Medicaid Planning Companies - Know How to Spot a Fraud
By Don Drake, Connelly Law Offices, Ltd.
"Preparing for the future is an essential aspect of life that everyone needs to consider, especially as the number of aging baby boomers reaching retirement age in this country will reach 61 million by 2030," stated professional fiduciary and certified elder law Attorney RJ Connelly III. "One of the most significant concerns for this age group is the potential need for long-term healthcare, which is expensive and can deplete savings and assets quickly. Medicaid planning is, therefore, a major aspect of preparing for the future."
While many legitimate professionals offer genuine Medicaid planning services, it is quite unfortunate that some individuals and companies seek to exploit people's needs and fears. These scammers often promote schemes that promise to protect assets and qualify individuals for Medicaid benefits. However, they can create financial havoc and legal problems for unsuspecting individuals and their families.
"Medicare and Medicaid scams are some of the most common scams for individuals over the age of 60," said Attorney Connelly. "According to the National Council on Aging, fraudsters take advantage of seniors' trust in the healthcare industry and use various tactics to defraud them, and that includes Medicaid planning. It is important to recognize when Medicaid planning becomes a scam and to understand the signs to look out for."
Signs of a Scam
"Some of the signs of Medicaid planning scams include the use of high-pressure sales tactics, promises of guaranteed eligibility, and the use of complicated legal language that is difficult to understand," stated Attorney Connelly. "Always conduct thorough research and seek advice from trusted professionals before engaging with any Medicaid planning company or individual. Knowing what to look for can save you from making costly mistakes that could lead to financial ruin and legal problems."
Scammers can be very vague about the details of their services and may try to conceal essential information from you. You should be wary if you encounter someone unwilling to explain the process or the fees involved. That's a significant red flag that you might be dealing with a scam.
Another concern is the lack of transparency. Legitimate service providers should be open and transparent about their business practices, processes, and fees. They will provide you with all the information you need to make an informed decision. Scammers, on the other hand, will often be evasive or vague when you ask for details. They may try to brush off your questions or deflect them altogether.
Another red flag to look out for is hidden fees. Scammers may advertise their services at a low price, only to charge you hidden fees later. These fees may not be disclosed upfront or buried in the fine print of a contract. Always read the fine print carefully and ask questions about any fees that aren't clear. Don't be afraid to walk away if you feel like you're being taken advantage of. Remember, a reputable service provider will always be transparent and upfront about their fees and services.
Every individual has a distinct financial situation, so finding a Medicaid planning service provider who can customize a plan that caters to your specific needs is important. Be wary of any service provider who offers a standard solution to everyone. Such a cookie-cutter approach may not consider your unique circumstances and could result in unsuitable or even illegal strategies.
Conflicts of Interest
According to the American Council on Aging (ACA), families seeking assistance to qualify for Medicaid are likely to encounter a range of professionals and volunteers, each with their own area of expertise. However, it's important to note that not every type of advisor is appropriate for every situation, and some individuals offering advice may not always have the family's best interests in mind. It's essential, therefore, to thoroughly research and vet the credentials of any professional or volunteer before seeking their help.
Navigating Medicaid planning can be challenging due to the program's complex and ever-changing nature. While Medicaid is a federal program, it is administered on a state level, and the regulations and rules that govern it can vary significantly from state to state. Even within a state, Medicaid laws and programs may regularly change, making it difficult to stay up to date on eligibility requirements and other crucial information. Staying informed of these changes and working with a trusted advisor who can help families navigate the complexities of Medicaid planning will ensure that they receive the best possible care. ACA listed two types of Medicaid planners (commission-based and insurance agents) with potential conflicts of interest.
Commission-Based Medicaid Planners
There is a category of Medicaid Planners who work on a commission basis and assist individuals whose assets exceed Medicaid eligibility limits. These planners offer their services free of charge to families and individuals and receive a commission only when they sell Medicaid-compliant annuities to help applicants meet the Medicaid asset limits. While they possess extensive knowledge about Medicaid eligibility, they may not be familiar with alternative options to Medicaid and are unlikely to advise clients in those areas, as they are only compensated through the sale of annuities. Their services are generally advertised under 'Asset Protection', and one should exercise caution when working with an Annuity Salesperson or Commission-Based Medicaid Planner. It is essential to note that these planners are more inclined to assist individuals who can purchase annuities and may not be able to provide assistance to those who cannot.
Insurance Agents
It is important to understand that insurance agents have a primary goal to sell insurance products. They offer various types of insurance, such as life insurance, health insurance, and long-term care insurance. However, certain insurance policies, such as “final expense” insurance or burial insurance, can help lower one’s assets to meet Medicaid’s asset limit. Some agents are known to offer free Medicaid planning assistance, which can be useful. However, it is crucial to keep in mind that assisting the family may not be their primary goal. The ultimate objective of insurance agents is to sell their insurance products. Therefore, the family should be aware of potential conflicts of interest.
