Texas Medicaid Provider Recoupment: Fill & Download for Free

All roads ahead for Theranos are now legal because the legal issues need full and clear resolution before trust can be reestablished.The sanctions by CMS are serious. From the Theranos press release on July 7:Revocation of the laboratory’s CLIA certificate which, as dictated by the regulations, includes a prohibition on owners and operators of the lab from owning, operating or directing a lab for at least two years from the date of revocationLimitation of the laboratory’s CLIA certificate for the specialty of hematologyA Civil Money PenaltyA Directed Portion of a Plan of CorrectionSuspension of the laboratory’s approval to receive Medicare and Medicaid payments for any services performed for the specialty of hematologyCancellation of the laboratory’s approval to receive Medicare and Medicaid payments for all laboratory servicesAll of this is in addition to lawsuits filed against the company earlier this year by at least 2 separate patients. Even though they aren’t today, these could easily expand to become class action status. Other legal actions (from investors and partners like Walgreens) may well be in the works - or pending.Beyond a dated and high profile valuation of $9B (effectively zero’d out recently), the company’s capacity to weather all these expensive legal storms is largely unknown.Assuming there’s a relatively large sum of “cash-on-hand” (from earlier rounds of venture financing), there’s a new risk that investors will want to quickly liquidate whatever assets remain and partners may want to recoup any losses. All this pressure is greatly increased by the CMS sanctions. It may be easy to quell investor concerns individually and privately - but CMS is a public lashing that instantly validates many of the clinical arguments against the accuracy of the technology itself.Beyond this, Elizabeth Holmes herself could be subject to new law suits against her personally for either securities violations or even personal liability for the mistakes of the technology. Those mistakes may well have caused serious patient harm - including (possibly) death.The resulting loss of time dealing with all these legal challenges cannot be trivialized. The market has already moved on and there are other competitors who will benefit directly from this.The new partnership between Safeway and Quest Diagnostics is a great example - and there are others targeting the Direct Access Testing (DAT) market. While Safeway originally partnered with Theranos, they dissolved the partnership after missed deadlines and questions around accuracy began to surface.Safeway, Theranos Split After $350 Million Dollar Deal FizzlesAs evidenced by this joint press release, the new Safeway/Quest partnership is now producing results and, not coincidentally, in the same city - Phoenix - that Theranos rolled out their (now failed) partnership with Walgreens.MADISON, N.J., June 15, 2016 /PRNewswire/ -- Quest Diagnostics (NYSE: DGX), the world's leading provider of diagnostic information services, and Safeway, one of the largest food and drug retailers in the U.S., are teaming up to offer diagnostic testing in 12 Safeway locations, in addition to the two locations currently operating in Arizona through Quest's Sonora Quest Laboratories joint venture with Banner Health.Quest Diagnostics will provide diagnostic testing services offered in company-branded Patient Services Centers (PSCs) in 12 Safeway locations in California, Colorado, Texas, Virginia and Maryland.Publicly traded Quest Diagnostics (NYSE: DGX) has about 44,000 employees and operations in the U.K., India, Mexico, Brazil, and Puerto Rico. Founded in 1967, it has revenue today of about $7.5B and it’s #358 on the Fortune 500 list.As it is today, the DAT market is very small compared to doctor-ordered tests and clinical lab services through hospitals. While the forecast for DAT may be attractive, it’s also poised for new innovations that threaten to disrupt the blood testing market yet again. One - called HemoLink - is designed to be low cost, disposable, needle-free, and available for home use.[The] ping pong ball-sized HemoLink blood sampler can be operated by the patient at home, and needs only to be placed against the skin of the arm or abdomen for two minutes to do its job.While it’s always hard to predict the future for any startup - including high profile ones like Theranos - the legal challenges ahead are daunting, expensive, and time consuming. They are also necessary for any company to restore trust in every direction - especially with a critical healthcare process like diagnostic testing. Trust in general - and patient trust in particular - is earned in ounces and lost in gallons.

You really need to take this to your lawyer. The thing this questioner needs is legal advice; that can’t be given on Quora.The general, “canonical” answer is that (1) it’s possible there was a mistake, (2) it’s also possible that the OAG (as the state’s support enforcement agency) is looking for all past-due support on the case, be it child or spousal, and (3) you need to take this seriously because support defaults can be punished with jail.¹ Quora answers are not a reasonable substitute for legal advice.According to an “Anonymous” answer apparently intended as clarifying context, the support obligor was directed to pay “mortgage and expenses of the marital home until it sells,” and believes that the limited scope of this relief (presumably divorce-related) was “clear” in the order, though the exact terms of that order weren’t provided. Recently the OAG has averred non-compliance and stated a figure for arrears that includes the amount ordered for the mortgage and expenses as well as an amount for child support. Another tidbit is also given: “We found out not too long ago that the [obligee] filed for some sort of state assistance.”I am inferring from the involvement of the OAG (which is Texas’ equivalent of our Domestic Relations Office), that this sum might actually supposed to be paid to the obligee (ex-wife) via the state collection and disbursement unit rather than directly to her or to the creditors. Whether or not it was supposed to be so paid is something we don’t know, but this is going to cause an irregularity in the numbers right off the bat that will look like a default. The “spousal support-child support” dichotomy may be irrelevant. Our SCDU collects spousal as well as child support cases; I don’t see any reason why Texas might not as well, and even though spousal only support cases are not IV-D cases² and thus not subject to all of the same Federal IV-D regulations as child support cases, it’s not uncommon that a support office will use the same sorts of procedures to enforce both types of cases; it’s not efficient to have a different scheme for the spousal stuff.Title IV-A (the welfare block grant statute) does require people who need to ask for TANF (and in many more conservative states, also food stamps or Medicaid) to seek formal support from ex-partners with potential liability for support. However, that’s limited to establishment proceedings. If the support were already established, the application should not have precipitated enforcement all by itself. If the child support hadn’t been established, the application would have required her to go and pursue establishment. And if it had been established, the State can subrogate the support to recoup certain sums paid out in welfare benefits; this doesn’t affect how much the obligor pays though.³Support enforcement isn’t dependent on the way that an applicant/recipient categorizes the support on an application for assistance, though; rather support enforcement is dependent on the way that the support enforcement agency categorizes the payments. It’s possible, I suppose, that Texas uses a scheme that where spousal support or other non-IV-D family obligations are rolled into the child support enforcement system at the time of child support establishment, something I couldn’t rule out from the “details,” so that could explain the sudden interest in the case by the OAG.¹ If this money was supposed to be paid in some way not involving the OAG, and/or it was actually paid and the obligor can prove that, these are potential substantive defenses to contempt. Construction of court orders is similar to statutory construction, and thus is a question of law. But because contempt cases involve specific factual scenarios and the temperaments of individual judges, a local attorney (or, ideally, the attorney you already have for the divorce) would be in a much better position to answer your questions.² John Gragson's answer to How does child support work in general?³ John Gragson's answer to Can I forgive child support?

