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Hi friends. Yesterday, I learned about California Employee Rights Breaks - An Llc in Va - How is the Virginia little Liability company Taxed?. Which may be very helpful in my experience and also you. An Llc in Va - How is the Virginia little Liability company Taxed?Taxation of an Llc in Va is a common request for those starting an Virginia puny liability company. The good news is that if you know the rules and meet positive timing requirements, you can pick how your Virginia Llc will be taxed for revenue tax purpose.
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Tax option #1: Pass straight through Taxation
The first tax option for an Llc in Va is to be taxed as a pass straight through entity. This means that the legal entity itself does not pay any revenue tax on its profits and gains. Instead the profits are passed straight through to the owners of the Virginia puny liability business and paid by the owners on their personel tax returns.
The process depends on whether the business is owned by a particular member or by more than one member. With a particular member Llc, the legal entity is disregarded for all tax purposes and the particular owner reports the revenue on its return as if the business were a sole proprietorship. This is for taxes only. A particular member Llc in Va still gets all the advantage of a puny liability business for all other purposes such as gaining puny liability protection.
For a multi-member business, the partnership tax rules of the Internal revenue Code apply. Same end succeed where the owners pay the tax but there are some added steps. The business must put in order an data return to file with the Irs and then send each member a tax form which is known as a K-1 which evidences his/her share of business profits and losses.
If you want this tax structure, this is the default tax structure which means there are no elections you or your Llc in Va need to make.
Tax option #2: C Corporation Taxation
The second tax option is to be taxed a C corporation under the Internal revenue Code. C corporation taxation means double taxation which is why most small businesses who are puny liability fellowships do not opt for this choice. double taxation means the entity itself pays a tax on its profits and then if the profits are distributed to its owners, the owners pay other tax on the same profits.
Nonetheless, an Llc in Va might find it advantageous to elect C corporation taxation. The C corporation tax rates may be lower than the personal rates of the owners. Also C corporation taxation can give a business some extra tax breaks when it comes to positive worker benefits.
It is always recommended you seek the advice of your business accountant if you are contemplating C corporation taxation.
Tax option #3: S Corporation Taxation
The Irs even allows for an Llc in Va to be taxed as an S corporation if the business meets all the requirements to qualify for S corporation tax treatment.
S corporation taxation is very similar to pass straight through taxation (Choice #1) in that it is a particular layer of taxation . There are distinct forms to file with the Irs. However, S corporation can be much more involved because there is a laundry list of rules and restrictions the Virginia puny liability business must meet and verbalize throughout its existence.
Many opt against this because if for some reason, they inadvertently fail to meet a requirement, they could lose the tax status and potentially requisite liabilities can be created.
However, there is one inherent advantage of S corporation taxation over pass straight through partnership or disregarded entity taxation and that is that an Llc in Va that has S corporation tax treatment may be able to pay less in self employment taxes. Talk to you accountant if this is something of interest as the rules can get complex.
Summary
An Llc in Va has the most tax choices over any other legal entity or business structure. While this was not always the case, the Irs provided for this in 1997. Since 1997, the Virginia puny liability business has come to be the most beloved option for small business owners.
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California Employee Rights Breaks - The divergence between Being Smart, Educated, and engaging
Good afternoon. Today, I found out about California Employee Rights Breaks - The divergence between Being Smart, Educated, and engaging. Which is very helpful in my experience and you. The divergence between Being Smart, Educated, and engagingI've all the time been intrigued by the branch of intelligence. As a child my mother would refer to me as "smart," but I swiftly noticed that all parents refer to their children as smart. In time I would scrutinize that all children are not smart, just as all babies are not cute. If that were the case, we'd have a world full of beautiful, smart people - which we don't.
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Some of us are smart; but not as smart as we think, and others are smarter than they seem, which makes me wonder, how do we define smart? What makes one man smarter than another? When do "street smarts" matter more than "book smarts"? Can you be both smart and stupid? Is being smart more of a direct work on of genetics, or one's environment?
Then there are the issues of education, brain and wisdom.
What does it mean to be extremely educated? What's the discrepancy in the middle of being extremely educated and extremely intelligent? Does being extremely educated automatically make you extremely intelligent? Can one be extremely attractive without being extremely educated? Do Iqs authentically mean anything? What makes a man wise? Why is wisdom typically linked with old age?
My desire to seek answers to these questions inspired many hours of intense explore which included the reading of 6 books, hundreds of explore documents, and countless hours on the Internet; which pales in comparison to the lifetime of studies and explore that pioneers in the fields of brain and schooling like Howard Gardner, Richard Sternberg, Linda S. Gottfredson, Thomas Sowell, Alfie Kohn, and Diane F. Halpern whose work is cited in this article.
My goal was simple: Amass, synthesize, and gift data on what it means to be smart, educated and attractive so that it can be understood and used by anything for their benefit.
Prenatal Care
With this in mind, there was not a good (or more appropriate) place to start than at the very starting of our existence: as a fetus in the womb.
There is mounting evidence that the consumption of food that's high in iron both before and while fertilization is requisite to construction the prenatal brain. Researchers have found a strong association in the middle of low iron levels while fertilization and diminished Iq. Foods rich in iron comprise lima beans, kidney beans, pinto beans, spinach, asparagus, broccoli, seafoods, nuts, dried fruits, oatmeal, and fortified cereals.
Children with low iron status in utero (in the uterus) scored lower on every test and had significantly lower language ability, fine-motor skills, and tractability than children with higher prenatal iron levels. In essence, allowable prenatal care is requisite to the development of cognitive skills.
Cognitive Skills
Cognitive skills are the basic mental abilities we use to think, study, and learn. They comprise a wide collection of mental processes used to analyze sounds and images, recall information from memory, make associations in the middle of different pieces of information, and declare attentiveness on particular tasks. They can be individually identified and measured. Cognitive skill compel and efficiency correlates directly with students' ease of learning.
Drinking, Pregnancy, And Its Intellectual Impact
Drinking while pregnant is not smart. In fact, it's downright stupid.
A study in Alcoholism: Clinical & Experimental explore has found that even light to moderate drinking - especially while the second trimester - is linked with lower Iqs in offspring at 10 years of age. This consequent was especially pronounced among African-American rather than Caucasian offspring.
"Iq is a portion of the child's ability to learn and to survive in his or her environment. It predicts the inherent for success in school and in everyday life. Although a small but requisite percentage of children are diagnosed with Fetal Alcohol Syndrome (Fas) each year, many more children are exposed to alcohol while fertilization who do not meet criteria for Fas yet perceive deficits in increase and cognitive function," said Jennifer A. Willford, assistant professor of psychiatry at the University of Pittsburgh School of Medicine.