Medicaid Fraud in Massachusetts
In a story published in the December 6 edition of McKnights Long-Term Care News,
Kaylie Giberson, a Medicaid consultant, has been accused of multiple charges of larceny, forgery, and lying to investigators by using nursing home meetings to access the financial information of residents and allegedly stealing tens of thousands of dollars from them. According to reports, Giberson exploited her access to elderly individuals in various nursing homes to gain secure private documents and information while assisting them in applying for Medicaid funding.
It is alleged that Giberson forged multiple signatures to gain durable power of attorney privileges falsely. This, in turn, gave her access to the victims’ bank accounts. It is reported that she stole money from at least three elderly nursing home residents since 2022. The accused has been transferred to Hampden County Superior Court, where she is expected to be arraigned.
Giberson's employment with her former employer, Brunelle Medicaid Consultants, was terminated, as she was accused of using her former employer’s credit card to complete unauthorized online purchases. She listed her location as Agawam, MA, and claimed to have started a new job at Genesis ten months ago. However, Genesis has denied employing her.
This case highlights the importance of staying vigilant when it comes to personal and financial information, particularly for vulnerable groups such as the elderly. It is vital to ensure that individuals with access to sensitive information are trustworthy and have no malicious intent.
Benefits of Using an Attorney
Earlier, we mentioned that there are several professionals who can provide Medicaid planning services. It's worth noting that hiring an elder law attorney can offer several advantages that other professionals might not be able to provide. Let's look at some of these:
Expertise: Medicaid is a complex program with constantly changing rules and regulations, and it can be challenging to navigate without the right expertise. Elder law attorneys specializing in Medicaid are the best resource for staying up to date on the latest policy changes and can provide tailored guidance based on your circumstances. These attorneys deeply understand the eligibility criteria, the application process, and the various benefits available under the program. They can also assist with Medicaid planning, asset protection, and estate planning issues, helping you make informed decisions for your future healthcare needs. With their knowledge and experience, Medicaid attorneys can help maximize benefits while minimizing any potential risks or pitfalls.
Utilizing Legal Techniques: Their knowledge and expertise can help structure your finances and assets to maximize your eligibility for Medicaid. This can include strategies such as establishing trusts, gifting assets, or converting assets into exempt forms. Additionally, an elder law lawyer can advise you on how to protect your assets while still satisfying the program's requirements. They can help you understand the legal implications of any actions you take and guide you through the process of applying for Medicaid benefits. By working with an elder law attorney, you can ensure that you or your loved ones receive the care they need while also preserving your financial security.
Minimizing Mistakes: When it comes to applying for Medicaid, the process can often be overwhelming and confusing. There are numerous forms to fill out and documentation to gather before submitting your application. By hiring an elder law attorney, you can receive guidance and assistance in completing your application accurately and on time. They can help you gather all the necessary paperwork and provide legal advice to ensure that your application is free from errors or omissions that could lead to delays or even rejection. Additionally, an attorney can help you navigate any complex legal issues that may arise during the application process, such as estate planning or asset protection. Overall, having an elder law attorney by your side during the Medicaid application process can help reduce stress and increase your chances of a successful outcome.
Addressing Complexities: If you own a business or have multiple sources of income, it can make the Medicaid application process more complex. In such situations, it's recommended to seek the help of an elder law attorney who works with Medicaid, they can guide you through the intricacies and ensure that all relevant information is presented correctly in your application. They can also help you navigate the application process and address any issues or concerns that may arise. Working with an elder law attorney ensures you have the best chance of getting approved for Medicaid benefits.
Appeals and Support: If you happen to face a situation where your application gets denied or encounter other issues during the application process, you can seek the assistance of the elder law attorney. The attorney can help by representing you in appeals or hearings and advocating for your rights. They can also assist you in resolving any disputes that may arise during the application process. With their expert knowledge and experience, they can guide you through the legal procedures and help you achieve the best possible outcome.
While hiring a lawyer is not mandatory, doing so can provide you with peace of mind and assurance that you have an expert by your side from the beginning to the end of the process, helping you make informed decisions and protecting your rights.
A Final Word
Attorney Connelly emphasized the importance of safeguarding oneself against fraudulent Medicaid planning services. To achieve this, one must adopt a cautious approach when engaging with companies or individuals offering such services.
"By educating yourself about the warning signs of a scam and how to protect yourself, you can make informed decisions about Medicaid planning," said Attorney Connelly. "This will ensure that you and your family are fully prepared for the future without falling victim to fraudulent schemes. Remember, preventing these scams starts with being informed, cautious, and thorough in your research."
Please note that the information provided in this blog is not intended to and should not be construed as legal, financial, or medical advice. The content, materials, and information presented in this blog are solely for general informational purposes and may not be the most up-to-date information available regarding legal, financial, or medical matters. This blog may also contain links to other third-party websites that are included for the convenience of the reader or user. Please note that Connelly Law Offices, Ltd. does not necessarily recommend or endorse the contents of such third-party sites. If you have any particular legal matters, financial concerns, or medical issues, we strongly advise you to consult your attorney, professional fiduciary advisor, or medical provider.