Truths and Falsehoods About Heart Risk

(Heart Health continued from page 25)

As plaque buildup continues, the risk of suffering a CV event – such as heart attack or stroke – increases. If plaque ruptures, the body will try to repair the injury, potentially causing a blockage to form, and when an artery becomes fully blocked, blood flow is restricted. Blocked blood flow to the heart causes a heart attack while blocked blood flow to the brain causes a stroke.

(Continued on page 28) Truths and Falsehoods About Heart Disease Risk

1. Statins reduce your chance of experiencing a CV event by up to 90%.

False. Statins, diet and exercise can lower your risk by about 2535%, but for many patients, controlled cholesterol doesn’t eliminate CV risk.

This residual risk, or “persistent CV risk,” puts millions of patients at risk and has been the focus of therapeutic development for many years.

2. Managing high triglycerides along with taking statins is enough to reduce your risk.

False. High triglycerides are a CV risk factor but lowering them won’t necessarily reduce your risk. For example, earlier generation medicines prescribed to lower triglycerides, like fenofibrates and niacin, failed to show clinical benefit when used with statins to reduce CV risk.

In fact, the FDA withdrew approval for fenofibrates and niacin in combination with statins because they add potential risk with no proven benefit to heart health.

3. Fish oil supplements are a proven way to get protection from a CV event.

False. Fish oil supplements are not FDA-approved medicines intended to treat or prevent a medical condition. Despite multiple clinical studies, these products have not been proven, to reduce CV risk on top of current medical therapies including statins.

4. Having a first CV event, such as a heart attack or stroke, puts you at greater risk to suffer another.

True. Having a CV event makes you more likely to suffer another. That’s why it’s important to protect against a first CV event or future events.

To closely monitor your heart health, stay in close contact with your doctor and reduce your risk by keeping up with your medications, exercising and sticking to a healthy diet. Family Features; Photos courtesy of Getty Images

(Little Acorns... continued from page 9) sistance policy at that time, it nevertheless tried to accommodate financially distressed patients who sought help. (In New York hospitals are now required to develop and publicize the availability of such programs.) The hospital sent a payment request three times in as many months.

Although the communications invited the patient to apply for assistance and told him how to do it he ignored them as well as the several subsequent demands for payment made by way of letters from the collection agency to which the hospital routinely referred its bad debt collections.

Then the debt “went legal.” From the service of a summons to the entry of the judgment, all with appropriate notice to him, the patient inexplicably did nothing.

The judgment resulted in supplementary proceedings and the eventual deposition subpoena. Upon the inevitable failure to appear counsel applied for a court order and served it.

When the patient again failed to appear the court found him in contempt. Served with the order he again did nothing. Then the sheriff locked him up. The headlines read, “Indigent Patient Jailed for Not Paying Hospital Bill.”

(Heart Health continued from page 27) Managing Risk Factors

The most effective way to prevent CVD is to understand and address risk factors. Triglycerides play an important role in heart health. Triglycerides store unused calories to give your body energy and are the most common type of fat in the body. They come from foods you eat such as butter, oils and other fats,

as well as carbohydrates, sugars and alcohol. Your diet, lack of exercise, medical conditions, certain drugs and genetics can all cause high triglycerides.

In the past, medicines used to lower triglycerides, like fenofibrates and niacin, were commonly prescribed to help manage CV risk along with statins. However, clinical studies failed to show benefits and both the U.S. Food and Drug Administration (FDA) and American Diabetes Association discourage combining niacin and fenofibrates with statins.

Some turn to dietary supplement fish oil to help manage CV risk. However, supplements contain only 30% of the omega-3 fatty acids EPA and DHA (docosahexaenoic acid) with the majority of the product consisting of non-omega-3 ingredients, including saturated fats. Some data suggests certain ingredients in dietary supplement fish oils, such as DHA and saturated fats, may raise bad cholesterol.

While high triglycerides are an indicator of CV risk, lowering them won’t necessarily reduce your risk. However, addressing the underlying causes of high triglycerides can help, according to the AHA.

