Live Up to Your Commitment to the Nursing Home, or Beware

A recent Connecticut case highlights the risk to family members of nursing home residents who don't live up to their financial commitments to such facilities.

When her mother was admitted to the Cook Willow Health Center, Judy Andrien signed an admission agreement on behalf of her mother as "responsible relative," agreeing to take steps to ensure that the nursing home would be paid from her mother's assets or by Medicaid.

The facility sued Ms. Andrien, claiming that she did not live up to this commitment. Ms. Andrien asked the court to dismiss the case, arguing that she cannot be held liable because she did not agree to use her own funds to pay for her mother's care.  

The Superior Court of Connecticut has ruled in the facility's favor, stating that the claim is not that Ms. Andrien personally guaranteed payment, but that she is in breach of contract for not using her mother's funds to pay the nursing home or taking steps to get her mother Medicaid coverage. The court's ruling means that the case will continue to trial on the nursing home's claim, which it still must prove.

Nursing Homes Overcharge Medicare More than One Billion Dollars Annually

Hundreds of nursing homes overcharge Medicare every year for so-called skilled services, adding $1.5 billion in annual costs to the program, according to a federal report.  About one-fourth of Medicare bills from facilities examined in the report were incorrect. The majority of these claims involved  "upcoding," where a nursing home or other provider inflates the cost of its bill to Medicare by claiming more intensive services were done than actually performed.

 In other cases, nursing homes provided treatments that were inappropriate for the patient.  Documents show that facilities billed for high-intensity work, such as speech therapy and occupational therapy, that went to patients who couldn't benefit from it. One patient under hospice care refused physical therapy but was given the therapy anyway, and Medicare was billed, officials said.

The report was prepared by the The Office of Investigations (OI), which  conducts criminal, civil, and administrative investigations of fraud and misconduct related to Health and Human Service programs, operations, and beneficiaries.  OI utilizes its resources by actively coordinating with the Department of Justice and other Federal, State, and local law enforcement authorities.  The investigative efforts of OI often lead to criminal convictions, administrative sanctions, and/or civil monetary penalties.

In recent years, the Office of Inspector General had identified a number of problems with billing by skilled nursing facilities (SNF), including the submission of inaccurate, medically unnecessary, and fraudulent claims.  Further, the Medicare Payment Advisory Commission has raised concerns about SNFs’ improperly billing for therapy to obtain additional Medicare payments.  In fiscal year (FY) 2012, Medicare paid $32.2 billion for SNF services.

The Report made a number of recommendations.  Recognizing that the Centers for Medicare & Medicaid Services (CMS) had recently made several significant changes to SNF payments, the Report stated that    "more needs to be done to reduce inappropriate payments to SNFs."  Accordingly,   it was suggested that   CMS:  (1) increase and expand reviews of SNF claims, (2) use its Fraud Prevention System to identify SNFs that  are billing for higher paying services, (3) monitor compliance with new therapy assessments, (4) change the current method for determining how much therapy is needed to ensure appropriate payments, (5) improve the accuracy of Minimum Data Set items, and (6) follow up on the SNFs that billed in error.  CMS concurred with all six recommendations.

A Minnesota probate court rules that language in the state's constitution that prohibits all people under guardianship from voting violates the United States Constitution and is therefore invalid.  In re Guardianship of Erickson(4^th Jud. Dist. Ct., Minn., No. 27-GC-PR-09-57, Oct. 4, 2012).

Brian Erickson was placed under guardianship in 2009 because he suffers from schizophrenia and dysthymia with psychotic tendencies that make it difficult for him to perform many activities of daily living.  In July 2012, Mr. Erickson's guardian filed a petition with the Hennepin County Probate Court seeking a declaratory judgment clarifying that people under guardianship retain the right to vote unless a court order removes that right. 

The petition was filed because there is a conflict between Minnesota Statute 524.313, which states that "unless otherwise ordered by the court, the ward retains the right to vote," and Article VII of the state constitution, which explicitly states that all people under guardianship are not allowed to vote.  Mr. Erickson attempted to reconcile these two provisions by claiming that since the state constitution did not define guardianship, the legislature could "effectuate the constitutional mandates" by passing statutes that limited the state's ability to disenfranchise people under guardianship.