Paul D. Connor, clinical director of the Fetal Alcohol and Drug Unit and assistant professor in the agency of psychiatry and behavioral sciences at the University of Washington has this to say about the subject:
"There are a estimate of domains of cognitive functioning that can be impaired even in the face of a relatively general Iq, together with academic achievement (especially arithmetic), adaptive functioning, and administrative functions (the ability to problem solve and learn from experiences). Deficits in intellectual, achievement, adaptive, and administrative functioning could make it difficult to appropriately conduct finances, function independently without assistance, and understand the consequences of - or react appropriately to - mistakes."
This is a key looking which speaks directly to the (psychological) definition of brain which is addressed later in this article.
Ultra Sounds
Studies have shown that the frequent exposure of the human fetus to ultrasound waves is linked with a decrease in newborn body weight, an increase in the frequency of left-handedness, and delayed speech.
Because ultrasound vigor is a high-frequency mechanical vibration, researchers hypothesized that it might work on the migration of neurons in a developing fetus. Neurons in mammals multiply early in fetal development and then migrate to their final destinations. Any interference or disruption in the process could consequent in abnormal brain function.
Commercial associates (which do ultrasounds for "keepsake" purposes) are now creating more great ultrasound machines capable of providing favorite 3D and 4D images. The procedure, however, lasts longer as they try to make 30-minute videos of the fetus in the uterus.
The main stream magazine New Scientist reported the following: Ultrasound scans can stop cells from dividing and make them commit suicide. Disposition scans, which have let doctors peek at fetuses and internal organs for the past 40 years, work on the general cell cycle.
On the Fda website this information is posted about ultrasounds:
While ultrasound has been around for many years, expectant women and their families need to know that the long-term effects of repeated ultrasound exposures on the fetus are not fully known. In light of all that remains unknown, having a prenatal ultrasound for non-medical reasons is not a good idea.
Nature Versus Nurture...The turn over Continues
Now that you are aware of some of the known factors which determine, improve, and impact the intellectual development of a fetus, it's time for conception. Once that baby is born, which will be more crucial in the development of its intellect: nature (genetics) or nurture (the environment)?
Apparently for centuries, scientists and psychologists have gone back and forth on this. I read many extensive studies and reports on this branch while the explore phase of this article, and I believe that it's time to put this turn over to rest. Both nature and nurture are equally as prominent and must be fully observed in the intellectual development of all children. This shouldn't be an either/or proposition.
A recent study shows that early intervention in the home and in the classroom can make a big discrepancy for a child born into ultimate poverty, according to Eric Turkheimer, a psychologist at the University of Virginia in Charlottesville. The study concludes that while genetic makeup explains most of the differences in Iq for children in wealthier families, environment - and not genes - makes a bigger discrepancy for minority children in low-income homes.
Specifically, what researchers call "heritability"- the degree to which genes work on Iq - was significantly lower for poor families. "Once you're put into an adequate environment, your genes start to take over," Mr. Turkheimer said, "but in poor environments genes don't have that ability."
But there are reports that contradict these findings...sort of.
Linda S. Gottfredson, a professor of educational studies at the University of Delaware, wrote in her article, The general brain Factor that environments shared by siblings have tiny to do with Iq. Many people still mistakenly believe that social, psychological and economic differences among families generate continuing and marked differences in Iq.
She found that behavioral geneticists refer to such environmental effects as "shared" because they are tasteless to siblings who grow up together. Her reports states that the heritability of Iq rises with age; that is to say, the extent to which genetics accounts for differences in Iq among individuals increases as people get older.
In her article she also refers to studies comparing identical and fraternal twins, published in the past decade by a group led by Thomas J. Bouchard, Jr., of the University of Minnesota and other scholars, show that about 40 percent of Iq differences among preschoolers stems from genetic differences, but that heritability rises to 60 percent by adolescence and to 80 percent by late adulthood.
And this is possibly the most attractive bit of information, and relevant to this section of my article:
With age, differences among individuals in their industrialized brain come to mirror more closely their genetic differences. It appears that the effects of environment on brain fade rather than grow with time.
Bouchard concludes that young children have the circumstances of their lives imposed on them by parents, schools and other agents of society, but as people get older they come to be more independent and tend to seek out the life niches that are most congenial to their genetic proclivities.
Breast-Feeding Increases Intelligence
Researchers from Christchurch School of treatment in New Zealand studied over 1,000 children born in the middle of April and August 1977. while the period from birth to one year, they gathered information on how these children were fed.
The infants were then followed to age 18. Over the years, the researchers collected a range of cognitive and academic information on the children, together with Iq, educator ratings of school operation in reading and math, and results of standardized tests of reading comprehension, mathematics, and academic ability. The researchers also looked at the estimate of passing grades achieved in national School Certificate examinations taken at the end of the third year of high school.
The results indicated that the longer children had been breast-fed, the higher they scored on such tests.
Talking To Your Children Makes A Difference
Thomas Sowell, author of Race, Iq, Black Crime, and facts Liberals Ignore uncovered some attractive information that every parent should take note of. He writes:
There is a strong case that black Americans suffer from a series of disadvantageous environments. Studies show time and again that before they go to school, black children are on median exposed to a smaller vocabulary than white children, in part due to socioeconomic factors.
While children from pro households typically exposed to a total of 2,150 different words each day, children from working class households are exposed to 1,250, and children from households on welfare a mere 620.
Yes, smart sounding children tend to come from educated, professional, two-parent environments where they pick-up requisite language skills and vocabulary from its smart sounding inhabitants.
Mr. Sowell continues: Black children are obviously not to blame for their poor socioeconomic status, but something beyond economic status is at work in black homes. Black people have not signed up for the "great mission" of the white middle class - the constant quest to stimulate intellectual increase and get their child into Harvard or Oxbridge.
Elsie Moore of Arizona State University, Phoenix, studied black children adopted by either black or white parents, all of whom were middle-class professionals. By the age of 7.5 years, those in black homes were 13 Iq points behind those being raised in the white homes.
Accumulated Advantages
At this juncture in my explore it dawned on me, and should be fairly determined to you, that many children are predisposed to being smart, educated, and intelligent, simply by their exposure to the influential factors which conclude them long before they start school.
An informed mother, allowable prenatal care, educated, communicative parents, and a nurturing environment in which to live, all add up to accumulated advantages that formulate intellectual abilities. As you can see, some children have unfair advantages from the very beginning.
Malcolm Gladwell, author of top-selling book Outliers, wrote that "accumulated advantages" are made inherent by arbitrary rules...and such unfair advantages are everywhere. "It is those who are thriving who are most likely to be given the kinds of social opportunities that lead to additional success," he writes. "It's the rich who get the biggest tax breaks. It's the best students who get the best teaching and most attention."
