Lowell Steiger's Los Angeles Law Blog

Recognizing Signs of Elder Abuse

The following is an excerpt from a posting on my website entitled Recognizing Signs of Elder Abuse

A U.S. Bureau of Justice study in 1998 estimated that as many as 500,000 cases of elder abuse were reported and substantiated in 1996. Further, estimates indicate that over 2 million additional incidents went unreported that same year. One reason that so many incidents were not reported may be that relatives and friends are not always sensitive to signs of abuse. Frequently, the most reliable indicators of abuse are complaints made by the elder, but the elder may be unable or unwilling to complain. Because most states impose reporting requirements on those who become aware of elder abuse, it is important to recognize the signs. The following are some of the possible signs indicating common forms of elder abuse.

 

Neglect Indicators

• Poor hygiene, evidenced by an unkempt appearance and stained or torn clothing
• Untreated problems, such as abrasions or bedsores
• Unexplained weight loss, malnutrition or dehydration
• Unsanitary and unclean living conditions, especially beds
• Limited staff at nursing facilities

Emotional or Psychological Abuse Indicators

• The elder is withdrawn and unresponsive, generally unwilling to communicate
• The elder is visibly upset or agitated
• Anger or evident fear
• Unusual or atypical behavior indicating dementia, such as sucking or rocking

 Physical Abuse Indicators
 

• Bruises, black eyes, welts or signs of choking or rope burns
• Suspicious scratches, cuts, pinch marks or cigarette burns
• Broken bones or skull fractures
• Radical changes in behavior, such as being withdrawn, disoriented or agitated
• Refusal of the caregiver to allow visitors

Financial or Material Exploitation Indicators

• Changes in bank accounts or banking practices; additional signatories on accounts
• Abrupt changes in a will or estate plan; documents signed without understanding them
• Disappearance of money and/or valuable possessions
• Payment for unnecessary services or overcharging for services
• Failure to pay bills in a timely manner, despite having sufficient resources from which to pay them 
  

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Medicare Reimbursement in Personal Injury Cases

The following is an article that was posted on my website, www.steigerlaw.com  As a preface to the article, it should be noted that your attorney has a statutory obligation to follow the rules as they apply to Medicare in relation to a personal injury matter.

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Medicare, established in 1965, is a federal health care plan for those 65 and older, in addition to certain persons under 65 (e.g., the disabled).  In the event a Medicare recipient is injured through the fault of another, he may have the right to recover from the person causing injury (or his insurance company).

Medicare
Medicare was initially the "primary payer" for medical services to beneficiaries, meaning that it paid first for medical costs, even where other sources existed.  However, high costs led Congress, beginning in 1980, to enact "Medicare Secondary Payer" (MSP) laws.  The MSP legislation sought to reduce Medicare costs by requiring beneficiaries to first exhaust other sources of payment before resorting to Medicare.

Medicare Payment for Treatment of Injuries

Federal law generally prohibits Medicare from paying for any item or service where payment can reasonably be expected from another "primary" source within 120 days.  Primary sources include the following:

• Automobile insurance
• Liability insurance (including self-insurance)
• No fault insurance

When payment from another source is probable, yet not likely to occur within 120 days, the law allows "Conditional Medicare Payment" for medical costs.  Although Medicare providers are often required to question patients regarding possible alternative sources of payment, as a practical matter, the agencies that run Medicare have little way of knowing about such alternatives.  As a result, "conditional payment" is often made.

 

Medicare Reimbursement: Rights and Duties

The MSP system includes provisions for reimbursement and "subrogation."  In other words, Medicare succeeds to the rights of the injured party to sue the injuring party, or others, for recovery.  Further, the administration of enforcement efforts of Medicare reimbursement rights has been contracted out to HGS Administrators (HGSA).

 

Debate has taken place over the nature and extent of Medicare's right to recover.  Some commentators, for example, have called it a "super lien" against any settlement or judgment in a personal injury lawsuit.  Strictly speaking, the right to recover does not technically constitute a lien (i.e., not a right to recover from specific property or funds).  However, the MSP program grants extensive powers and specifies broad rights and duties related to reimbursement of "conditional payments."  These include, but are not limited to:   

