Consumer Advocacy

Have you been talking to Victor Creed at 1-215-642-2119?  How about Drew Ensign at 1-661-228-7777? Scammer talks on a phone with a senior woman and trying to steal money out of her purse, vector illustration, no transparencies, EPS 8

Does this logo look familiar?

American Dream & Lucky Club logo

The letter claims that this company has been in good standing in Kentucky for years. I checked the Secretary of State and there is no such active business. The scammers probably lifted the logo from a legitimate business site and pasted it create the appearance of a letterhead.

If you received notice that you are the winner of the second place drawing and are entitled to $8.5 million dollars you are being scammed.  Recently clients of mine received exiting news that they won the exact same prize.  The letters ask you to call an individual named Victor Creed or Drew Ensign.  Probably invented names.  I’m sure that there are law abiding citizens with those same names.  The purpose of the this post is warn persons dealing with those individuals at the numbers in the headline above that they are being scammed by persons posing as company officials.

Click the box below to see how you can tell that this is a fraud.

There are grammar, capitalization, spelling and punctuation errors.  The materials are internally inconsistent.

scam red flags

Click to see the signs that this is a fraud.

How the Scam Works:

The fraudsters will be extremely happy that you won the prize.  Of course nothing in this life escapes taxes.  Therefore, in order to actually receive the winnings you must, according to the scoundrels, prepay the taxes.  The ways are to be paid does not involve them withholding them from the winnings.  Odder still you are not to complete an IRS form and mail in the payment.  Instead, they will ask you to do one of many things.  I won’t pretend to know them all but here are a few:

  • Wire Transfers:  You are asked to either wire fund from your account to an “agent”.  Once the funds are gone it is almost impossible to retrieve them.  In rare instances, if the victim acts immediately the transfer may be interrupted.  However, if not done within hours the likelihood of success is next to zero.  Check quickly with the banker who handled the transaction, make lots of noise and seek assistance of law enforcement.

  • Withdraw and money transfer services:  It was very popular to use legitimate companies like Western Union or Money Gram.  The victim is told that the money is needed for customs, taxes, fees, registration, processing, etc.  They are instructed to take the funds to a wire transfer center then call back with the information.  An individual with an ID and the information can pick up the money at any of the locations worldwide.  Nigeria, Jamaica, etc.

  • Credit Card Loading:  You may be asked to purchase a prepaid credit card and the scam can work one of two ways:  See Video Below

    • You are told to deposit the fees in the prepaid credit card then to provide the information to the crooks.  Once they have that information they can access all of the money.

    • You may be told that you are eligible to receive the money to pay the fees on a prepaid card.  You are told to purchase a card for $500, $1000, whatever amount they think you can handle.  They tell you that you need to call back with  the information so that the amounts to cover the taxes, etc. can be deposited on the card.  Of course, whatever is on the card is immediately stolen by the thieves.

    • Another scam convinces you that you will be a personal assistant for a businessman who is about to visit your city and need to open a prepaid card.  Give them the info and the money disappears.


Here are a few of the other scams:

  • Over-payment scam:

    You list something on Craigslist or in the classifieds and eager buyer wants to send you money to purchase your item.  They send you an official looking cashier’s check for more than your asking price.  They instruct you to deposit the check and return the difference by one of the methods listed above.  You deposit the check, send them the money and voila their check is a fake.  You are out the money you sent plus have returned check issues.  They never show up to pick up the thing bought.

  • Secret Shopper Scam:

    Similar to the over-payment scam, you are told to cash the check spend the money and buy a prepaid card.  You do so and poof, the check bounces and the funds in the prepaid card disappear.

  • IRS Scam:  IRS calls and tells you to do one of the above techniques to resolve a tax liability.  They threaten to sue or imprison you.  The IRS doesn’t call.   In the IRS scam they ask the victim to load the card, call with information then mail the card to the IRS.  Of course, by the time the IRS receives the card the balance has been emptied.

  • Gram Pa I’m in Jail:

    Caller convinces grandparent that they a relative are in trouble and needs bail or legal fees.

  • Attorney Engagement Scam

    Yep, attorneys are also targeted.  Attorneys are often solicited out of the blue to handle transactions, collections or escrow of funds.  They are asked to cash checks in escrow and to pay the difference less a hefty attorney’s fee.  Of course, the check bounces and the attorney is out the funds.  I get at least 3 per week.