With that in mind, we turn our attentiveness to schooling and intelligence.
What Does It Mean To Be Well Educated?
Alfie Kohn, author of the book What Does It Mean To Be Well Educated? poses the question, does the phrase well educated refer to a ability of schooling you received, or something about you? Does it denote what you were taught? Or what you remember?
I declare that to be well educated is all in the application; the application and use of information. information has to be used in order to come to be knowledge, and as we all have heard, knowledge is power.
Most people are aware of the floundering state of schooling in this country on some level. We tell our children that nothing is more prominent than getting a "good" education, and every year, due to government budget shortfalls, teachers are laid off, classes are condensed, schools are closed, and many educational programs - especially those which help the underprivileged - are cut.
The reality is, we don't authentically value education. We value it as a business, an industry, political ammunition, and as an accepted form of discrimination, but not for what it was intended: a means of enriching one's character and life straight through learning.
What we value as a society, are athletes and the entertainment they offer. The fact that a pro athlete makes more money in one season, than most teachers in any region will make in their careers, is abominable. There's all the time money to build new sports stadiums, but not adequate to give teachers a decent (and well-deserved) raise.
Ironically, the best teachers don't go into the profession for money. They teach because it's a calling. Most of them were influenced by a authentically good educator as a student. With the mass exodus of teachers, many students are not able to cultivate the mentoring relationships that they once were able to because so many are leaving the profession - voluntarily and involuntarily - within an median of three years.
At the high school level, where I got my start, the emphasis is not on how to educate the students to prepare them for life, or even college (all high schools should be college-prep schools, right?), it was about establishment them to excel on their standardized tests. Then the controversial "exit" exams were implemented and literally, many high schools were transformed into testing centers. Learning has almost come to be secondary.
This mentality carries over into college, which of policy there's a test one must take in order to enroll (the Sat or Act). This explains why so many college students are more involved with completing a course, than Learning from it. They are focused on getting "A's" and degrees, instead of becoming degreed thinkers. The latter of which are in greater ask by employers and comprise the bulk of the self-employed. The "get-the-good-grade" mindset is directly attributable to the relentless and often unnecessary testing that our students are subjected to in schools.
Alfie Kohn advocates the "exhibition" of learning, in which students relate their understanding by means of in-depth projects, portfolios of assignments, and other demonstrations.
He cites a model pioneered by Ted Sizer and Deborah Meier. Meier has emphasized the point of students having five "habits of mind," which are: the value of raising questions about evidence ("How do we know what we know?"), point of view, ("Whose perspective does this represent?"), connections ("How is this linked to that?"), supposition ("How might things have been otherwise?"), and relevance ("Why is this important?").
Kohn writes: It's only the ability to raise and sass those questions that matters, though, but also the Disposition to do so. For that matter, any set of intellectual objectives, any article of what it means to think deeply and critically, should be accompanied by a reference to one's interest or intrinsic motivation to do such thinking...to be well-educated then, is to have the desire as well as the means to make sure that Learning never ends...
History And Purpose Of Iq
We've all the time wanted to portion intelligence. Ironically, when you look at some the first methods used to evaluate it in the 1800s, they were not, well, very intelligent. Tactics such as subjecting people to various forms of torture to see what their threshold for pain was (the longer you could withstand wincing, the more attractive you were believed to be), or testing your ability to detect a high pitch sound that others could not hear.
Things have changed...or have they?
No argument of brain or Iq can be perfect without mention of Alfred Binet, a French psychologist who was responsible for laying the groundwork for Iq testing in 1904. His primary intention was to devise a test that would diagnose Learning disabilities of students in France. The test results were then used to prepare extra programs to help students overcome their educational difficulties.
It was never intended to be used as an absolute portion of one's intellectual capabilities.
According to Binet, brain could not be described as a particular score. He said that the use of the brain Quotient (Iq) as a exact statement of a child's intellectual ability would be a serious mistake. In addition, Binet feared that Iq estimation would be used to condemn a child to a permanent "condition" of stupidity, thereby negatively affecting his or her schooling and livelihood.
The primary interest was in the evaluation of 'mental age' -- the median level of brain for a man of a given age. His creation, the Binet-Simon test (originally called a "scale"), formed the archetype for hereafter tests of intelligence.
H. H. Goddard, director of explore at Vineland Training School in New Jersey, translated Binet's work into English and advocated a more general application of the Simon-Binet test. Unlike Binet, Goddard thought about brain a solitary, fixed and inborn entity that could be measured. With help of Lewis Terman of Stanford University, his final product, published in 1916 as the Stanford revision of the Binet-Simon Scale of brain (also known as the Stanford-Binet), became the accepted brain test in the United States.
It's prominent to note that the fallacy about Iq is that it is fixed and can not be changed. The fact is that Iq scores are known to fluctuate - both up and down while the policy of one's lifetime. It does not mean that you come to be more, or less intelligent, it merely means that you tested good on one day than another.
One more thing to know about Iq tests: They have been used for racist purposes since their importation into the U.S. Many of those who were complicated in the importation and refinement of these tests believed that Iq was hereditary and are responsible for feeding the fallacy that it is a "fixed" trait.
Many immigrants were tested in the 1920s and failed these Iq tests miserably. As a result, many of them were denied entry into the U.S., or were forced to feel sterilization for fear of populating America with "dumb" and "inferior" babies. If you recall, the tests were designed for white, middle class Americans. Who do you think would have the most strangeness passing them?
Lewis Terman industrialized the primary opinion of Iq and proposed this scale for classifying Iq scores:
000 - 070: exact feeble-mindedness
070 - 079: Borderline insufficiency
080 - 089: Dullness
090 - 109: general or median brain
110 - 119: first-rate intelligence
115 - 124: Above median (e.g., university students)
125 - 134: Gifted (e.g., post-graduate students)
135 - 144: extremely gifted (e.g., intellectuals)
145 - 154: Genius (e.g., professors)
155 - 164: Genius (e.g., Nobel Prize winners)
165 - 179: High genius
180 - 200: top genius
200 - higher ?: Immeasurable genius
*Genius Iq is commonly thought about to begin around 140 to 145, representing only 25% of the people (1 in 400).
*Einstein was thought about to "only" have an Iq of about 160.
Defining Intelligence
Diane F. Halpern, a psychologist and past-president of the American Psychological association (Apa), wrote in her essay offering to Why Smart people Can Be So slow-witted that in general, we recognize people as attractive if they have some compound of these achievements (1) good grades in school; (2) a high level of education; (3) a responsible, complicated job; (4) some other recognition of being intelligent, such as winning prestigious awards or earning a large salary; (5) the ability to read complicated text with good comprehension; (6) solve difficult and novel problems.