• A duty on the part of the beneficiary (and maybe her attorney) to notify HGSA of any lawsuit and pending or possible settlement or recovery.
• The beneficiary (and maybe her attorney) has a statutory duty to reimburse Medicare for its "conditional payments" within 60 days of receipt of a "third party-payment" (e.g., a settlement or collection on a judgment).  If payment is not timely made, Medicare may begin charging interest.
• HGSA and Medicare have the right to seek repayment (e.g., bring a collection action) from a wide range of individuals who receive payment, but fail to reimburse Medicare (including the injured party and her attorney).  Although it is not clear whether Medicare can proceed directly against the injured person's attorney after the money has been distributed, at least one court has affirmed this right.  In general, however, it appears that if the money has been distributed and spent, the injured person's future Social Security benefits will be used to reimburse Medicare.
• As part of Medicare's right of action, it may recover double the amount of the conditional payments from an insurance company that is a "third-party payer" and "primarily liable" for the damages.  This is true even if payment has already been made to the injured party.  As a consequence, the insurance company may end up paying the injured person and Medicare (resulting in triple payment).  Furthermore, Medicare has the right to deduct the amount from Medicare payments owing to the third-party payer.
• Medicare is deemed to have a "priority right of recovery;" i.e., it takes precedence even if state law or the third-party payer asserts otherwise.

Waiver or Compromise

Depending on the circumstances, Medicare may waive its right to reimbursement, though it is more likely to compromise the amount.  Under applicable regulations, Medicare will reduce its recovery to allow for the cost of procuring the settlement or judgment, including attorneys' fees.

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If you, or someone you know, has been injured, please call me immediately at

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"Treated With the Respect That You Deserve"

Link of the Day: Handicapped Fraud

How do you feel when you see a perfectly healthy person park in the disabled parking zone? Don't you just want to shake them and say "Hey, what are you doing?  There's an elderly lady over there who NEEDS this spot."  This issue is of particular importance to me because, as you know, I represent injured people -- legitimately injured people for whom the designated disabled parking spots mean the difference between being able to be a part of the world or staying home while being alienated from the rest of society. 

Well, welcome to Handicapped Fraud.org.  Here's their mission statement:

Handicappedfraud.org was launched as a community service effort to end the misuse of handicapped parking spaces and placards. The disabled have run out of places to park, as their designated handicapped parking spaces are being taken by fraudulent individuals. Our cities are being robbed of serious metered parking revenue to to this abuse as well. The police are far too valuable and busy to stake out parking lots to ticket handicapped parking violators. The abusers go largely unpunished. It's time for our community to become the ambassadors for our cities, and report handicapped parking violators when they see it.

A grass roots vigilante organization designed to protect those who truly need and deserve to park in the handicapped spots.

Here are some videos that drive the point home:

This is why you should not park in a disabled parking space. A woman with Multiple Sclerosis (MS) gives her view.:

A mother of two children with disabilities in Concord, California channels her frustration with people taking disabled parking spaces in a positive way. Her idea is turned into a new California law by Assembly member Mark DeSaulnier:

Jim Carrey reacts to a man illegally parking in a Handicapped Zone:

If you, or someone you know, has been injured, please call me immediately at (323) 852-1100 or send an e-mail to me at lowell@steigerlaw.com

"Treated With the Respect That You Deserve"

Senior Citizen Driving: Warning Signs and Helping an Unsafe Driver to Stop Driving

I found an interesting article on the Helpguide.org website entitled Senior Citizen Driving: Warning Signs and Helping an Unsafe Driver to Stop Driving.  The article details a great many issues of importance to senior drivers and those who love them:

• Risk Factors of Aging That Can Affect Driving Ability
• Warning Signs of Unsafe Driving
• Steps to Take if You're Concerned About the Safety of a Senior Driver
• Talking to a Senior Driver Who Should Stop Driving
• When a Senior Driver Refuses to Give up the Keys
• Helping a Senior Adjust to Life Without Driving
• References and Resources for Helping an Unsafe Senior to Stop Driving

In addition to an extensive discussion and analysis on the subject of seniors on the road, there is a link to an article by Rod Clark entitled Making the "Key" Decision: When Should an Older Adult Surrender Their Keys? (courtesy of Agenet.com) which includes an actual checklist with questions that answer the question "Can I Still Drive Safely in Spite of My Age?"

Here are but just a few of the relevant links provided in this article:

• AARP Driver Safety Course
• Driving Safely While Aging Gracefully (National Highway Traffic Safety Administration)
• Family Conversations with Older Drivers (The Hartford)
• Vision Connection: Tips for Older Drivers (Lighthouse International)
• Test Your Driving I.Q. (AARP)
• Drugs and the Older Driver (Canada Safety Council)
• Alzheimer's, Dementia & Driving (The Hartford)
• Helping Your Parents Stay Mobile (AARP)

Again, I encourage you to read the entire article by clicking here.

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Contact Attorney Lowell Steiger at          (323) 852-1100       

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www.steigerlaw.com

If you have suffered a Personal Injury, Call for a Free Consultation