The Ridgewood Blog Brings a Free Market Laissez-faire Point of View to Local, New Jersey State and National Issues.
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Westwood NJ, one would think after the nursing and Veteran Home fiasco’s during the COVID-19 pandemic the medical profession would be more on guard as to the care of the elderly .
Continue reading Are New Jersey Hospitals Drugging Elderly Patients to keep them Docile?
In today’s complex healthcare landscape, understanding the intricacies of insurance plans is essential for individuals seeking comprehensive coverage. One such crucial program is Medicare, a federally funded insurance initiative primarily designed for individuals aged 65 and older, as well as certain younger people with disabilities. This article aims to shed light on the nuanced aspects of Medicare, elucidating its primary beneficiaries and the myriad benefits it offers. As we delve into the world of Medicare, we will uncover the diverse range of services it provides, demystifying the often perplexing realm of healthcare coverage.
Continue reading Understanding Medicare: Who is it for, and What Are its Benefits?
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Ridgewood NJ, we reported earlier that in June, the FTC warned about scammers stealing people’s Medicare numbers and billing Medicare for COVID-19-related services (and other things) that they sometimes got — and sometimes didn’t. The difference now? You might be getting the bill instead of Medicare. That’s because after May 11th, when the COVID-19 Health Emergency officially ended, Medicare and other health insurance plans stopped paying for many at-home over-the-counter COVID-19 tests. Once Medicare denies payment, those scammy companies could come back with a bill in your name.
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Ridgewood NJ, unordered COVID-19 tests and bills arriving at your doorstep. What’s going on? It’s another scam targeting people with Medicare. Here’s what to do if you get billed for tests you didn’t order.
Continue reading Got COVID-19 tests you didn’t order, It’s a Scam !
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
July 10,2018
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NEWARK, N.J. – The president of Parsippany, New Jersey-based Biodiagnostic Laboratory Services LLC (BLS) and his brother – a senior employee at the now-defunct company – were sentenced today to federal prison terms for their respective roles in a conspiracy in which millions of dollars in bribes were paid to physicians for blood sample referrals worth more than $100 million to the company, U.S. Attorney Craig Carpenito announced.
David Nicoll, 44, of Mountain Lakes, New Jersey, was sentenced to 72 months in prison; Scott Nicoll, 37, of Wayne, New Jersey, was sentenced to 43 months in prison. Each defendant had previously pleaded guilty before U.S. District Judge Stanley R. Chesler to an information charging one count of conspiracy to violate the Anti-Kickback Statute and the Federal Travel Act and one count of money laundering. Judge Chesler imposed the sentences today in Newark federal court.
Derek Michalski explained , “Two crooked New Jersey “entrepreneurs” doctors pocketed more than $100 million from Medicare. No wonder people of this country elected Donald Tump as President. These crimes were going on for over a decade but finally Trump’s DOJ shows some teeth and looks like it’s going after those parasites. It‘s about time….“David and Scott Nicoll admitted that BLS made substantially more than $100 million from Medicare and private insurance companies – just from bills related to blood specimens sent to BLS by bribed doctors.”
“Today, the president of a diagnostic lab company and his brother were sentenced for their leading roles in a scam that led to one of the largest ever prosecutions of medical professionals in a bribery case,” U.S. Attorney Carpenito said. “Medical referrals from a doctor should be based on what’s in the patient’s best interest, not on how much money the doctor is offered in kickbacks. The number of doctors and medical professionals sent to prison in this case should make that message abundantly clear.”
The investigation has resulted in the convictions of 53 defendants – 38 of them of doctors – in connection with the bribery scheme, which its organizers have admitted involved millions of dollars in bribes and resulted in more than $100 million in payments to BLS from Medicare and various private insurance companies. It is believed to be the largest number of medical professionals ever prosecuted in a bribery case. The investigation has recovered more than $15 million through forfeiture. On June 28, 2016, BLS, which is no longer operational, pleaded guilty and was required to forfeit all of its assets.