Throughout my explore and in the early phases of this article, I came over many definitions of the word intelligence. Some were long, some were short. Some I couldn't even understand. The definition that is most prevalent is the one created by the Apa which is: the ability to adapt to one's environment, and learn from one's mistakes.
How about that? There's the word environment again. We just can't seem to escape it. This adds deeper meaning to the saying, "When in Rome, do as the Romans do." It means recognizing what's going on in your environment, and having the brain adapt to it - and the people who occupy it - in order to survive and consequent within it.
There are also many different forms of intelligence. Most notably those created by Dr. Howard Gardner, professor of schooling at Harvard University.
Dr. Gardner believes (and I agree) that our schools and culture focus most of their attentiveness on linguistic and logical-mathematical intelligence. We esteem the extremely declare or logical people of our culture. However, Dr. Gardner says that we should also place equal attentiveness on individuals who show gifts in the other intelligences: the artists, architects, musicians, naturalists, designers, dancers, therapists, entrepreneurs, and others who enrich the world in which we live.
He felt that the primary opinion of intelligence, based on Iq testing, was far too tiny and created the Theories Of complicated Intelligences in 1983 to list for a broader range of human inherent in children and adults.
These intelligences are:
Linguistic brain ("word smart")
Logical-mathematical brain ("number/reasoning smart")
Spatial brain ("picture smart")
Bodily-Kinesthetic brain ("body smart")
Musical brain ("music smart")
Interpersonal brain ("people smart")
Intrapersonal brain ("self smart")
Naturalist brain ("nature smart")
Not linked with Dr. Gardner, but equally respected are:
Fluid & Crystallized Intelligence
According to About.com, Psychologist Raymond Cattell first proposed the concepts of fluid and crystallized brain and additional industrialized the law with John Horn. The Cattell-Horn law of fluid and crystallized brain suggests that brain is composed of a estimate of different abilities that interact and work together to yield extensive private intelligence.
Cattell defined fluid brain as "...the ability to comprehend relationships independent of previous exact custom or schooling about those relationships." Fluid brain is the ability to think and infer abstractly and solve problems. This ability is thought about independent of learning, experience, and education. Examples of the use of fluid brain comprise solving puzzles and coming up with problem solving strategies.
Crystallized brain is Learning from past experiences and learning. Situations that wish crystallized brain comprise reading understanding and vocabulary exams. This type of brain is based upon facts and rooted in experiences. This type of brain becomes stronger as we age and gather new knowledge and understanding.
Both types of brain increase throughout childhood and adolescence. Fluid brain peaks in adolescence and begins to decline progressively starting around age 30 or 40. Crystallized brain continues to grow throughout adulthood.
Successful Intelligence
Then there's thriving Intelligence, which is authored by brain psychologist and Yale professor, Robert J. Sternberg, who believes that the whole opinion of relating Iq to life achievement is misguided, because he believes that Iq is a pretty miserable predictor of life achievement.
His thriving brain law focuses on 3 types of brain which are combined to lead to one's extensive success: Analytical Intelligence; mental steps or components used to solve problems; Creative Intelligence: the use of perceive in ways that nurture understanding (creativity/divergent thinking); and Practical Intelligence: the ability to read and adapt to the contexts of everyday life.
With regard to environment, Mr. Sternberg writes in his book thriving Intelligence: Successfully attractive people comprehend that the environment in which they find themselves may or may not be able to make the most of their talents. They actively seek an environment where they can not only do thriving work, but make a difference. They generate opportunities rather than let opportunities be tiny by circumstances in which they happen to find themselves.
As an educator, I subscribe to Mr. Sternberg's thriving brain coming to teaching. It has proven to be a extremely productive tool and mindset for my college students. Using thriving brain as the backbone of my context-driven curriculum authentically inspires students to see how schooling makes their life goals more attainable, and motivates them to additional form their expertise. Mr. Sternberg believes that the major factor in achieving expertise is purposeful engagement.
Emotional Intelligence
In his best-selling 1995 book, Emotional Intelligence, Daniel Goleman reported that explore shows that approved measures of brain - Iq - only list for 20% of a person's success in life. For example, explore on Iq and schooling shows that high Iq predicts 10 to 25% of grades in college. The percentage will vary depending on how we define success. Nonetheless, Goleman's assertion begs the question: What accounts for the other 80%?
You guessed it...Emotional Intelligence. What exactly is emotional intelligence? Emotional brain (also called Eq or Ei) refers to the ability to perceive, control, and evaluate emotions. Many corporations now have mandatory Eq training for their managers in an attempt to enhance worker
relations and increase productivity.
Tacit Knowledge aka "Street Smarts"
You've heard the phrase, "Experience is the many teacher..."
In psychology circles knowledge gained from everyday perceive is called tacit knowledge. The colloquial term is "street smarts," which implies that formal, classroom schooling (aka "book smarts") has nothing to do with it. The private is not directly instructed as to what he or she should learn, but rather must citation the prominent part from the perceive even when Learning is not the primary objective.
Tacit knowledge is closely linked to tasteless sense, which is sound and economical judgment based on a uncomplicated perception of the situation or facts. As you know, tasteless sense is not all that common.
Tacit knowledge, or the lessons obtained from it, seems to "stick" both faster and good when the lessons have direct relevance to the individual's goals. Knowledge that is based on one's own practical perceive will likely be more instrumental to achieving one's goals than will be knowledge that is based on man else's experience, or that is overly generic and abstract.
Being Both Smart And Stupid
Yes, it's inherent to be both smart and stupid. I'm sure man you know comes to mind at this definite moment. But the goal here is not to ridicule, but to understand how some seemingly extremely intelligent, or extremely educated individuals can be so smart in one way, and incredibly slow-witted in others.
The woman who is a respected, well paid, dynamic administrative who consistently chooses men who don't appear to be worthy of her, or the man who appears to be a pillar of the community, with a loving wife and happy kids, ends up being arrested on rape charges.
It happens, but why? I found the sass in Why Smart people Can Be So Stupid. Essentially, intellect is domain specific. In other words, being smart (knowledgeable) in one area of your life, and slow-witted (ignorant) in someone else is natural. Turning off one's brain is quite tasteless especially when it comes to what we desire. A shared characteristic among those who are smart and stupid, is the strangeness in delaying gratification.
Olem Ayduk & Walter Mischel who wrote the part summarized: Sometimes slow-witted behavior in smart people may arise from faulty expectations, erroneous beliefs, or merely a lack of motivation to enact control strategies even when one has them. But sometimes it is an inability to regulate one's affective states and the behavioral tendencies linked with them that leads to slow-witted and self-defeating behavior.
The central character in this book who many of these lessons about being smart and slow-witted revolve around is Bill Clinton and his affair with Monica Lewinksky.
