.5 million total individuals who gained health insurance coverage, 71 percent of that net coverage gain was attributable to Obamacare’s expansion of Medicaid to able-bodied, working-age adults.
In the states that adopted and implemented Medicaid expansion under Obamacare, enrollment skyrocketed as an additional 5.7 million Americans signed up for coverage.
In 21 states opting out of Medicaid expansion, however, enrollment was strikingly lower. The Heritage report finds that 355,674 Americans signed up for Medicaid in those states.
In all, Medicaid enrollment increased by 6 million individuals for the first half of 2014.
The Daily Signal is the multimedia news organization of The Heritage Foundation.
The Affordable Care Act, popularly known as Obamacare, loosened eligibility requirements for Medicaid, traditionally the government’s health program for the poor. The changes made it easier for individuals with an income of up to 138 percent of the federal poverty line (roughly $16,000) to qualify for the taxpayer-funded health coverage.
As the Heritage experts note, many Medicaid-eligible Americans under the new requirements also don’t have dependent children.
States got an incentive–federal dollars–to adopt the requirements.
Twenty-seven states and the District of Columbia opted to expand Medicaid. By July, however, 24 states had implemented the program.
The Affordable Care Act went into effect in October. Its implementation included the rollout of HealthCare.gov, the online marketplace where consumers can peruse and purchase insurance plans.
HealthCare.gov’s advent was accompanied by well-publicized malfunctions, glitches and failures. White House officials scrambled to fix the website as consumers experienced long delays. As a result, the Obama administration extended the close of open enrollment from March 30 until April 15.
Despite the rocky rollout of HealthCare.gov, President Obama and then-Health and Human Services Secretary Kathleen Sebelius touted that enrollment in Obamacare insurance plans topped the original goal of 7 million.
According to reports from the Department of Health and Human Services, enrollment likely hovered around 7.3 million, as original estimates took into account those who selected a plan, but did not pay their first month’s premiums.
Sylvia Mathews Burwell, who in June replaced Sebelius as HHS secretary, said in a speech last month at the Brookings Institute:
Four years after President Obama signed the law, middle class families have more security, and many who already had insurance have better coverage. Fewer Americans are uninsured, and at the same time, we’re spending our health care dollars more wisely, and we’re starting to receive higher quality care.
https://www.heritage.org/research/reports/2014/10/obamacares-enrollment-increase-mainly-due-to-medicaid-expansion
ObamaCare Shunts My Patients Into Medicaid
Knocked out of private insurance, they are forced to settle for longer waits and worse care
Rep. Scott Garrett Take a minute to read this eyeopening article about ObamaCare written by Dr. Jeffrey Singer, a general surgeon in Phoenix, Ariz.
His take: “Even if my patients save money by no longer paying premiums, they suffer in the long run by being trapped in a subpar health-care system [Medicaid]… ObamaCare has shifted—and will continue to shift—people into substandard and often-delayed care, all in the name of increasing health-care “coverage.” That is the saddest irony of all.”
By JEFFREY A. SINGER
Oct. 20, 2014 7:12 p.m. ET
90 COMMENTS
Thirty years of experience in private medical practice uncovers many ironies. For example, recently several of my patients who had been paying for their own individual health insurance informed me that they were forced off private insurance and placed into Medicaid when they signed up for health care at Healthcare.gov. This unwanted change—built into ObamaCare with the intention of helping patients—has harmed them by taking away their freedom to choose a health-care plan that works best for them.
This is not an unusual phenomenon. A recent Boston University/Harvard Medical School study suggests that up to 80% of people participating in ObamaCare’s Medicaid expansion have been shifted off their private insurance. These patients’ plans—that they liked, and were told they could keep—did not meet Affordable Care Act requirements, and were wiped out. Healthcare.gov offered them Medicaid.
But the irony doesn’t stop there. Even if my patients save money by no longer paying premiums, they suffer in the long run by being trapped in a subpar health-care system. A Medicaid card does not translate into quality medical care. In some cases, it does not translate into medical care at all.