“The FBI views health care fraud as a severe crime problem that impacts every American,” FBI Special Agent in Charge Gregory W. Ehrie said. “Fraud and abuse take critical resources out of our health care system, and contribute to the rising cost of health care for everyone. Today’s sentencing of David Nicoll and his brother Scott Nicoll are the result of a multi-agency investigation into a complex health care fraud scheme, requiring substantial investigative resources. The FBI, with its law enforcement partners, will continue to allocate a significant amount of expert resources to investigate these crimes and prosecute all those that are intent in defrauding the American public.”
“These two individuals masterminded an elaborate health care fraud scheme based on nothing more than greed,” Scott J. Lampert, Special Agent in Charge for the Office of Inspector General of the U.S. Department of Health and Human Services, said. “We trust that the work with our law enforcement partners – especially the U.S. Attorney’s Office, FBI, IRS, and Postal Inspection Service – will send a clear message and dissuade individual health ‘professionals’ from making such corrosive schemes possible.”
According to documents filed in this case and statements made in court:
On April 9, 2013, federal agents arrested BLS president and part owner, David Nicoll; Scott Nicoll, a senior BLS employee and others, who were charged by complaint with bribery conspiracy, along with the BLS company. The conspiracy made millions in illegal profits between 2006 and April of 2013. David and Scott Nicoll admitted that BLS made substantially more than $100 million from Medicare and private insurance companies – just from bills related to blood specimens sent to BLS by bribed doctors.
BLS paid doctors millions of dollars – in cash or under the guise of sham lease, service, and consulting agreements through an elaborate network of shell entities used for that purpose. The defendants also admitted that one component of the bribery scheme was to pay some doctors a fee per test to induce them to increase their ordering of certain tests.
“Health care fraud of this magnitude cannot be tolerated, and today’s sentencings are the direct result of the tremendous investigative skills of all the participating law enforcement agencies,” Bryant Jackson, Acting Special Agent in Charge, IRS – Criminal Investigation, Newark Field Office, said. “IRS – Criminal Investigation is proud to have been a part of this investigative team that helped to bring down and dismantle this massive health care conspiracy.”
“Throughout the course of this long-running investigation, Postal Inspectors, federal prosecutors and our law enforcement partners have diligently worked to unravel this elaborate bribery conspiracy,” Acting Inspector in Charge Judy Ramos of the U.S. Postal Inspection Service said. “Although, the final defendants in this matter face sentencing today, Postal Inspectors will continue to tirelessly investigate complex fraud schemes that target consumers and businesses through the U.S. Mail.”
In addition to the prison terms, Judge Chesler sentenced the Nicolls to one year of supervised release.
June 29, 2017
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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.
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Ridgewood NJ, President Trump’s first proposed budget shows respect for the people who pay the bills. The administration’s “Calvin Coolidge style” proposal reverses the damaging trends from previous administrations by putting our nation’s budget back into balance and reducing our debt through fiscally conservative principles, all the while delivering on President Trump’s campaign promise not to cut Social Security retirement or Medicare. The budget’s combination of regulatory, tax, and welfare reforms will provide opportunities for economic growth and creation.
Trump Budget Facts:
President Trump’s budget is designed to put the taxpayer first, create jobs, and build economic growth.
President Trump’s budget finally balances the Federal budget and turns the deficit into a $16 billion surplus by 2027.
President Trump’s budget makes national defense a top priority by increasing defense spending by $54 billion.
President Trump’s budget increases funding for the Department of Veterans Affairs by $4.3 billion.
President Trump’s budget puts Americans’ safety first by providing $2.6 billion in increased funding for border security.
President Trump’s budget balances the budget and makes no cuts to either Medicare or Social Security retirement.
President Trump’s budget provides national paid family leave for the first time in the history of this country.
President Trump’s budget helps American families by implementing the first national paid family leave initiative.
President Trump’s budget saves the American people billions of dollars through welfare and regulatory reform.
President Trump’s budget sees a decline in debt as a percentage of GDP every year in the budget window.
By Michael Symons February 10, 2017 3:36 AM
New Jersey was among the states with the highest levels of Medicare billing errors in 2015, though mistakes were actually at their lowest level in four years, according to government data and an analysis by a group representing the auditors.
The mistakes were made by providers such as hospitals, not the state. They weren’t fraud, said Council for Medicare Integrity spokesperson Kristin Walter – but at $22.6 million in overpayments take a toll on the program’s long-term viability, she said.
