Is Out-Of-State Real Estate Investing Right for You?
Have you made up your mind to start investing in real estate, but you’re torn in deciding where to invest?Are you thinking about making a local investment, but wondering if an out-of-state investment might be better?This is one of the first of many choices you’ll have to make when you decide to invest in real estate: the simple question of where you should invest your hard-earned dollars. While there are definite benefits to investing in your area, there are also some potentially profit-limiting downsides.That’s not to say investing in outside areas doesn’t have its own pros and cons. Let’s take a look at both and see why out-of-state real estate investing might be a profitable option you have not yet explored.Investing LocallyThis is the most obvious choice for many real estate investors, but is it really right for you?If you choose to buy a property local to you, you’ll rest easier about your investment since you know the market. First, you know your competition. You might know the names of professionals you can trust and you’ll have an intimate understanding of what the cost of living is for that area and how to make things more affordable.Second, if you like to be hands-on, it will be much easier for you since you’re right there. If you want to see the property, it’s just a short drive away. If you want to talk to the property manager face-to-face, you just put it on your calendar for the end of the day.Drawbacks to Local InvestmentsOn the other hand, investing solely local can narrow your options. Not every market has the inventory of good investment opportunities that you can avail yourself of if you invest out-of-state. The local inventory of available properties may or may not be big enough or well-suited for investment opportunities.You also run into the problem of whether your local market is the one you want. The recession made a huge impact on housing markets throughout the country and some areas have recovered at different paces than others. You might find yourself out-priced in your current market, but even if you aren’t, you might not be able to see a favorable future where you’re at.Investing Out-of-StateIf you decide to invest out-of-state, you can greatly increase your options. You can literally choose any location, any market and invest in properties there. Whether you want to invest in Florida vacation homes and coastal villas or homes in the suburbs of Detroit, the sky’s the limit. You can make your investment fit your price point and interests.By investing out-of-state, you can put your money to work in markets with high ROI. You pick and choose which markets you’re interested in, and which ones are rising stars in the real estate investment scene, ignoring your own market’s changes.Investing out-of-state also allows you to scale based on your needs. For many would-be investors, their local market is priced too extravagantly to make real estate investment prudent. The cost of living in a different state, just a few borders east or west, might be considerably lower. That means you can snatch up excellent properties at a much lower cost than you might in your own market.Even better, you can snag those investment deals on excellent properties that would go for three to four times as much, if not more, in your own local market. Your purchasing power becomes much stronger in other markets, because everything’s relative.Challenges of Out-of-State InvestmentsThere are still some challenges to these remote investments. First of all, you have to learn who you can trust and maintain the peace of mind that comes from having easy local access to your investment. You also have to be able to trust that the property you’re investing in is what it’s advertised as.The property is also more difficult to visit if you like to be hands on. You might have to fly out to visit the property, which some people enjoy but others are seriously bothered by. If you are the type of investor who prefers the more passive turn-key approach, this is an excellent opportunity.Finally, the market won’t be what you’re used to. Nothing will be quite the same as being there and immersing yourself in the market, but you can learn and study. You just have to rely on someone else to have knowledge of the nuances of the market.Doing Out-of-State RightThere is a solution to all of the challenges of real estate investing outside your state. When you find a reputable, proven company to handle your turn-key real estate transaction, you have someone you can count on to know the market you’re investing in. Here are the main reasons you should find a partner to work with you on your out-of-state investments.
They can keep a more educated eye on the market, since they know all of the nuances of that area.
They’ll serve as your presence near your investment, keeping everything on track, so you don’t have to make numerous trips to the property.
If the turn-key real estate investment firm is reputable, they want you to succeed. This means they’ll do anything they can to make sure you do succeed.