Treatment Options

With ongoing research, new standards-of-care are emerging. High cholesterol is a key CV risk factor with statins currently the first-line therapy for lowering cholesterol. Statins, diet and exercise can lower your CV risk by about 25-35%, but, for many people, controlled cholesterol doesn’t eliminate CV risk. This residual risk, or “persistent CV risk,” puts millions of patients at risk and has been the focus of therapeutic development for many years.

Talk with your doctor about FDA-approved options that can help further reduce your heart risk if you already take statins. For more information about CVD and what you can do, look for #RethinkCVRisk on social media or visit truetoyourheart.com

On average, someone in the United States dies from cardiovascular disease (CVD) every 36 seconds, approximately 2,380 deaths each day, according to the American Heart Association.

(Understanding Advanced Directive Language continued from page 16) the answer is yes. The New York Health Care Proxy Law allows people over age 18 to appoint someone they trust — a family member or close friend (but not their own treating physician) — to make health care decisions for them (if they lose the ability to make decisions themselves) and a successor.

Consider also executing what is called “a Living Will” so that your medical instructions are clear and can be read by people, if and when you are unable to communicate your wishes. This is helpful when the people you have named that cannot act, you are outside the country and/or the agent named needs guidance and maybe assurance they are doing what you want. An attorney experienced in these and other documents (such as a power of attorney and other estate planning documents) should be consulted. Make 2021 the year you ensure you — and your clients — have what is needed in case an unforeseen health care situation arises.

(9/11 Victim Compensation Fund continued from page 15) ber that registration with the WTCHP is NOT same as registration with the VCF -- you must separately register with both programs.

For individuals with conditions certified by the WTCHP or families whose loved ones died after July 29, 2019, the VCF registration deadline is two years after the date of death or WTCHP certification date. It must be understood that a VCF “Registration Deadline” is different than the “Filing Deadline.” “Registration” simply preserves the right to file a 9/11 claim in the future, waives no legal rights, and does not obligate a claimant to file a claim.

Registration serves only to alert the VCF that you may be a potential claimant and it meets the legal requirement of timeliness set forth in the law. The Registration Deadline is not the same for everyone. If you lost a loved one since 9/11 who was present in lower Manhattan below Canal Street or anywhere that 9/11 debris was handled (see exposure zone map) at any time between September 11th, and May 30th, 2002, you should immediately register a potential claim for 9/11 death compensation and benefits with the VCF before the strict registration deadline on July 29, 2021.

would permit such discussion to continue off the record in a subsequent confidential manner.

Medical Debt in Chapter 13 cases

Some consumers are not able to file for Chapter 7 relief, either because they do not qualify for that chapter or for other reasons. Such consumers will often file for Chapter 13 relief instead. In Chapter 13, the debtor pays some or all of their debt back through a payment plan over a period of three to five years. In order to be paid, the creditor must file proof of claim form and any documents supporting the claim. The issue then becomes: What information should the health care creditor provide to protect its rights to file a claim, and what details should it hold back because they may impair the debtor’s patient privacy rights? In the past, there has been tension between the general bankruptcy concept that there should be full transparency when one seeks bankruptcy relief, and a patient’s right to reasonable medical privacy.

The official court instructions for preparing a proof of claim are found in Form B-410. With regard to health care providers, the instructions provide that: “If a claim is based on delivering health care goods or services, limit the disclosure of the goods or services to avoid embarrassment or disclosure of confidential health care information.”As many hundreds of thousands of medical debt claims are filed each year, there is always a danger that the creditor will carelessly violate privacy laws. Any health care provider or collections agent on their behalf who fills out a proof of claim form should be especially careful to comply with privacy requirements. If any party, including the party filing the information, realizes that confidential information was inadvertently included, that party can immediately file a motion to seal the record. As mistakes do happen, the sooner the offending party takes responsibility for the error and engages in remedial action, the more likely they will be able to mitigate any negative recourse.

Bankruptcies Filed by Health Care Providers

Doctors, hospitals and health care businesses are not immune from debt problems. However, when they do seek bankruptcy relief, they face unique challenges regarding the use and disclosure of patients’ medical information and must especially comply with HIPAA.

