My elderly uncle has fairly recently entered a nursing home as a permanent resident. He established a resident trust fund account there from which his monthly fee is withdrawn to pay for his care (he is self-pay for the time being). He was given his first quarterly print-out of the account's activity and noticed a withdraw for $3000 for "patient liability". He questioned this as he had no idea what it was about and finally got the scoop after what he considered some hemming and hawing: the business office manager withdrew the money to pay a company called Medicaid Done Well to submit paperwork to help my uncle get Medicaid when his personal funds run out. My uncle is well aware that his funds will not last forever and that eventually he will need to apply for Medicaid but he did not give permission for the BOM to withdraw the money to pay Medicaid Done Well for its services. He didn't even know such a company existed. My uncle was not too happy at first about this whole thing but has decided that he doesn't want to rock the boat. He is happy with the care in the nursing home; he really likes several of the caregivers, says the food is decent, and the big plus with this place is that is provides hemodialysis services in the building. The BOM told my uncle that what happened was a "misunderstanding" and that, since my uncle has to spend down his money anyway, the $3000 was a way to accomplish that goal (or something along those lines). But this whole thing makes me very uneasy. The nursing home administrator is aware of what transpired but I think that corporate office should be told (they own probably about a dozen nursing homes in the state). I'm no lawyer but I think something illegal took place and I also wonder if this could possibly be some kind of scheme between the nursing home and Medicaid Done Well. My sister wants to report it to the state's attorney general's office. But since our uncle wants to let it go, should we honor his wishes?
About a week and a half passes, my husband is still in the hospital, and I get a letter in the mail from the business office manager from the nursing home. It is addressed to my husband. It tells my husband that upon reviewing his account, it has been discovered that there is a past due balance of $3,000 and to please take care of that promptly. I found this very odd. “Past due” implies that payment had been asked for before and I knew that no such request had been received at our home. I called my husband at the hospital and he didn’t recall any request for $3,000 or any type of payment at all. Obviously, with his insurance being cancelled, payment was owed but any previous conversation had to do with getting his insurance reinstated via COBRA or now, apparently, Medicaid.
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We had gotten advice from a knowledgeable person to request an itemized bill of this $3,000 charge in writing. What we received was pretty strange. The business office manager sent an itemized bill of EVERY charge, such as all my husband’s therapy sessions, days of room and board, and two separate charges labelled as “patient liability”, $1500 for January and $1500 for February (my husband had entered the facility mid-January and left for the hospital late February). In total, the charges were over $30,000.00. This printout was several pages long and rather dense so it took me a while to see the two $1,500 charges but I figured that they add up to $3,000 so could that be it? But still, it didn’t answer the question “what is the $3,000 for”? Is it some kind of co-pay? My mind even considered if my husband had broken a piece of expensive equipment in the rehab room that he had to pay for on an installment plan. When I asked the NH administrator for an explanation of the $3,000 charge, she responded by telling me to ask the business office manager. Her response was not helpful at all obviously and I was becoming more convinced that something odd was going on here. Why could I not get an answer to a very simple question? I believe that I eventually found the answer but it took me many months. The answer did not come from the nursing home; they continued to be evasive all the way up to the corporate level. They couldn’t admit what the business office manager had done because it was most likely illegal. It was definitely unethical. This is what I believe happened because it is the only thing that makes sense. I have tried to break my hypothesis on this and it doesn’t break. The business office manager took it upon himself to pay, from the nursing home’s coffers, Medicaid Done Right’s $3,000 fee to process my husband’s application without my husband’s knowledge or consent. I think he did this because he wanted to get the ball rolling on the Medicaid application, but my husband wasn’t there to sign paperwork agreeing to pay MDR’s $3,000 fee for processing more complex applications. If you remember from earlier, everyone seemed to be working under the assumption that my husband’s case would be “easy”. Then the BOM had to recoup the $3000 because the nursing home isn’t the one who is supposed to pay this fee; the patient is. I have next to zero doubt that MDR was paid their fee, and it wasn’t my husband and me who paid it, so that only leaves the nursing home in my opinion. There was never any legitimate “patient liability” of $1500 for January and $1500 for February. That was a falsehood concocted to add the illegitimate $3000 charge to my husband’s account. I’ll go ahead and call it low-key money laundering if you all don’t mind. I believe that the business office manager thought I would question nothing; my husband was in the hospital quite ill (he had tested covid positive in the nursing home, was in quarantine for 10 days and seemed to have come out of it OK but then developed severe kidney dysfunction about a week later), and I wouldn’t want to burden him with this issue, I would just pay the $3000 and be done with it. And he knew without a doubt that I could pay it, no problem. How? Because he knew how much money we had in the bank. I know this because he told me. He phoned me a day or two after I had met with the MDR rep and said (paraphrasing) “your husband has almost $70,000 in the bank. He isn’t going to qualify for Medicaid”. Unbeknownst to me, MDR gives all the financial info you give them to the nursing home. Or at least they did then. Not to be dramatic, but this made me feel a sense of violation. I think that if some third party is going to have access to the private information I give you, you should tell me beforehand. I was feeling antsy enough knowing that I had given my personal info (including my SSN) to someone whom I thought was from the state and turned out not to be.
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You are very bright! Stick around. We need you here. This is great info.
And a warning to all to watch things and stay on the toes.
Nothing at all under Medicaid Done Well. So, either your Uncle has the name wrong or it is a scam of sorts. $3K sounds steep. Is it possible he doesn't remember signing to do it? Are you getting all your info from him verbally and not in person yourself? Many elders with memory deficits get their info wrong.
Also:
https://www.agingcare.com/questions/shocker-of-a-phone-call-today-about-medicaid-application-and-her-stay-at-the-nh-how-does-this-happen-477565.htm
This OP mentions that Medicaid Done Right processed the applications at their LO's NH.
If all you indicate above is true I would be VERY VERY uncomfortable with this.
I would suggest to the POA Uncle that the two of you make an appointment with the ADMINISTRATOR in charge at this nursing home.
Reports of this done without signed permission would be very very concerning and could lose them their licensure in the state. This isn't good.
I myself would be tempted to pay to have this application work done, myself. But I would want to shop out the prices and choices and certainly wouldn't want it done over my head. OR under my hand!
No concern about "Rocking the boat", the BOM and probably the rest of the administration has little to no contact with residents unless it is a business matter or the state is there.
There is a company called Medicaid Done. Right which contracts with NHs for the Medicaid application; it has expanded to several states and NHs