The question becomes, whom can you trust? You want to make sure you engage in a partnership with a firm who is reputable, knowledgeable and engaged in your market. Referrals from other investors are key, so be on the lookout for like-minded people who have been there and done that.You should also investigate what the turn-key operation offers you, and what their fee or cut of your profit is. Ideally, you’ll want a partner who can help you throughout your investment lifecycle, from acquiring the property to managing it.Getting StartedWe’ve gone over the benefits and drawbacks of out-of-state investing, so now the decision is yours to make. Do you still want to invest locally or have you realized that the time is ripe to diversify your portfolio and invest in out-of-state properties? The benefits of out-of-state real estate investment are huge and the drawbacks can easily be mitigated by partnering with someone in the area in which you’re investing.
Investigating Health Care Fraud
Investigations relating to health care fraud activity are reportedly at an all time high, and will continue to flourish with the advent of new working groups, task forces and other fraud-fighting activity that existence depends on the development and investigation of health care fraud cases. Simply put, the investigation of health care fraud consists of proving that the provider engaged in an intentional deception or misrepresentation (of material fact) that resulted, or could have resulted, in an unauthorized payment. Some key facts related to health care fraud investigations:Complaint Driven: Private, local, state and/or federal agencies are actively involved in the identification and investigation of health care fraud and abuse, which, for the most part, are initiated by complaints received from patients, insurers and others on a health care provider or entity.Complaint Evaluation: The investigative process starts by the investigator evaluating the information in the complaint to determine if it represents actual misconduct, and then to identify what specific laws, rules, and/or regulations may have been violated. Critical areas to be addressed may include:oDOCUMENTATION-was the services documented as medically necessary, and completely and accurately documented in the patient’s health care record?oREGULATORY LAWS & RULES-were the services rendered consistent with the administrative law for the State, including scope of practice, training, supervision and delegation? Additionally, were the services, or the manner in which they were rendered, in violation of prohibited conduct?oTHIRD PARTY PAYER RULES-were the services rendered consistent with the rules set by the involved third party payer, including those relevant to limitation of services rendered, and those limiting the service provider?oCODING-were the proper ICD-9 and CPT-4 codes used to identify the condition (s) being treated and the services rendered when seeking reimbursement?Investigative Plan: The investigator will identify potential witnesses to interview, other needed information, such as patient and insurance claim files that may possess evidence of the misconduct. The successful investigation will result in the collection identify and collect all relevant evidence that would indicate the laws, rules and/or regulations governing health care have been violated, and to identify storytellers who will be able to testify on matters relevant to the identified misconduct. The patient file is the crime scene when investigating health care fraud & abuse.MAJOR TRENDS IN HEALTH CARE FRAUDProblem (Multidiscipline Practices): Some multidiscipline practices of medical doctors, chiropractors, and other providers working together in one practice entity are formed by some chiropractors as a means to circumvent managed care and other third party payer limitations on reimbursement of chiropractic services. At times, when necessary, multiple corporations are created to allow the chiropractor to employ medical doctors and to maintain control over all revenues of the multidiscipline practice. The services rendered by the chiropractor in cases where there is little or no chiropractic coverage are billed to the third party payer under the license and name of the medical doctor, purportedly following “Incident-to” billing principles after the medical doctor evaluated the patient and referred them for care with the chiropractor. Is the chiropractor billing for their services rendered under the license of a medical doctor?Problem (Mobile Labs): Some external companies, or mobile labs, market their electro-diagnostic testing services extensively to health care providers as a means to increase patient retention and increase revenues. The mobile lab provides on-site electro-diagnostic testing on the provider’s patients with their equipment and by their technician. The provider pays the lab a rental fee for the equipment and technician, and agrees to provide a minimum number of patients for testing during one day. The lab bills the third party payer for only the reading of the tests, or the professional component, and the provider bills for administering the tests, or the technical component, because they rented the equipment/technician and supervised its administration. Further, the lab will provide the provider with the CPT codes and amounts that should be reported and billed for the technical portion of the test. The provider, claiming to have supervised the administration of the diagnostic test, may not have the requisite training and skill on the test. Often, the total amount billed (both professional and technical) for the tests will far exceed the RVU (Relative Value Unit) set for these tests. The client provider usually will have no actual knowledge on what the labs will bill to the third party payer. What service did the provider