November 2023

From The Certified Elder Law Attorney's Desk:


William W. "Bill" Erhart

Blog Spotlight:

Social Security overpayments: Tips to prevent them

November 3, 2023

Article of Interest:

Baby Boomers: Inheritance Conversations With Your Children

Elder Law Answers

Calendar of Events

Inspirational Quote

Our Team

From The Certified Elder Law

Attorney's Desk:

William W. “Bill” Erhart



Two times you may need to appeal a decision for the denial of Medicare benefits is when you are in the nursing home or in the hospital. There is no time to consult with a lawyer. Indeed, lawyers are of little use when you or your family member are hurting and need treatment. What you need is to get your doctor involved as fast as possible and take action.

Nursing Home Appeals

Medicare beneficiaries should seek “expedited review” of a skilled nursing facility, home health, hospice or comprehensive outpatient rehabilitation facility (CORF) services discharge or termination.

Expedited review is available in cases involving a discharge from the

provider of services, or a termination of services.

A reduction in service is not considered a termination or discharge for purposes of triggering expedited review except in the case of skilled nursing facility care when the reduction of care from daily to intermittent will mean that the beneficiary is no longer eligible for Part A coverage. Coverage under Part B is very expensive for you the consumer. You must fight the reduction in care.

For home health care and CORF services, a successful appeal requires that a physician certify that “failure to continue the provision of such services is likely to place the individual’s health at risk.”

The provider must give the you, the Medicare beneficiary a general,

standardized notice at least two days in advance of the proposed end of the service. If the service is fewer than two days, or if the time between services is more than two days, then notice must be given by the next to last service. The notice describes the service, the date coverage ends, the beneficiary ‘s financial liability for continued services, and how to file an appeal.

A beneficiary who wishes to exercise the right to an expedited

determination must submit a request for a determination with the Qualified Independent Organization or Contractor, (“QIO” or “QIC”) in the state in which the beneficiary is receiving the services at issue. The request may be made in writing or by telephone, but the request must be made no later than noon of the calendar day following receipt of the provider ‘s notice of termination.

If the QIO is unavailable to accept the beneficiary’s request, the beneficiary must submit the request by noon of the next day the QIO is available. At that time, the beneficiary is given a more specific notice that includes a detailed explanation of why services are being terminated, a description of any applicable Medicare coverage rules and information on how to obtain them, and other facts specific to the beneficiary’s case. The beneficiary is not financially liable for continued services until two days after receiving the notice, or the termination date specified on the notice, whichever is later.

Coverage of the services at issue continues until the date and time

designated on the termination notice, unless the QIO reverses the

provider’s service termination decision. If the QIO’s decision is delayed because the provider did not timely supply necessary information or records, the provider may be liable for the costs of any additional coverage, as determined by the QIO. If the QIO finds that the beneficiary did not receive valid notice, coverage of the provider services continues until at least 2 days after valid notice has been received. Continuation of coverage is not required if the QIO determines that coverage could pose a threat to the

beneficiary ‘s health or safety.

If the QIO upholds the decision to terminate services or discharge the beneficiary, the beneficiary may request expedited reconsideration, orally or in writing, by noon of the calendar day following the QIO’s initial notification. The reconsideration will be conducted by the QIC, which must issue a decision within 72 hours of the request. If the QIC does not comply with the time frame, the beneficiary may “escalate” the case to the administrative law judge level.

Medicare beneficiaries retain the right to utilize the standard appeals

process rather than the new expedited process in all situations. A QIO may review an appeal from a beneficiary whose request is not timely filed, but the QIO does not have to adhere to the time frame for issuing a decision, and the limitation on liability does not apply.

Special Rules for Hospital Claims

Hospital inpatients denied Medicare during their stay may request an “expedited review” of a Medicare denial by the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO). This link will take you to the telephone numbers and website.

A beneficiary may request reconsideration review by the QIC for an

unfavorable decision. If the reconsideration decision is unsatisfactory and the amount in controversy is sufficient, the beneficiary may request an ALJ hearing. Hearing requests must be made within 60 days of receipt of the notice of the reconsideration decision. The hearing request should be made in writing and should be filed with the entity identified in the reconsideration notice.

If the hearing request is unsatisfactory, a beneficiary may request a review from the Medicare Appeals Council (MAC). The request must be made within 60 days of receipt of the hearing decision. If, after the hearing, the amount in controversy meets the requirements the case may proceed into United States District Court.