  • Some scams provide you with a check that looks real.  They do this so that you can cash the check and send in the amount to pay the taxes.  In fact, the crooks have become so sophisticated that they are using actual checks and not just something off of a printer.  On two occasions I called the company who supposedly issued the checks.  Their response was that somebody is forging their checks and that they are getting lots of calls.

I am not looking to handle these cases.

This is a public service announcement to warn the public about these scams.

In my estate planning I attempt to work in protections that family members can use when somebody begins to fall for these scams.  If you have been already a victim of a scam your remedies are few and expensive.  Recovery is highly unlikely.  Usually, the best way forward to ignore the scammers.  However, once they have your telephone numbers they can become relentless.

One Extreme Case:

In one extreme case the scammers resorted to impersonating FBI, IRS and local police officials.  They obtained a voice over internet telephone line with a local area code.  Then they forged the local police letterhead to send a message impersonating an actual high ranking official.    When the victim changed the home and cell numbers they called their neighbors to have them hand deliver messages.  On one occasion, they had a taxi driver deliver a cell phone to the victim (and asked the victim to pay the driver).

 

DHS Denies Grandmother’s SoonerCare Nursing Home Benefits

Imagine that your grandmother is denied benefits because she spent all of her money trying to remain in her home. DHS looks at the finances and says that because she paid family members that she now has to wait 2 years. We did not like that answer and fought the decision.

Before a person is qualified for Medicaid they must be both financially and medically eligible.  An application is completed then the family must provide 60 months’ worth of financial records to the Oklahoma Department of Human Services.  DHS looks for gifts with the assumption that they were made to become eligible for Medicaid.

Gifts create Penalty Periods

It is not unusual for the DHS to impose a penalty period when someone applies for nursing home benefits.  The rules are so complex that the caseworker may apply the wrong standard.  Money paid for legitimate services may be treated as gifts.  This happened in the case of Ms. Clara.**  Ms. Clara and her husband were in their 90s.  They suffered from limited mobility, medical problems and dementia.  Living alone was not an option as they were both at risk of falling. Ms. Clara often put beans on the stove and forgot about them causing a fire risk.  Their doctor suggested 24 monitoring.  The family held a meeting and agreed that they, together with some close friends, would provide caregiving services and be compensated at the rate of $10 per hour.   They provided needed supervision and other services for about two years.

Out of Money and Out of Help

Ms. Clara’s husband passed away.  Shortly afterwards her daughter, who spearheaded the caregivers, also passed away.  The family was no longer able to manage the caregiving.  About this time Ms. Clara ran out of money as well and entered a nursing home.  She applied for Medicaid skilled nursing benefits.  DHS examined the bank statements and initially concluded that $60,000 was transferred to family members. Instead of viewing the payments as compensation for services, DHS treated them as gifts. Later, they revised the number to $113,000 which created a penalty period for 792 days.  Click Here To See Denial of Claim

Caseworker Used Flawed Reasoning, Ignored Facts

The caseworker used flawed analysis when she rejected the application.  She treated the $10 per hour as an being paid without return of fair market value.  In short, she treated the payments as gifts. She ignored Ms. Clara and her husband’s needs.  She also failed to consider that paying a company would have cost at least twice as much to provide the same care.

The Caseworker was 98.6% wrong. 

A brief was written to explain to the Administrative Law Judge how the caseworker erroneously applied the law and ignored relevant facts.  Negotiations with DHS’s attorney reduced the amount in controversy fro $113,000 to $106,000.  A fair hearing was needed to resolve this amount.

The Hearing:  Facts and Witnesses

The Administrative Law Judge conducted the hearing by telephone.  About a week in advance, we delivered Ms. Clara’s exhibits.  The family did a great job keeping time logs that were used to calculate the amounts paid to the caregivers.  Exhibits were created to show how the checks related to the time logs.  The grandson was an excellent witness and was able to describe the care his grandparents needed.  The Administrative Law Judge asked pointed questions to each side.  It was clear that he wanted to know the facts and come to the right decision.

The $111,000 Victory*

Family provided care for 2 years.