Wisdom & Conclusion
My great grandmother, Leola Cecil, maybe had an 8th grade schooling at the most. By no stretch of the imagination was she extremely educated, but she had what seemed like infinite wisdom. She was very observant and could "read" people with imaginable accuracy. Till the very end of her life she shared her "crystallized intelligence" with whomever was receptive to it.
She died at the age of 94. I often use many of her sayings as a social speaker, but most importantly, I use her philosophies to make sure that I'm being guided spiritually and not just intellectually. Many of us who are lucky adequate to have a great grandparent can testify that there is something extra about their knowledge. They seem to have life figured out, and a knack for helping those of us who are smart, educated and attractive see things more clearly when we are too busy thinking.
What they have is what we should all aspire to end up with if we are lucky: wisdom.
Wisdom is the ability to look straight through a person, when others can only look at them. Wisdom slows down the mental process and makes it more organic; synchronizing it with intuition. Wisdom helps you make good judgments about decisions, and makes you less judgmental. Wisdom is understanding without knowing, and accepting without understanding. Wisdom is recognizing what's prominent to other people, and knowing that other people are of the utmost point to you. Wisdom is both a starting point, and a final conclusion.
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While most hospice health care organizations supply thorough and ethical rehabilitation for their hospice patients, because hospice eligibility under Medicare and Medicaid involves clinical judgments which may consequent in the payments of large sums of money from the federal government, there are stupendous opportunities for fraudulent practices and false billing claims by unscrupulous hospice care providers. As recent federal hospice fraud compulsion actions have demonstrated, the amount of health care companies and individuals who are willing to try to defraud the Medicare and Medicaid hospice benefits programs is on the rise.
A recent example of hospice fraud thoughprovoking a South Carolina hospice is Southern Care, Inc., a hospice enterprise that in 2009 paid .7 million to decide an Fca case. The defendant operated hospices in 14 other states, too, including Alabama, Georgia, Indiana, Iowa, Kansas, Louisiana, Michigan, Mississippi, Missouri, Ohio, Pennsylvania, Texas, Virginia and Wisconsin. The alleged frauds were that patients were not eligible for hospice, to wit, were not terminally ill, lack of documentation of terminal illnesses, and that the enterprise marketed to potential patients with the promise of free medications, supplies, and the provision of home health aides. Southern Care also entered into a 5-year Corporate Integrity deal with the Oig as part of the settlement. The qui tam relators received approximately million.
Understanding the Consequences of Hospice Fraud and Whistleblower Actions
U.S. And South Carolina consumers, including hospice patients and their family members, and health care employees who are employed in the hospice industry, as well as their Sc lawyers and attorneys, should post themselves with the basics of the hospice care industry, hospice eligibility under the Medicare and Medicaid programs, and hospice fraud schemes that have developed across the country. Consumers need to safe themselves from unethical hospice providers, and hospice employees need to guard against knowingly or unwittingly participating in health care fraud against the federal government because they may branch themselves to administrative sanctions, including lengthy exclusions from working in an society which receives federal funds, stupendous civil monetary penalties and fines, and criminal sanctions, including incarceration. When a hospice laborer discovers fraudulent escort thoughprovoking Medicare or Medicaid billings or claims, the laborer should not partake in such behavior, and it is imperative that the unlawful escort be reported to law compulsion and/or regulatory authorities. Not only does reporting such fraudulent Medicare or Medicaid practices shield the hospice laborer from exposure to the foregoing administrative, civil and criminal sanctions, but hospice fraud whistleblowers may benefit financially under the recompense provisions of the federal False Claims Act, 31 U.S.C. §§ 3729-3732, by bringing false claims suits, also known as qui tam or whistleblower suits, against their employers on profit of the United States.
Types of Hospice Care Services
Hospice care is a type of health care assistance for patients who are terminally ill. Hospices also supply withhold services for the families of terminally ill patients. This care includes corporeal care and counseling. Hospice care is ordinarily provided by a communal department or secret enterprise beloved by Medicare and Medicaid. Hospice care is ready for all age groups, including children, adults, and the elderly who are in the final stages of life. The purpose of hospice is to supply care for the terminally ill sick person and his or her family and not to cure the terminal illness.
If a sick person qualifies for hospice care, the sick person can receive curative and withhold services, including nursing care, curative communal services, doctor services, counseling, homemaker services, and other types of services. The hospice sick person will have a team of doctors, nurses, home health aides, communal workers, counselors and trained volunteers to help the sick person and his or her family members cope with the symptoms and consequences of the terminal illness. While many hospice patients and their families can receive hospice care in the comfort of their home, if the hospice patient's health deteriorates, the sick person can be transferred to a hospice facility, hospital, or nursing home to receive hospice care.
Hospice Care Statistics
The amount of days that a sick person receives hospice care is often referenced as the "length of stay" or "length of service." The length of assistance is dependent on a amount of separate factors, including but not little to, the type and stage of the disease, the quality of and passage to health care providers before the hospice referral, and the timing of the hospice referral. In 2008, the average length of stay for hospice patients was about 21 days, the average length of stay was about 69 days, approximately 35% of hospice patients died or were discharged within 7 days of the hospice referral, and only about 12% of hospice patients survived longer than 180 days.
Most hospice care patients receive hospice care in secret homes (40%). Other locations where hospice services are provided are nursing homes (22%), residential facilities (6%), hospice sick person facilities (21%), and acute care hospitals (10%). Hospice patients are commonly the elderly, and hospice age group percentages are 34 years or less (1%), 35 - 64 years (16%), 65 - 74 years (16%), 75 - 84 years (29%), and over 85 years (38%). As for the terminal illness resulting in a hospice referral, cancer is the determination for approximately 40% of hospice patients, followed by debility unspecified (15%), heart disease (12%), dementia (11%), lung disease (8%), stroke (4%) and kidney disease (3%). Medicare pays the great majority of hospice care expenses (84%), followed by secret assurance (8%), Medicaid (5%), charity care (1%) and self pay (1%).
As of 2008, there were approximately 4,700 locations which were providing hospice care in the United States, which represented about a 50% increase over ten years. There were about 3,700 companies and organizations which were providing hospice services in the United States. About half of the hospice care providers in the United States are for-profit organizations, and about half are non-profit organizations.
General overview of the Medicare and Medicaid Programs
In 1965, Congress established the Medicare program to supply health assurance for the elderly and disabled. Payments from the Medicare program arise from the Medicare Trust fund, which is funded by government contributions and through payroll deductions from American workers. The Centers for Medicare and Medicaid Services (Cms), previously known as the health Care Financing management (Hcfa), is the federal department within the United States department of health and Human Services (Hhs) that administers the Medicare program and works in partnership with state governments to administer Medicaid.