Actor Sherman Hemsley Remains Not Laid to Rest as Legal Dispute Continues

Sherman Hemsley died at his home in El Paso, Texas on July 24. But three months on, the star of the CBS series “The Jeffersons” has yet to be laid to rest as the beneficiaries of his will, and even his cause of death, have been called into question.

A worker at the Eastside location of the San Jose Funeral Home in El Paso, Texas confirmed that Hemsley was still at the home, and that they were waiting for a court order telling them what to do with his body.

It was revealed in August that Hemsley’s body had not been buried amid a legal dispute between his former manager and self-proclaimed business partner and live-in best friend Flora Enchinton – who was named as the sole beneficiary in his will – and a Philadelphia man, Richard Thornton, who claims to be the actor’s brother. Thornton filed a civil lawsuit disputing the validity of the will, signed by Hemsley one month prior to his death.

Read more: http://www.foxnews.com/entertainment/2012/10/29/sherman-hemsley-still-not-buried-3-months-after-death-bizarre-legal-dispute/?intcmp=features#ixzz2Ai8pneZS

Things to Consider Before Retiring Abroad

Retiring to another country can be a very attractive option. Lower cost of living and health care expenses along with exotic locales and temperate climates persuade many seniors to retire outside of the United States. If you want to ensure a smooth transition, however, there are many issues to consider and steps to take before packing up and moving.

Local Laws 

You should familiarize yourself with the local laws, and should seek professional legal advice before settling abroad.  Determine whether your trust, will and powers of attorney are legally enforceable in your country of destination.  If not, you will want to draft and implement legally enforceable planning documents.  Some documents, such as health care powers, even if enforceable, may be more practically accepted locally if in the form and format common among the local population. Specific legal advice is necessary and advisable.

In addition to your lawyer in the United States, the U.S. embassy or consulate can provide you with a list of local English-speaking lawyers willing to assist U.S. citizens.  Especially in local real estate matters, it is important to understand any contracts you are asked to sign. Review the local traffic laws and licensing requirements if you intend to drive.  Some countries have a changeable political environment with different legal systems than you are accustomed to.  Be sure to find out what civil liberties and political rights you will have as a foreign resident.

Bank Accounts 

One of your first considerations should be where to keep your money. When you move abroad, you will most likely need to open a bank account in the new country in order to pay local bills. Opening a bank account in a foreign country can be difficult because of the Foreign Account Tax Compliance Act (FATCA), passed in 2010. The law requires banks to disclose data on American clients to the IRS, and many banks are refusing to accept clients from the United States because they don't want to deal with the requirements. Your best bet may be to look for a big bank that has routine dealings with the United States.

Once you have a bank, you will need to consider how much money you want to put into the local account as well as the best way to transfer money into the local currency.  If your money remains in a U.S. bank and the exchange rate changes suddenly, the value of your money can change drastically. Another option is a foreign exchange specialty firm that may be able to provide you a fixed rate for transferring money. Before moving, you should consult with a financial planner to determine the best way to protect your money.

Currency Exchange 

Navigating currency markets is an often unexpected and complicated consequence of retiring abroad.  Hidden foreign-exchange fees are, according to some, the No. 1 culprit in dwindling your hard-earned retirement savings in another country. Exposure to the volatile currency markets on a daily basis can add up quickly in the form of unwanted fees.

The first such fee is what's known as a transfer fee, which can cost $15 to $100 per transfer of money to the foreign location of your choice. If there are regular transfers on a monthly basis, those fees will rapidly add up.  But the biggest expense factor can be the exchange rate itself.  Currency specialists, such as USForex offer tools and calculators to structure and protect nest eggs against currency exposure.  But you will want to shop local services and solutions, because these may prove more or less expensive.  Be careful, though, because unexpected and undisclosed costs are, sadly, common in the currency exchange industry.