perform to bill for the technical portion?Problem (Rehab): Some providers implement (active) rehabilitation care into their health care practices by having their unlicensed staff administer therapeutic procedures to patients that are defined as one-on-one with the patient by a licensed provider, and are reported in 15-minute increments. Documentation of medical necessity of therapeutic procedures may not be properly established in the patient’s clinical record as part of a treatment plan. Documentation of procedures in file, even when directly provided by licensed provider, may not be properly documented to account for the time component of the service, i.e., Start & End time, which includes pre-intra-post service time. Is the provider’s unlicensed staff rendering the rehab services to the patients of the practice? What does the patient’s health care record show? Do they support the need and accuracy of the billings?Problem (Billing): Various insurance companies have limitations on what health care conditions and services they will reimburse providers for. Some providers provide their patients with health care services that are not reimbursable by the involved managed care organization or third party payer, but report and bill for these services via use of ICD-9 and CPT-4 codes that are reimbursable. Some providers provide their patients with various health care services based solely on the premise that the involved managed care organization or third party payer will reimburse for those services.Problem (Solicitation): A number of providers market “free” services, such as consults, exams and x-rays to attract new patients that may not be established as medically necessary, or will later be billed to a third party payer. A number of providers’ market “free” services, such as therapeutic massage, as a means to attract new patients to the health care practice, which later may become a part of the patient’s billed care. A number of providers inform marketed individuals when converting them to patients that they will not be responsible for what the insurance company does not pay. For the health care provider what is a consult? Isn’t it a history? Was the promised free service, or a portion of it, later billed? Is it possible to give away a therapeutic massage without first examining the patient to establish need?
8 Questions to Ask Your Home Health Care Agency Or Nurse
If you are in the process of finding a home care services agency or if you are considering hiring a home care nursing aide or a home health care physical therapist or occupational therapist, it is critical to find out their qualifications.We assembled a list of 8 questions you can ask the home care agency to ensure that you are choosing the right provider for your needs.1) What is the background of the home care company & how long have they been in business?You want to find a reputable in home nursing agency that has been in business for a number of years and has a successful track record. Most newer home nursing care agencies haven’t been around long enough to build a proven track record or a list of red flags.So, it’s important to find out as much information about the company as possible. You can do this by finding information on who owns the company and what role the ownership plays in the type and levels of service.2) What are the home nursing care agencies qualifications, certifications, experience and training of their home care aides and nurses?It’s extremely important to find out about the credentials of the home health aides and nurses that the home care company sends to your home.Make sure their home health aides and nurses are certified and have received adequate training.3) How does the home nursing care agency monitor care and can the family provide feedback?Find out if there are any quality assurance measures in place. Many home health care agencies periodically visit the home of the client or make regular calls to gather client feedback.If this is not the case, find out how a family member can provide feedback on the quality of care or who they may contact in the home care agency to have any questions answered.4) Are there any home visits or assessments that take place prior to home health care services beginning?Find out if there are any options available that allow the family members, client and the home care agency representative to meet prior to the start of services. Most reputable home nursing care agencies offer free consultations.5) Does the agency have a current operating license in their respective state or city?It is important to find out if the home health care agency has a current and valid license to operate in their respective city or state. This often overlooked aspect is the most important factor in choosing a home health care agency.6) How does the home nursing care company work with your doctor in developing a plan of care?Most agencies work directly with your doctor in planning for your care, especially if the client requires care that is beyond the scope of activities related to activities of daily living.7) Can the home care company provide references or testimonials?Most reputable home health care companies can provide references from doctors, nurses, social workers and even clients if requested. They may even have a page on their website that is dedicated to providing this type of information to potential clients.8) What happens if a home health aide or nurse is absent from the agency on a particular day?If the home health care provider is required to take a day off for illness or another emergency, what type of protocol is put in place by the home health care company to cover the absence?There are usually plans put in place to ensure that the client receives that continuity of care in the event of an absence by their home care provider or nurse.