The Florida Agency for Health Care Administration (AHCA) is very involved with Florida nursing home and long term care facilities, and Florida Medicaid proceedings and administration. This includes all Medicaid planning activities.

Florida AHCA is responsible for:

  • administrating the Florida Medicaid program,
  • licensure and regulation of Florida’s health facilities and
  • providing information to Floridians about the quality of care they receive.

What is elder abuse and exploitation with regards to Medicaid planning by nonlawyers?

Exploitation generally refers to the loss of a person’s assets and property, money or income. In the case of UPL, this refers to types of harm caused by nonlawyer Medicaid planners which includes denial of Medicaid eligibility, exploitation, catastrophic or severe tax liability, and the purchase of inappropriate financial products threatening or destroying client’s life savings.31

The Florida Department of Children and Families (DCF) further explains Elder Exploitation as follows: 32

Adult exploitation means a person who stands in a position of trust and confidence with a vulnerable adult knowingly, by deception or intimidation, obtains or uses, or endeavors to obtain or use, a vulnerable adult’s funds, assets, or property with the intent to temporarily or permanently deprive a vulnerable adult of the use, benefit, or possession of the funds, assets, or property for the benefit of someone other than the vulnerable adult.

OR

That a person who knows or should know that the vulnerable adult lacks the capacity to consent, obtains or uses, or endeavors to obtain or use, the vulnerable adult’s funds, assets, or property with the intent to temporarily or permanently deprive the vulnerable adult of the use, benefit, or possession of the funds, assets, or property for the benefit of someone other than the vulnerable adult.

Florida Statute 825.103—Exploitation of an elderly person or disabled adult; penalties—states the following people can be held liable for elder exploitation 33

  • Someone in a position of trust with the elderly person or disabled adult
  • A person who has a business relationship with the elderly person or disabled adult
  • Guardians
  • Trustees
  • Agents under a power of attorney
  • Caregivers

Financial exploitation is a form of elder abuse.

Elder abuse in Florida is a felony. The failure to report abuse that has occurred also may be a crime.

Florida statute 825.103 breaks down the financial exploitation felony and penalty potential:

825.103 (3) If the funds, assets, or property involved in the

(a) exploitation of the elderly person or disabled adult is valued at $50,000 or more, the offender commits a felony of the first degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084.

(b) If the funds, assets, or property involved in the exploitation of the elderly person or disabled adult is valued at $10,000 or more, but less than $50,000, the offender commits a felony of the second degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084.

(c) If the funds, assets, or property involved in the exploitation of an elderly person or disabled adult is valued at less than $10,000, the offender commits a felony of the third degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084.

I have an elder abuse concern or complaint. Who can I call?

The following contact information is provided by the Florida Agency for Health Care Administration (AHCA)

Bureau of Medicaid Program Integrity

1-888-419-3456

Medicaid Program Integrity audits and investigates providers suspected of overbilling or defrauding Florida’s Medicaid program. If you feel that you have been charged for services that should be paid for by Medicaid, or if someone billed Medicaid for services that were not provided, this unit will investigate Medicaid billing practices to determine if they were appropriate. To report a complaint, please call toll-free 1-888-419-3456, or go to the Agency website at 
http://ahca.myflorida.com/Executive/Inspector_General/medicaid.shtml.

Medicaid Fraud Control Unit

1-866-966-7226

Medicaid fraud means an intentional deception or misrepresentation made by a health care provider with the knowledge that the deception could result in some unauthorized benefit to him or herself or some other person. It includes any act that constitutes fraud under applicable federal or state law as it relates to Medicaid. To report suspected Medicaid fraud, please call the Attorney General toll-free 1-866-966-7226.

Under Florida law, you may be entitled to a reward for providing information after a criminal case has resulted in a fine, penalty, or forfeiture of property. The amount of the reward may be up to 25 percent of the amount recovered or a maximum of $500,000 per case.

The Florida Department of Children and Families Abuse Hotline

#1-800-96-ABUSE

The Florida Department of Children and Families accepts reports 24 hours a day, 7 days a week.

 

Excerpt From: John R. Frazier, Leonard E. Mondschein. “Protecting Nursing Homes and Their Residents from the Unlicensed Practice of Law.” iBooks.