In 2007, Cms reorganized its ten geography-based field offices to a Consortia structure based on the agency's key lines of business: Medicare health plans, Medicare financial management, Medicare fee for assistance operations, Medicaid and children's health, explore & certification and quality improvement. The Cms consortia consist of the following:
• Consortium for Medicare health Plans Operations
• Consortium for Financial management and Fee for assistance Operations
• Consortium for Medicaid and Children's health Operations
• Consortium for quality correction and explore & Certification Operations
Each consortium is led by a Consortium Administrator (Ca) who serves as the Cms's national focal point in the field for their enterprise line. Each Ca is responsible for consistent implementation of Cms programs, course and advice across all ten regions for matters pertaining to their enterprise line. In expanding to accountability for a enterprise line, each Ca also serves as the Agency's senior management official for two or three Regional Offices (Ros), representing the Cms Administrator in external matters and overseeing administrative operations.
Much of the daily management and doing of the Medicare program is managed through secret assurance companies that ageement with the Government. These secret assurance companies, sometimes called "Medicare Carriers" or "Fiscal Intermediaries," are expensed with and responsible for accepting Medicare claims, determining coverage, and manufacture payments from the Medicare Trust Fund. These carriers, including Palmetto Government Benefits Administrators (hereinafter "Pgba"), a department of Blue Cross and Blue Shield of South Carolina, control pursuant to 42 U.S.C. §§ 1395h and 1395u and rely on the good faith and careful representations of health care providers when processing claims.
Over the past forty years, the Medicare program has enabled the elderly and disabled to accumulate valuable curative services from curative providers throughout the United States. valuable to the success of the Medicare program is the basic thought that health care providers accurately and indeed submit claims and bills to the Medicare Trust Fund only for those curative treatments or services that are legitimate, uncostly and medically necessary, in full compliance with all laws, regulations, rules, and conditions of participation, and, further, that curative providers not take benefit of their elderly and disabled patients.
The Medicaid program is ready only to definite low-income individuals and families who must meet eligibility requirements set forth by federal and state law. Each state sets its own guidelines about eligibility and services. Although administered by private states, the Medicaid program is funded primarily by the federal government. Medicaid does not pay money to patients; rather, it sends payments directly to the patient's health care providers. Like Medicare, the Medicaid program depends on health care providers to accurately and indeed submit claims and bills to program administrators only for those curative treatments or services that are legitimate, uncostly and medically necessary, in full compliance with all laws, regulations, rules, and conditions of participation, and, further, that curative providers not take benefit of their indigent patients.
Medicare & Medicaid Hospice Laws Which influence Sc Hospices
Hospice fraud occurs when hospice organizations, by and through their employees, agents and owners, knowingly violate the terms and conditions of the applicable Medicare and Medicaid hospice statutes, regulations, rules and conditions of participation. In order to be able to recognize hospice fraud, hospices, hospice patients, hospice employees and their attorneys and lawyers must know the Medicare laws and requirements relating to hospice care benefits.
Medicare's two main sources of authorization for hospice benefits are found in the communal protection Act and the U.S. Code of Federal Regulations. The statutory provisions are primarily found at 42 U.S.C. §§ 1395d, 1395e, 1395f(a)(7), 1395x(d)(d), and 1395y, and the regulatory provisions are found at 42 C.F.R. Part 418.
To be eligible for Medicare benefits for hospice care, the sick person must be eligible for Medicare Part A and be terminally ill. 42 C.F.R. § 418.20. terminal illness is established when "the private has a curative determination that his or her life expectancy is 6 months or less if the illness runs its general course." 42 C.F.R. § 418.3; 42 U.S.C. § 1395x(d)(d)(3). The patient's doctor and the curative director of the hospice must guarantee in writing that the sick person is "terminally ill." 42 U.S.C. § 1395f(a)(7); 42 C.F.R. § 418.20. After a patient's first certification, Medicare provides for two ninety-day benefit periods followed by an unlimited amount of sixty-day benefit periods. 42 U.S.C. § 1395d(a)(4). At the end of each ninety- or sixty-day period, the sick person can be re-certified only if at that time he or she has less than six months to live if the illness runs its general course. 42 U.S.C. § 1395f(a)(7)(A). The written certification and re-certifications must be maintained in the patient's curative records. 42 C.F.R. § 418.23. A written plan of care must be established for each sick person setting forth the types of hospice care services the sick person is scheduled to receive, 42 U.S.C. § 1395f(a)(7)(B), and the hospice care has to be provided in accordance with such plan of care. 42 U.S.C. § 1395f(a)(7)(C); 42 C.F.R. § 418.56. Clinical records for each hospice sick person must be maintained by the hospice, including plan of care, assessments, clinical notes, signed observation of election, sick person responses to medication and therapy, doctor certifications and re-certifications, outcome data, progress directives and doctor orders. 42 C.F.R. § 418.104.
The hospice must accumulate a written observation of choosing from the sick person to elect to receive Medicare hospice benefits. 42 C.F.R. § 418.24. Importantly, once a sick person has elected to receive hospice care benefits, the sick person waives Medicare benefits for curative rehabilitation for the terminal disease upon which is the admitting diagnosis. 42 C.F.R. § 418.24(d).
The hospice must designate an Interdisciplinary Group (Idg) or groups composed of individuals who work together to meet the physical, medical, psychosocial, emotional, and spiritual needs of the hospice patients and families facing terminal illness and bereavement. 42 C.F.R. § 418.56. The Idg members must supply the care and services offered by the hospice, and the group, in its entirety, must supervise the care and services. A registered nurse that is a member of the Idg must be designated to supply coordination of care and to ensure continuous estimate of each patient's and family's needs and implementation of the interdisciplinary plan of care. The interdisciplinary group must include, but is not little to, the following excellent and competent professionals: (i) A doctor of rehabilitation or osteopathy (who is an laborer or under ageement with the hospice); (ii) A registered nurse; (iii) A communal worker; and, (iv) A pastoral or other counselor. 42 C.F.R. § 418.56.
The Medicare hospice regulations, at 42 C.F.R. § 418.200, summarize the requirements for hospice coverage in pertinent part as follows:
To be covered, hospice services must meet the following requirements. They must be uncostly and valuable for the palliation and management of the terminal illness as well as connected conditions. The private must elect hospice care in accordance with §418.24. A plan of care must be established and periodically reviewed by the attending physician, the curative director, and the interdisciplinary group of the hospice program as set forth in §418.56. That plan of care must be established before hospice care is provided. The services provided must be consistent with the plan of care. A certification that the private is terminally ill must be completed as set forth in section §418.22.