Several self-help packets are available at the Center for Medicare Advocacy, upon which this article is based. The link below will connect you to them.

Again, the key is to get your physician involved as soon as possible. Do not rely upon the hospital or nursing home physician who may not support you or be available in a timely manner.

Social Security Overpayments: Tips to prevent them

This week on 60 Minutes, correspondent Anderson Cooper reports on what happens when Social Security overpays people who receive benefits. Beneficiaries may find out years later that they owe tens of thousands of dollars—even if it was not their fault.

During the 2021 fiscal year alone, the agency estimates it made approximately $6 billion in overpayments, according to a report by the Social Security Administration's inspector general.

While researching the story, the 60 Minutes team, including producer Andy Court and associate producer Annabelle Hanflig, asked experienced professionals in the field: What can people do to reduce the chances of getting an unexpected bill from Social Security? Here are some of those tips.

Retirement benefits

If you receive Social Security retirement benefits, one of the best ways to prevent overpayments is to check the earnings history Social Security has on record for you. You can do this before you retire.

How much Social Security should pay when you retire is determined by how much you contribute in payroll taxes while you're working. If the agency has the wrong information, you may face problems years later. You can find the information on your annual Social Security statements or on your My Social Security account on the Social Security Administration's website.

If you are nearing retirement or have already retired, there are products that can help you figure out how much you should be getting. A program called Maximize My Social Security lets you analyze complex scenarios, like when you and your spouse should claim retirement benefits, since who claims first and when can make a big difference. The program costs $39 a year.

AARP also has a free basic Social Security calculator to determine how much you should be getting.

Specialists 60 Minutes spoke with advised that all recipients should figure out what they should be receiving because it can take the Social Security Administration years to catch mistakes.

Non-covered pension plan

If you work in the public sector—for example, as a teacher or a firefighter—it's important to know whether you're part of a non-covered pension plan.

If you are, instead of paying into the Social Security system, you are paying into a pension plan run by a state or local government. When you retire, you must tell Social Security about this non-covered pension money. If you don't and you receive Social Security from another job you had, you may end up being overpaid.

Social Security disability benefits

If you're receiving Social Security disability benefits and decide to go back to work, you need to be extra careful. After an initial trial work period is over, you cannot make more than a set amount per month, or you will no longer be eligible for disability benefits. That monthly income limit is called Substantial Gainful Activity. The monthly limit for 2023 is $1,470 for non-blind recipients, but the amount changes each year.

If you are receiving both Social Security disability benefits and worker's comp, you must report the worker's comp. If you don't, you may end up owing Social Security a lot of money.


Our office will be closed on Thursday, November 23rd and Friday, November 24th in observance of Thanksgiving.

We wish you and your family a Happy Thanksgiving!

Baby Boomers: Inheritance Conversations With Your Children

From Elder Law Answers

November 16, 2023

Not talking to your adult children about their inheritance comes at a cost. Do what you can to manage expectations for adult children as they forge their financial plans. Knowing their general inheritance situation can change their decision-making process and lead to better outcomes. These are practical matters of allocating resources for things like housing, retirement, 529 plans, and more.

When children don’t understand your inheritance intentions, it can result in arguments and legal battles among siblings and other heirs after you’re gone. The solution is a mature discussion with your inheritors, sharing details of your estate plan relevant to your child. You can withhold actual numbers by a range, such as enough for a home down payment. That way, you may provide a sense of magnitude without committing to exact amounts.

The Great Wealth Transfer

According to the Federal Reserve, the baby boomers are the wealthiest generation in US history. Baby boomers hold 70 percent of disposable income in the US and spend over $548 billion annually.

Forbes cites research stating that as much as $84 trillion may change hands by 2045. Much of the wealth is from high net-worth baby boomers. Millennials will control five times as much wealth in 2030 as they do today. Are they prepared for responsible stewardship?

Many who currently have substantial wealth have concerns that if their children know the extent of their wealth, it will reduce their motivation for productivity and growing into responsible citizens. Most parents prefer their children learn to grow their success independent of their parent’s wealth.

However, wealth is relative, and many parents also fear losing their ability to cover retirement, medical expenses, and long-term care. They want to maintain their quality of life while protecting their legacy. Because of this uncertainty, generally managing the expectations of their children’s future inheritance is better than providing exact amounts. After all, things always have the potential to change.

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