Reporting

The United States wants to prevent citizens from hiding money in overseas bank accounts, so there are special reporting requirements. If you have $10,000 or more in a foreign bank account you will have to fill out an annual Report of Foreign Bank and Financial Accounts (FBAR) with the Department of Treasury. FATCA (see above) also has its own reporting requirements. If you are married and have a foreign account with more than $400,000 at the end of the year (or more than $600,000 at any time during the year), you will need to file a special form with your income taxes. If you don't comply with the requirements, you could face stiff penalties.

Taxes

Moving to another country doesn't mean you don't have to pay taxes in the United States anymore. All U.S. citizens have to pay taxes, regardless of where they live, and if you still have a residence in a U.S. state, you may also have to pay state taxes. In addition, you will likely have to file a tax return in the country you are living in. If you pay taxes to a foreign country on a source of income and are subject to U.S. tax on the same income, you may be able to take either a credit or an itemized deduction for the foreign taxes paid. For more information, click here.  It is important to consult with a tax professional who is familiar with taxes in the country you are moving to.  

Investments

You may want to invest some money in the local currency so that your assets keep pace with cost-of-living increases. Having investments in the currency of the country you are living in also protects the value of your investments from drops in the value of the dollar.

Real Estate

Purchasing real estate is not always straightforward in another country. Before deciding to buy, it is important to understand the rules of the country you are moving to. For example, in Mexico foreigners are prohibited from owning property within 31 miles of the coast, so property is often held inside corporations or trusts, which can create tax issues for U.S. citizens. In addition, there may also be different inheritance laws that could affect property. For example, in France children have priority over a surviving spouse.

Health Care

Most countries have a national healthcare system that covers all residents, and monthly premiums are often less than $100. It’s relatively easy to become a resident of another country, which typically involve proving you’ll have at least a modest amount of income, perhaps $1,000 a month.  Traditional Medicare does not provide coverage for hospital or medical costs outside the United States, so if you are retiring in another country, you will need to purchase health insurance from another source.

Quality of health services varies, so research carefully, especially if you have medical problems. Even in countries with well-rated health care systems, the best services are centered around metropolitan areas.  Emergency care and emergency response time may be important considerations when considering the idyllic village off the beaten path.  

Regardless, Medicare may remain an important part of your health care plan, however, because If you return to the United States, you will still be covered by Medicare Part A, which covers hospital stays.  Unless you paid the premiums for Medicare Part B while you were away, however, you may have to pay a penalty to enroll in Medicare Part B. Of course, you could continue to pay the Part B premium.  For more information about Medicare while traveling or living overseas, click here.

Safety and Security

Consider carefully safety and security issues too. Use the State Department’s Retirement Abroad advisory for information for country-specific reports on crimes, infrastructure problems and even scams that target Americans abroad.

Retirement funds are an attractive target for charlatans and scammers who make false promises of romance, friendship, or financial gain.  Scammers operate primarily through the Internet, email, and phone, but personal targeting at airports, bus stations, and market places are also common.  For more information,  review the State Department's information on International Financial Scams. Information on scams common in your destination country can also be found in each country's Country Specific Information.

Accessibility and Accommodations

If you have mobility difficulties or use a wheelchair, determine access to areas such as swimming pools, public facilities, restaurants, bars, toilets, etc.  Determine if shopping and entertainment are accessible.  For more information, check out the State Department's section on Traveling with Disabilities. 

Prepare for Emergencies

Leave emergency contact information and a copy of your passport biographic data page with family and trusted friends.  Carry emergency contact information for your family in the United States with you when you travel (be sure to also pencil it in the emergency contact information section of your passport).  Know the contact information for the nearest U.S. embassy or consulate and provide that information to your family and friends.  If there is an emergency where you are staying, such as civil unrest, disrupted transportation, or a natural disaster, prevent undue worry or concern by contacting your family and friends as soon as possible.

A secure way to maintain your emergency contact information is to enroll with the Smart Traveler Enrollment Program.  Your information is stored securely and enables the Department of State, U.S. embassy, or consulate to contact you, your family, or your friends in an emergency according to your wishes.  

For more information, consider International Living's "Best Places to Retire."   AARP also writes about retiring abroad and Expatinfodesk.com publishes relocation guides.

Updated 4/1/2015