The communal protection Act, at 42 U.S.C. § 1395y(a), limits Medicare hospice benefits, providing in pertinent part as follows: "Notwithstanding any other provision of this title, no cost may be made under part A or part B for any expenses incurred for items or services-... (C) in the case of hospice care, which are not uncostly and valuable for the palliation or management of terminal illness...." 42 C.F.R. § 418.50 (hospice care must be "reasonable and valuable for the palliation and management of terminal illness"). Palliative care is defined in the regulations as "patient and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering. Palliative care throughout the continuum of illness involves addressing physical, intellectual, emotional, social, and spiritual needs and to facilitate sick person autonomy, passage to information, and choice." 42 C.F.R. § 418.3.
Medicare pays hospice agencies a daily rate for each day a beneficiary is enrolled in the hospice benefit and receives hospice care. The daily payments are made regardless of the amount of services furnished on a given day and are intended to cover costs that the hospice incurs in furnishing services identified in the patient's plan of care. There are four levels of payments which are made based on the amount of care required to meet beneficiary and family needs. 42 C.F.R. § 418.302; Cms Hospice Fact Sheet, November 2009. These four levels, and the corresponding 2010 daily rates, are as follows: routine home care (2.91); continuous home care (4.10); sick person respite care (7.83); and, general sick person care (5.74).
The mixture every year cap per sick person in 2009 was ,014.50. This cap is thought about by adjusting the traditional hospice sick person cap of ,500, set in 1984, by the consumer Price Index. See Cms Internet-Only manual 100-04, episode 11, section 80.2; 42 U.S.C. § 1395f(i); 42 C.F.R. § 418.309. The Medicare Claims Processing Manual, at episode 11 - Processing Hospice Claims, in Section 80.2, entitled "Cap on thorough Hospice Reimbursement," provides in pertinent part as follows: "Any payments in excess of the cap must be refunded by the hospice."
Hospice patients are responsible for Medicare co-insurance payments for drugs and respite care, and the hospice may fee the sick person for these co-insurance payments. However, the co-insurance payments for drugs are little to the lesser of or 5% of the cost of the drugs to the hospice, and the co-insurance payments for respite care are commonly 5% of the cost made by Medicare for such services. 42 C.F.R. § 418.400.
The Medicare and Medicaid programs require institutional health care providers, including hospice organizations, to file an enrollment application in order to qualify to receive the programs' benefits. As part of these enrollment applications, the hospice providers guarantee that they will comply with Medicare and Medicaid laws, regulations, and program instructions, and further guarantee that they understand that cost of a claim by Medicare and Medicaid is conditioned upon the claim and basic transaction complying with such program laws and requirements. The Medicare Enrollment Application which hospice providers must execute, Form Cms-855A, states in part as follows: "I agree to abide by the Medicare laws, regulations and program instructions that apply to this provider. The Medicare laws, regulations, and program instructions are ready through the Medicare contractor. I understand that cost of a claim by Medicare is conditioned upon the claim and the basic transaction complying with such laws, regulations, and program instructions (including, but not little to, the Federal Aks and Stark laws), and on the provider's compliance with all applicable conditions of participation in Medicare."
Hospices are commonly required to bill Medicare on a monthly basis. See the Medicare Claims Processing Manual, at episode 11 - Processing Hospice Claims, in Section 90 - Frequency of Billing. Hospices commonly file their hospice Medicare claims with their Fiscal Intermediary or Medicare Carrier pursuant to the Cms Claims manual Form Cms 1450 (sometime also called a Form Ub-04 or Form Ub-92), whether in paper or electronic form. These claim forms include representations and certifications which state in pertinent part that: (1) misrepresentations or falsifications of valuable facts may serve as the basis for civil monetary penalties and criminal convictions; (2) submission of the claim constitutes certification that the billing facts is true, spoton and complete; (3) the submitter did not knowingly or recklessly disregard or misrepresent or conceal material facts; (4) all required doctor certifications and re-certifications are on file; (5) all required sick person signatures are on file; and, (6) for Medicaid purposes, the submitter understands that because cost and delight of this claim will be from Federal and State funds, any false statements, documents, or concealment of a material fact are branch to prosecution under applicable Federal or State Laws.
Hospices must also file with Cms an every year cost and data description of Medicare payments received. 42 U.S.C. § 1395f(i)(3); 42 U.S.C. § 1395x(d)(d)(4). The every year hospice cost and data reports, Form Cms 1984-99, include representations and certifications which state in pertinent part that: (1) misrepresentations or falsifications of facts contained in the cost description may be punishable by criminal, civil and administrative actions, including fines and/or imprisonment; (2) if any services identified in the description were the goods of a direct or indirect kickback or were otherwise illegal, then criminal, civil and administrative actions may result, including fines and/or imprisonment; (3) the description is a true, spoton and complete statement prepared from the books and records of the victualer in accordance with applicable instructions, except as noted; and, (4) the signing officer is well-known with the laws and regulations about the provision of health care services and that the services identified in this cost description were provided in compliance with such laws and regulations.
Hospice Anti-Fraud compulsion Statutes
There are a amount of federal criminal, civil and administrative compulsion provisions set forth in the Medicare statutes which are aimed at preventing fraudulent conduct, including hospice fraud, and which help vocalize program integrity and compliance. Some of the more foremost compulsion provisions of the Medicare statutes include the following: 42 U.S.C. § 1320a-7b (Criminal fraud and anti-kickback penalties); 42 U.S.C. § 1320a-7a and 42 U.S.C. § 1320a-8 (Civil monetary penalties for fraud); 42 U.S.C. § 1320a-7 (Administrative exclusions from participation in Medicare/Medicaid programs for fraud); 42 U.S.C. § 1320a-4 (Administrative subpoena power for the Comptroller General).
Other criminal compulsion provisions which are used to combat Medicare and Medicaid fraud, including hospice fraud, include the following: 18 U.S.C. § 1347 (General health care fraud criminal statute); 21 U.S.C. §§ 353, 333 (Prescription Drug Marketing Act); 18 U.S.C. § 669 (Theft or Embezzlement in connection with health Care); 18 U.S.C. § 1035 (False statements relating to health Care); 18 U.S.C. § 2 (Aiding and Abetting); 18 U.S.C. § 3 (Accessory after the Fact); 18 U.S.C. § 4 (Misprision of a Felony); 18 U.S.C. § 286 (Conspiracy to defraud the Government with respect to Claims); 18 U.S.C. § 287 (False, Fictitious or Fraudulent Claims); 18 U.S.C. § 371 (Criminal Conspiracy); 18 U.S.C. § 1001 (False Statements); 18 U.S.C. § 1341 (Mail Fraud); 18 U.S.C. § 1343 (Wire Fraud); 18 U.S.C. § 1956 (Money Laundering); 18 U.S.C. § 1957 (Money Laundering); and, 18 U.S.C. § 1964 (Racketeer Influenced and Corrupt Organizations ("Rico")).