It amounted to $18.09 for each of the roughly 1.25 million Medicare beneficiaries in New Jersey, which was fourth highest among the states.
“Anything from billing a surgery twice to billing a higher paying billing rate within Medicare for a particular service, to just very simple typographical errors that cause something to be billed to the wrong place or not shown to have sufficient documentation,” Walter said.
Read More: NJ among states with most Medicare waste and billing mistakes, report finds | https://nj1015.com/nj-among-states-with-most-medicare-waste-and-billing-mistakes-report-finds/?trackback=tsmclip
November 28,2016
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Ridgewood NJ, It’s decision time for the 55 million Americans covered by Medicare.
Open enrollment, when people can enroll in Medicare or make changes to their plans, runs every year from Oct. 15 to Dec. 7. But anyone who thinks that signing up for the medical plan for seniors is simple could be in for a rude awakening – and a costly one.
“People need to realize that enrolling in Medicare can be complicated,” says Chris Orestis, a senior-care advocate and author of the books “Help on the Way” and “A Survival Guide to Aging.”
“If you don’t pay attention you can end up missing needed coverage or paying more out-of-pocket expenses in premiums, co-pays and deductibles than you realize – or can afford.”
This year open enrollment comes during a presidential election and a time when there are concerns about Medicare’s long-term future and whether it can remain solvent. At the final presidential debate, Donald Trump and Hillary Clinton were asked what they might do to make sure the program, first implemented in 1965, will be there for seniors for decades to come.
Trump said he would grow the economy, which in turn would help Medicare. Clinton said her plan is to reduce the cost of health care and to emphasize wellness.
But any future political decisions about Medicare can seem far off to anyone whose main concern is figuring out how they fit into what’s offered right now, says Orestis, CEO of Life Care Funding (www.lifecarefunding.com).
He says some important things to keep in mind or understand during Medicare enrollment include:
• Medicare coverage comes in two primary forms that participants can choose from. They are original Medicare, the traditional program administered through the federal government which anyone 65 and older qualifies for automatically, and Medicare Advantage plans, which are sold by private insurance companies. The Advantage plans sometimes offer additional services, such as routine vision, hearing and dental care.
• Most people probably have heard references to Medicare Part A or Medicare Part D. Here’s how that alphabet breaks down: Medicare Part A pays for hospital and skilled nursing facility care. Medicare Part B pays 80 percent of costs for doctors, outpatient services and medical equipment. Medicare Part C is a private Advantage Plan. Medicare Part D pays for prescriptions.
• Anyone who visits a doctor or has been hospitalized knows that deductibles and co-pays can add up quickly. That’s where Medicare Supplemental Insurance (Medigap) comes in. It’s a private insurance that pays the gaps in the varieties of Medicare coverage.
• Want to learn more? Orestis says a good place to check is the Center for Medicare and Medicaid Services website (www.cms.gov), which provides a wealth of information and resources to review and assist enrollment.
Orestis says it’s important to act as soon as possible and not wait until the last minute.
“When it comes to Medicare enrollment,” Orestis says, “not being informed and missing deadlines can cause delays and penalties that could have a negative impact on your coverage – and your wallet.”
About Chris Orestis
Chris Orestis is CEO of Life Care Funding (www.lifecarefunding.com) and a 20-year veteran of both the insurance and long-term care industries. A former Washington, D.C., lobbyist, he is a nationally known senior-care advocate and author of the Amazon best-selling books “Help on the Way” and “A Survival Guide to Aging.” Orestis also is a legislative expert, featured speaker, columnist and contributor to a number of insurance and long-term care industry publications. He is a frequent guest on national radio programs, and has been featured in the Wall Street Journal, the New York Times, USA Today, Fox Business News and PBS.