**EDIT: I took the question to mean what could hospice patients use that they aren’t currently receiving? I have answered that question below, based on US hospice regulations and my experiences as a hospice social worker in Texas. The other ladies above have already done a good job of listing things that hospice patients DO receive.**Ha! I love this question, if only because I think the possibilities are endless.I care for a lot of very poor families. San Antonio has some of the worst poverty rates in the nation. And although I haven’t done any studies to prove this is true, my personal experience gives me the impression that the poor are more likely to utilize hospice. Why? Well, for one, I think one of hospice’s biggest draws is the availability of aides to assist with bathing and hygiene. For many families, this is a determining factor. After all, Junior may not have the training or strength to maneuver his father (who cannot even get into and out of a wheelchair without assistance) into the shower, but hospice will do it for him, usually 3 times per week. And unless you have a ton of money, paying a private provider agency to do it for you is impossible.So that’s one of the reasons why I think I see more poverty-stricken patients and families than demographics alone account for. Part of my answer depends on how I understand your question. Do you consider providers medical or not? I think there is a lot of disagreement on that, and that is probably the one thing hospice families need more than anything. A lot of families think that hospice will care for their loved one day in and day out. That is true in the sense that a nurse is always available for emergencies, but no, we do not place an aide by the bedside 24/7 to change diapers whenever it’s needed. Families have a hard time with that. Sometimes the primary care giver is also 90 years old and frail, or sometimes it is a daughter who works 3 jobs to make ends meet and is therefore not home often. They may expect hospice to change diapers, and then when they find out we aren’t available for that, they don't know what to do. And frankly, often, neither do I.I can usually arrange for placement in a nursing home, but many families won’t hear of it. If the family can cough up $1500 (at an absolute minimum) or more per month, I can put the patient in a personal care home, wherein a live-in provider cares for 3–4 people round-the-clock. If the family can afford $20/hour, agency providers are easy to come by, but who can honestly afford that? (By the way, long term care insurance takes care of these worries, but it costs enough that in the end, all you have done is spread the expense over decades instead of months.). And Medicare does not pay for any of this, people! The people for whom you have voted made sure of that.(By the way, I also hear a lot that “Such-and-such hospice has an inpatient unit where mom can stay.” It is true that there are hospices that have kept patients in inpatient units for weeks at a time, but that is Medicare fraud. They’re only supposed to do that for 2–3 days at a time, in order to control otherwise intractable symptoms, like pain, vomiting, or shortness of breath. But it makes it hard for those hospices that are trying to obey the law, because then families demand that.)The State of Texas will send a provider to the home if you meet certain income qualifications, which are the same as for nursing home Medicaid. An individual can make up to $2200 per month and have $2000 in assets, not counting the homestead and one vehicle. The vast majority of my patients qualify. But the State retains the right to confiscate the patient’s home after he/she (and the spouse, if there is one) has died, and sell it to recoup the State’s costs. For most poor families, the house they spent their lives paying off is the one thing they have to pass on to their children, so they refuse. The patient figures he just needs to struggle through a couple of months of lying in his own waste, and then he can still leave the home to his kids. It’s all very sad. Provider care is the hardest thing I deal with as a social worker, because I can only offer the resources that exist, and in Texas, they just don't.As for other non-medical things, there are tons. Some families are too poor to pay for electricity, which means we have dying people living with the heat of a 100′F+ San Antonio summer with no A/C. Or they can’t afford to buy sheets for their hospital beds. Or they are too poor to buy groceries, and the Food Bank is great with canned goods, but there is no way they will ever get truly fresh produce.Transportation is always an issue, poor or not. It is very difficult for a person in a wheelchair to ever go anywhere. The City of San Antonio provides wheelchair vans through their city bus service, but you usually have to request the ride 2 weeks in advance, and there is usually a 2 hour window for them to pick you up. I did an internship with a dialysis clinic when I was in my social work program, and those poor patients spent their ENTIRE day, 3 days a week, doing dialysis. It was usually 4 hours in the chair, and 2 hours on either end getting to and from home. And a long wait for the wheelchair van is not good for a hospice patient, already weak and fatigued.I am sure I can think of other things, but this is already lengthy.