The False Claims Act (Fca)
Hospice fraud whistleblowers may benefit financially under the recompense provisions of the federal False Claims Act, 31 U.S.C. §§ 3729-3732, by bringing false claims suits, also known as qui tam or whistleblower suits, against their employers on profit of the United States. The plaintiff in a hospice fraud whistleblower suit is also known as a relator. The most coarse Fca provisions upon which hospice fraud qui tam or whistleblower relators rely are found in 31 U.S.C. § 3729: (A) knowingly presents, or causes to be presented, a false or fraudulent claim for cost or approval; (B) knowingly makes, uses, or causes to be made or used, a false description or statement material to a false or fraudulent claim; (C) conspires to commit a violation of subparagraph (A), (B), (D), (E), (F), or (G);..., and, (G) knowingly makes, uses, or causes to be made or used, a false description or statement material to an compulsion to pay or transmit money or asset to the Government, or knowingly conceals or knowingly and improperly avoids or decreases an compulsion to pay or transmit money or asset to the Government.... There is no requirement to prove definite intent to defraud. Rather, it is only valuable to prove actual knowledge of the false claims, false statements, or false records, or the defendant's deliberate indifference or reckless disregard of the truth or falsity of the information. 31 U.S.C. § 3729(b).
The Fca anti-retaliation provision protects the hospice whistleblower from retaliation from the hospice when the laborer (or a contractor) "is discharged, demoted, suspended, threatened, harassed, or in any other manner discriminated against in the terms and conditions of employment" for taking performance to try to stop the fraudulent activity. 31 U.S.C. § 3730(h). A hospice employee's relief includes reinstatement, 2 times the amount of back pay, interest on the back pay, and compensation for any special damages sustained as a consequent of the discrimination or retaliation, including litigation costs and uncostly attorneys' fees.
A Sc hospice fraud Fca whistleblower would initially file a disclosure statement, complaint and supporting documents with the U.S. Attorney's Office in Columbia, South Carolina, and the Us Attorney General. After the disclosures are filed, a federal court complaint can be filed. The Sc department where the frauds occurred, the relator's residence, and the defendant residence, will decide which department the case will be assigned. There are eleven federal court divisions in South Carolina. Once the case has been filed, the government has 60 days to decide whether or not to intervene. During this time, federal government investigators located in South Carolina will study the claims. If the case complicated Medicaid, Sc Medicaid fraud unit investigators will likely become complicated as well. If the government intervenes in the case, the U.S. Attorney for South Carolina is ordinarily the lead attorney. If the government does not intervene, the relator's Sc attorney will prosecute the case. In South Carolina, expect a qui tam case to take one to two years to get to trial.
Tips on Recognizing Hospice Fraud Schemes
The Hhs Office of Inspector general (Oig) has issued special Fraud Alerts for fraudulent and abusive practices of hospices. U.S. And South Carolina hospices, patients, hospice employees and whistleblowers, their attorneys and lawyers, should be well-known with these hospice fraud practices. Tips on recognizing hospice frauds in South Carolina and the U.S. Are:
• A hospice offering free goods or goods at below market value to induce a nursing home to refer patients to the hospice.
• False representations in a hospice's Medicare/Medicaid enrollment form.
• A hospice paying "room and board" payments to the nursing home in amounts in excess of what the nursing home would have received directly from Medicaid had the sick person not been enrolled in the hospice.
• False statements in a hospice's claim form (Cms Forms 1450, Ub-04 or Ub-92).
• A hospice falsely billing for services that were not uncostly or valuable for the palliation of the symptoms of a terminally ill patient.
• A hospice paying amounts to the nursing home for "additional" services that Medicaid thought about included in its room and board cost to the hospice.
• A hospice paying above fair market value for "additional" non-core services which Medicaid does not think to be included in its room and board payments to the nursing home.
• A hospice referring patients to a nursing home to induce the nursing home to refer its patients to the hospice.
•A hospice providing free (or below fair market value) care to nursing home patients, for whom the nursing home is receiving Medicare cost under the skilled nursing facility benefit, with the anticipation that after the sick person exhausts the skilled nursing facility benefit, the sick person will receive hospice services from that hospice.
• A hospice providing staff at its price to the nursing home to accomplish duties that otherwise would be performed by the nursing home.
• Incomplete or no written Plan of Care was established or reviewed at definite intervals.
• Plan of Care did not include an estimate of needs.
• Fraudulent statements in a hospice's cost description to the government.
• observation of choosing was not obtained or was fraudulently obtained.
• Rn supervisory visits were not made for home health aide services.
• Certification or Re-certification of terminal illness was not obtained or was fraudulently obtained.
• No Plan of care was included for bereavement services.
• Fraudulent billing for upcoded levels of hospice care.
• Hospice did not escort a self-assessment of quality and care provided.
• Clinical records were not maintained for every patient.
• Interdisciplinary group did not chronicle and modernize the plan of care for each patient.
Recent Hospice Fraud compulsion Cases
The Doj and U.S. Attorney's Offices have been active in enforcing hospice fraud cases.
In 2009, Kaiser Foundation Hospitals located an Fca lawsuit by paying .8 million to the federal government. The defendant allegedly failed to accumulate written certifications of terminal illness for a amount of its patients.
In 2006, Odyssey Healthcare, a national hospice provider, paid .9 million to decide a qui tam suit for false claims under the Fca. The hospice fraud allegations were commonly that Odyssey billed Medicare for providing hospice care to patients when they were not terminally ill and ineligible for Medicare hospice benefits. A Corporate Integrity deal was also a part of the settlement. The hospice fraud qui tam relator received .3 million for blowing the whistle on the defendant.
In 2005, Faith Hospice, Inc., located claims an Fca claim for 0,000. The hospice fraud allegations were commonly that Faith Hospice billed Medicare for providing hospice care to patients more than half of whom were not terminally ill.
In 2005, Home Hospice of North Texas located an Fca claim for 0,000 about allegations of fraudulently billing Medicare for ineligible hospice patients.
In 2000, Michigan osteopath Donald Dreyfuss, who pleaded guilty to criminal fraud charges, including violation of the Aks for receiving illegal kickbacks from a hospice for recommending the hospice to the staff of his nursing home, located an Fca suit for million.
Conclusion
Hospice fraud is a growing question in South Carolina and throughout the United States. South Carolina hospice patients, hospice employees, and their Sc lawyers and attorneys, should be well-known with the basics of the hospice care industry, hospice eligibility under the Medicare and Medicaid programs, and typical hospice fraud schemes. Hospice organizations should take steps to ensure full compliance with Medicare/Medicaid hospice billing requirements to avoid hospice fraud allegations and Fca litigation.
© 2010 Joseph P. Griffith, Jr.
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