Resolving the issue took about a year
Resolving the issue took about a year
In this case, the Appellant’s Representative/daughter SS submitted an exhibit which included various monthly recurring household expenses. (Exhibit C-1) The ALJ reviewed these expenses to determine if the expenses were causing financial duress for the CS. The regulations however state that the opportunity to increase the CSMNA was not to “guarantee the amenities of any current lifestyle” but rather to prevent the impoverishment of a Community Spouse. The ALJ looked at the Appellant’s verified expenses: water bill of $60.25, electric bill of $287.56, home owner’s insurance of $62.00 (stipulated by the parties; previously verified by the Department), phone bill of $231.94, real estate taxes of $124.33, gas bill of $141.29 The CS total shelter expenses were $907.37.…
In most cases victims are unaware that they are even victims until it is too late to do anything about the theft and there is already a multitude of debt built up in our name. There are so many different ways that identity theft is done these days that the best line of defense is to stay visitant and keep a journal of all expenditures, and check your credit reports regularly. In this chapter we learn that Staying alert to our credit monitoring is like setting a home alarm system (Kapoor, Dlabay, L, & Hughes, 2014). If when checking through financial records and credit reports if there is anything that seems peculiar or out of place immediately dispute and investigate to make sure if it is as simple as a billing error or in fact your identity has been compromised. If you do find that your identity has been stolen immediately report to the appropriate agencies (Kapoor, Dlabay, L, & Hughes, 2014).…
On June 13th, 2016 at 10:57 am, Mrs. Diane Higgs called into our office. She was questioning the amount of life insurance she had on all of her grandchildren. I told her the amount was $25,000 for each child. She told me her bill says she has $50,000 on all her grandchildren except for her grandson, Cooper Turnmier. She said his only showed $25,000 and that she would never have lowered his coverage and not the others.…
The reporting party (RP) is resident Danny Madrid DOB: 8/20/91 who disclosed he was recently released from Cedar Sinai Hospital. On 10/04/16 the RP walked into the Children's Institute located at 701 S. New Hampshire Ave., Los Angeles CA 90005. Per staff member Kimberly Orellana the RP walked into the institute requesting foster care assistance for the homeless. The RP was informed the Institute only provides services to children less than 18 years of age. The RP disclosed to the staff member he had not food, nowhere to sleep, and no resources.…
These match the pay dates of April 6, April 28, May 17, June 10, June 29 and July 14. This fraud resulted in a loss of…
Tera, I need your help, The above unit is stated that the payment posted on the account via Click Pay for the amount $738.40 don’t belong to them. Do we have any other record to show to the resident other than the screen shoot below? And how that payment was allocated to their account if the payment was never initiated by them?…
In 2006 in Edmonds, Washington, a woman from Everett by the name of Barbara Reuter who was 48 years old, stole information about her homeless shelter roommate. She stole her name, social security number, date of birth and other information in order to commit medical identity theft. Her roommate was a Medicaid client from DSHS in Washington State. Barbara assumed her identity to go to doctors. She would then present certain symptoms to the doctors in order to get a prescription for narcotics.…
Mr. Buckley was charged and convicted in the trial court with theft under the Offenses Against Property Act, unlawful use of a credit card, and uttering a forged document. Upon conviction, he appealed to the Court of Appeals of Indiana, Second District claiming insufficient evidence. The first charge of theft under the Offenses Against Property Act requires one to acquire and/or use someone else’s property without permission. Since Mr. Phipps did not give Mr. Buckley permission to use his credit card for any purchases the burden of proof has been met for this charge to stand.…
The reporting party (RP) stated he received a letter date 12/31/15 from CalPERS Investigation Branch. The letter consisted of a completed review of her plan of care. According to the review CalPERS was paying for services not rendered. The facility was charging for dependent toileting, dependent diapering, and dependent showering. The RP stated he received an invoice/accounts receivable from Lilian Mendez (562) 777-1477 showing services 1-4.…
This caller wanted to do an order with multiple shipping addresses and Dorothy told the caller she could give her CS to take care of that. The caller said she would place the one order with her and then do the other through CS. Dorothy took the order and should have sent the caller to CS for all of them.…
Professional Interview A medical biller responsibility in a healthcare facility is to follow the claim to ensure that the practice receives reimbursement for the work that the providers perform. A medical biller also review hospital and patient records, examine and submit claims, answer patient questions, calculate charges, and manage payments. In this interview we will learn the difference between an NPI and a TIN number, explains what a EOB/ERA is, the difference between a deductible, co-pay and co-insurance, the three (3) common mistakes for a claim denial, and the seven (7) step process to submitting an electronic claim. Difference between an NPI and TIN number…
Your post this week was very interesting, I completely agree with the choices when it comes to medical billing coding errors. I do believe in keeping everything up to date in an office is the best way to operate an office. Making errors can become very costly it can also cost the person there job. I do believe that patient should always keep their doctors, specialists in formed of any changes to prevent coding errors and lawsuits. Following all guide lines and protocols is the best thing to do, to prevent any lawsuits and losing their job as well.…
Wells Fargo AML Investigations (AMLI) conducted an investigation of customer Perla Judith Felix Velazqquez (Velazqquez), originating from an internal referral identifying Velazqquez conducted several cash withdrawals in a manner that appears to have been structured to avoid the currency transactions report (CTR) threshold. AMLI finds this activity suspicious because patterns of transactions were observed that appears to have been structured in an attempt to avoid CTR reporting requirements, additionally; Valazqquez was citied in September 2015, SAR filing (case # FCI-2015082800210),for these reason’s the activity is considered suspicious.…
According to ACFE’s article on False Employee Claims, “Occupational fraud is fraud committed by an employee on an employer during their employment” (False Employee Claims – Payroll Fraud, n.d.) “Common expenses claimed are private meal costs classified as business meals with clients, private travel expenses, and other entertainment expenses classified as business expenses” (False Employee Claims – Payroll Fraud, n.d.). In this case, the employee who is a “rising star” claims non-business expenses such as a personal lunch with a co-worker in the company as a business expense. If you intentionally charge your personal lunch when you are given the policy at the start of your employment and you are aware that personal lunches are not allowed in…
This report analyses a 74-second British advertisement for identity fraud and the ID fraud Centre of Royal Mail, with the theme,’ Heist – Don’t let your identity fall into the wrong hands’. The theme aims to raise the public awareness of the safety of their personal information and introduce the online ID fraud centre to them (Royal mail id fraud centre 2017). Royal Mail is a UK’s pre-eminent delivery company. It makes a significant contribution to the UK economy. Their postal system is one of the largest and broadest delivery networks in Europe.…