About 2 weeks after the hearing, and just in time for Ms. Clara’s 97th birthday, the Appeals Committee issued its opinion.  Of the original $113,000 used to calculate the penalty period, the committee found only $1,983 to be a gift.  So instead of 792 days of ineligibility, only a 13 day penalty period was imposed.  Read Decision Here.  It turns out that the caseworker was 98.6% wrong.  The ineligibility or penalty period was reduced from more than 2 years to less than 1/2 of a month.

What this case means:

Medicaid rules are complicated.  Attorneys who practice in this area must seek constant training to stay up-to-date on the changes.  DHS’s overworked caseworkers and employees approach their job with a certain viewpoint. This prospective can lead them to make the wrong decision resulting in potentially devastating results for applicants.  In Ms. Clara’s case they applied the wrong law and were wrong about the facts.  Frankly, as with all humans, they make mistakes.  A fair hearing is one way to rectify a bad decision.

Planning vs. Legal Challenges

Attorney involvement occurred late in this case.  There may have been ways that the family could have protected more assets with advance  or crisis planning.  Perhaps the caregiver compensation could have been structured or explained in a manner that was more palatable to DHS.   Providing more detailed information during the application may have prevented DHS from taking a position that they stubbornly held onto.  Instead, a year long battle occurred before DHS was required to approve the benefits.  Ms. Clara, the family and the nursing facility would have benefited from more certainty.

If you receive a bad decision, have it reviewed

It is very possible that a denial or imposition of a penalty period is wrong.  An attorney knowledgeable in Medicaid rules and regulations should be consulted.  If DHS’s decision is wrong there are avenues to challenge the decision.  Ms. Clara’s family and the nursing facility worked with our firm to present her case at the fair hearing and achieved a significant result.


 

*The appeals, results, awards, and settlements listed on this website are an example.   These results should not be used for comparison to your case or to any other case.  These examples and are not intended to predict the outcome of any potential case. Every case is different and must be evaluated based on its own merits. This website should be not be construed as a representation or guarantee that your case will produce a similar settlement or result.

I am the grandson and legal guardian for the above case. Richard did an excellent job representing us in the DHS fair hearing. Uber knowledge of case law and dhs interworking. I recommend him highly.
thanks, DLM

 

** Clara is not the client’s last name.  The attached opinion was redacted or otherwise modified to preserve the client’s identity.

No client photographs were used in this article.

Crisis Medicaid Planning, What to do When You Need a Nursing Home Now

Medicaid is a needs based program. This means that people with excessive assets or income cannot qualify for Medicaid. For many, this will be the only government program that they will ever seek.  (These are general rules in Oklahoma).

What Assets Count and Don’t Count?

Non-Countable Resources:

These are things that you can own without becoming unqualified for Medicaid. Generally these are:Nursing Home Patient
• Your home
• One car
• Household belongings
• Prepaid burial plans
• Family burial plots
• Term life insurance
• Whole life insurance with face & cash value below $1,500.
• Retirement accounts in payment status

Countable Resources:

Maze Medicaid Rules fotoAlmost everything else is considered a resource that Medicaid look at to determine whether or not you qualify. This can include:
• Cash / Money Market Accounts / CDs
• Stocks / Mutual Funds / Bond Funds
• Nonresidential land
• 2nd or more cars
• Cash value in life insurance policies
• Businesses
• Income generating properties

Things you cannot have & qualify

paperbackstack_550x498-1

Click Here to Get More Answers

  •  Life insurance with cash value over $1500

  • Institutionalized individual with

    • More than $2,000 in countable assets or

    •  Income greater than $4365

  • A married couple with excessive assets (those with more than $25,000 in countable resources need a plan)

Crisis Planning can solve many of the issues that would prevent an individual from receiving benefits.

For example, it may be possible to shift assets and income from the institutionalized spouse to the well spouse.
Life insurance policies may be converted to a living benefit or liquidated.
It is possible to “Spend Down” countable assets so that they do not count. Spending down may include:
• Repairs or improvements to the home
• Upgrading vehicle
• Purchasing Prepaid Burial Policies
• Paying off debts or taxes
• Paying for services
• Purchasing Medicaid Qualifying Annuities
• Making Medicaid Qualifying Loans

What if Medicaid Has Turned You Down?  Has Medicaid Imposed a Penalty Period?

It may be possible to correct the issues and reapply.

Get my resource brochure.

For those seeking services in Oklahoma, download and complete this Questionnaire:

mediciad crisis planning worksheet

show