HIPAA Laws

The most extensive federal health care privacy law got its start with the Health Insurance Portability and Accountability Act of 1996, most frequently referred to as HIPAA. Now viewed as our nation’s primary patient privacy law, its privacy rules were added in 2003, which adopted national standards to prevent the disclosure of protected health information (PHI), which it defined as “any information held by a covered entity which concerns health status, the provision of healthcare, or payment for healthcare that can be linked to an individual.” Since then, most medical providers have endeavored to achieve full HIPAA compliance. However, a bankruptcy filing certainly complicates matters. The Bankruptcy Code does not contain any provisions that excuse a health care debtor from HIPAA compliance.

In general, in a health care business bankruptcy, the trustee or the Chapter 11 debtor in possession must provide certain notice to patient creditors. In addition, health care business debtors or trustees will often seek bankruptcy court approval of procedures to ensure HIPAA compliance and to avoid potential liability for violating HIPAA requirements for protecting for patient data. With a healthcare business bankruptcy, it can be the patient who is the creditor and who must file a proof of claim. In such cases, the debtor should seek a bankruptcy court order before sending out blank claims forms to patients, to restrict public access to the proofs of claims.

In some cases, the trustee or debtor in possession is sometimes left with the difficult task of disposing of thousands of patient files, each containing very confidential medical information. Ordinarily, the Chapter 7 trustee can abandon assets and simply walk away from them. However, when it comes to dealing with files containing sensitive medical data, Bankruptcy Code 351 addresses this issue.

It provides that when a debtor lacks funds to retain medical records, certain notice requirements must be adhered to, such as providing written and/or published notices to patients and insurance companies, and destroying unclaimed records.

The Bankruptcy Code provides another protection for patients in health care business bankruptcies. Code Section 333 requires the Court to appoint a patient care ombudsman in such cases to monitor the quality of patient care and represent the interests of patients, unless the court determines that doing so is not necessary for the protection of patients. Bankruptcy Code Section 101(27A) sets forth a lengthy definition of what comprises a health care business.

Medical privacy in bankruptcy cases is an evolving area of the law. There are many cases that patients have brought against parties that have improperly disclosed confidential medical information. This is one area where extra care and attention is mandatory.

Yet, non-compliance penalties can be as high as $110 per day, per employee, for as long as the employer is deemed to be out of compliance. It is also important to note that the insurance carriers do not provide any of these ERISA documents for distribution. Employers should be working with a knowledgeable benefits consultant or an ERISA service company that can provide these documents to them and advise them on distribution. The NYS DOL has partnered with the EBSA to audit health plans in NY State for ERISA violations. This was proudly announced by then Attorney General Eric Schneiderman back in 2016.

Since then, the Department has greatly increased their auditing personnel and even have quotas to fill, so they are very serious about enforcement.

There is also a tremendous amount of inter-agency cooperation happening at both the federal and state levels, thanks to technology. An employer might be audited for Workman’s Comp, sales tax, ACA compliance, unemployment insurance, etc. and that can trigger an ERISA audit as well, especially if there are any violations found.

If the employer is not compliant in one area, the assumption is that the employer is likely deficient in other areas as well, so the case is easily referred to the other departments.

The current regulatory environment makes it more important than ever that employers work with professionals who specialize in employee benefit consulting to assure that they remain fully compliant under the law.

The consequences of non-compliance are extremely costly.

(Advanced Planning continued from page 22)

risk, for the sake of themselves and their families. Easier said than done!

However, there are tools and legal strategies available to use that reflect personal needs, values and objectives.

The bottom line is that it is always a good idea to start planning sooner rather than later. So, what are these tools to help us pay for Long Term Care? We can pay for it ourselves, we can purchase Long Term Care Insurance or we can utilize the benefits of the Medicaid program as long as we are “eligible” to receive those benefits. If you don’t have enough money put away for your care and long term care insurance is unavailable or unaffordable, Medicaid then becomes the only realistic alternative.

But Medicaid is not the ideal solution since, at best, it is lukewarm about paying for enough home care and even worse when it comes to paying for assisted living but very generous for paying fully for a nursing home – the place most people do not want to be.