November 13,2016
Paramus NJ,The Valley Hospital/Mount Sinai Comprehensive Cancer Care will present a Medicare Open Enrollment event that’s open to the public on Wednesday, November 16, from 1 to 3 p.m., at the Dorothy B. Kraft Building on 15 Essex Road in Paramus, New Jersey. A state-trained and certified State Health Insurance Program (SHIP) Medicare Counselor from the Bergen County Division of Senior Services in Hackensack will be available to assist with Medicare Open Enrollment and answer questions related to Medicare, including the following: Medicare changes for 2017, differences between Medicare and HMO Medicare Advantage plans; 2017 prescription plans; benefits to choosing a Medicare plan versus a HMO Medicare Advantage plan; differences between Part A, B, C Medicare; out-of-pocket expenses; social security; and pharmaceutical assistance.
Those interested in attending should RSVP to Gail Johnson, Patient Financial Advocate at The Valley Hospital, at 201-634-5644 or gjohnso@valleyhealth.com
New law’s success or failure will ‘profoundly influence the future of the U.S. health care system’
by John S. O’Shea, M.D. | Updated 21 Oct 2016 at 9:22 AM
In what may be the most significant modification to Medicare since the program began in 1966, on Oct. 15, the Centers for Medicare and Medicaid Services (CMS) released the final rule for implementing the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). It dramatically changes how Medicare pays doctors for their services.
Does it really matter how doctors get paid? Yes — the success or failure of the new payment system will profoundly influence the future of the U.S. health care system. And while the goals of MACRA are laudable, its implementation carries a number of unknowns and the potential for unintended consequences — for patients and doctors alike.
https://www.lifezette.com/polizette/risk-of-mass-exodus-of-doctors-from-medicare/
BY RICARDO ALONSO-ZALDIVAR
ASSOCIATED PRESS
WASHINGTON (AP) — Changing the way it does business, Medicare on Friday unveiled a far-reaching overhaul of how it pays doctors and other clinicians.
The goal is to reward quality, penalize poor performance, and avoid paying piecemeal for services. Whether it succeeds or fails, it’s one of the biggest changes in Medicare’s 50-year history.
The complex regulation is nearly 2,400 pages long and will take years to fully implement. It’s meant to carry out bipartisan legislation passed by Congress and signed by President Barack Obama last year.
APRIL 14, 2015, 8:16 AM LAST UPDATED: TUESDAY, APRIL 14, 2015, 6:35 PM
BY MELISSA HAYES
STATE HOUSE BUREAU |
THE RECORD
Governor Christie called for raising the eligibility age for Social Security and Medicare and suggested wealthier retirees forgo the benefits in a speech in New Hampshire Tuesday.
Christie unveiled a 12-point plan that includes reducing Social Security benefits for retirees earning more than $80,000 and eliminating them altogether for those earning more than $200,000.
The governor told a crowd of about 100 students and other attendees at St. Anselm College that the retirement age for social security should be raised to 69 and the early retirement age should be 64. And he called for the eligibility age for Medicare to be gradually increased to 67 by 2040.
Medicare penalizes 23 New Jersey hospitals over errors, infections
DECEMBER 18, 2014, 11:44 PM LAST UPDATED: THURSDAY, DECEMBER 18, 2014, 11:48 PM
BY LINDY WASHBURN
STAFF WRITER |
THE RECORD
The federal government will reduce its Medicare payments to 23 hospitals in the state — including six in North Jersey — in a crackdown on hospital errors and infections.
The list of hospitals, released Thursday, includes Hackensack University Medical Center, St. Mary’s Hospital in Passaic and Bergen Regional Medical Center in Paramus. In all, 721 hospitals nationwide will see their Medicare payments cut by 1 percent for the year that began Oct. 1.
New Jersey was one of 10 states where a third or more of the hospitals were penalized.
The financial incentives and public reporting are a two-pronged strategy under the health care reform law known as Obamacare aimed at reducing harm to patients from hospital stays. Hospital errors are estimated to cost Americans more than $17 billion a year and contribute to the deaths of 180,000 Medicare patients alone.
And because Medicare, the federal insurance program for those over 65, is one of the largest sources of hospital revenue, even a 1 percent reduction can have a sizable impact on health care facilities.
For example, Hackensack University Medical Center, with $1.2 billion in revenue in 2012, had more than $263 million in Medicare payments that year. So a reduction of 1 percent would cost it nearly $3 million.
https://www.northjersey.com/news/medicare-penalizes-23-new-jersey-hospitals-over-errors-infections-1.1169219