The bottom line is that you want to do whatever you can to maximize your choices, and this is something you have to do in advance.

There is a lot of incentive to plan ahead for the possible need of long term care, especially with the general declining heath of America in the form of rising obesity rates and the increase of diabetes, high blood pressure and cholesterol levels.

And, putting your lifetime savings, your home and your emotional well-being at risk is just as compelling a reason to plan ahead.

The most important thing is to choose the approach that best reflects the individual’s values, circumstances, desires and needs and to keep in mind that “Delay is the enemy.”

As people age, it’s really important for them to do their best to try and remain in control of their destiny as much as possible. They need to have choices and planning ahead will allow them to retain as much flexibility as possible.

Unfortunately, this type of planning is often put off until there is a crisis thereby limiting their available choices.

agencies. Included in the Symposium will be a discussion on implicit bias and best employment hiring practices.

A Path Forward through Diversity means that the essential fact of life is our shared humanity. Human beings are more alike than they are different.

The Diversity Symposium will allow us, from that day forward, to explore how we treat others that are different and monitor or be aware of what we do to maximize our human talents.

For our future as a Bar Association, we require one another. We have a responsibility for others' professional growth and well-being and must incorporate that responsibility into the way we do business, more than we have ever done before.

(Medical Debt continued from page 19) 2017, there’s a 180-day waiting period before unpaid medical debts can show up on people’s credit reports. With that, though, you will want to address the medical debt before this happens to avoid damaging your credit.

A last resort available to those with impossible amounts of medical debt is bankruptcy. If you qualify for Chapter 7 Bankruptcy, your medical debt will be discharged. If you don’t qualify for this type of bankruptcy, you might be eligible for Chapter 13 Bankruptcy.

This option will require you to repay a portion of the medical debt that’s deemed affordable as part of a repayment plan. This remaining debt will be discharged but will show up on your credit as bankruptcy and thus impact your overall credit score.

March 10, 2021 Hon. Derrick J. Robinson President, Suffolk County Bar Association

(Covid 19 & Property Taxes continued from page 21) of income and expense.

In Nassau County, it is called the Annual Statement of Income and Expense (ASIE) and in New York City, it is the Real Property Income and Expense (RPIE). Assessors rely on the income and expense information timely reported by property owners to prepare the subsequent tentative assessments.

In 2020, New York City also required property owners to file a rent roll with their financial information and then, months later, to file a supplement to the rent roll, to reflect any new vacancies, revised lease terms, rent concessions, etc. While this information may not be requested by every municipality, it is important that your tax certiorari attorney have the most current financial information on your property to arrive at an accurate reflection of value.

Increased vacancies have been a significant result of the effects of COVID-19 in the real estate market. In addition to vacancies, the following factors may also strengthen an argument for reduction in assessment and should be conveyed with supporting documentation to your tax certiorari counsel: 1) business closings, 2) rent concessions, 3) claims for rent relief, 4) non-payment of rent, 5) collection loss and 6) expenses incurred in leasing new space. Additionally, any other defaults — from non-payment of property taxes, water bills or sewage bills, to short-term forbearance or permanent loan modifications — should also be conveyed to your counsel as they may all affect the property value.

File Your Grievance!

While many property owners looked to their local and state governments for property tax relief, municipal responses were extremely inadequate- mostly in the form of extended tax payment deadlines and, in some municipalities, fees or interest being reduced or waived for a limited time. The municipalities themselves have also been adversely affected by COVID-19.

They are hopeful there will be sufficient financial assistance from the federal government. Without federal assistance, it is likely that property tax rates will increase, as municipalities have their budgets to maintain.

While there is no guaranteed property tax relief, the best way to reduce your property taxes is to consult with a tax certiorari attorney and timely file a grievance.

If you miss the filing deadline, you will lose your opportunity to get a reduction based on your COVID-19 related losses for the year 2020.

(Resident Rights continued from page 20)

Although both actions are eminently reasonable from an Administrative point of view, and paternalistically in the “best interests” of the Resident, they are nonetheless violating the individual’s rights.

So, what is the answer to the dilemma? Public health mandates aside, the final analysis must always favor the resident’s rights, and the right to make their own choices.