According to an investigation conducted by the Tennessee Comptroller’s office, a nursing home in Knoxville owes more than $250,000 to former residents, their representatives, and the state of Tennessee due to overcharges. Specifically, the facility failed to properly manage and promptly refund accounts for 81 residents, resulting in a total overcharge of $265,671.42.
The comptroller’s report said that the primary cause of these errors was the nursing home’s inadequate logging of expenses, which the facility says it has addressed.
The investigation covered the period from January 1, 2022, to November 21, 2023. During this time, the management at the facility did not notify account holders about refund credits owed to them. Of the total amount owed, $126,817.26 is owed to former Medicaid residents, while $138,854.16 is owed back to the Medicaid program.
Additionally, the investigation found that the facility had charged six residents a total of $260 for haircuts, even though haircuts are covered under Medicaid. The facility has been asked to refund this money as well.
The facility’s management said they have now implemented additional checks and balance auditing processes to ensure timely refunds for the affected individuals.
Compliance Perspective
Issue
F582 says that if a resident dies or is hospitalized or is transferred and does not return to the facility, the facility must refund to the resident, resident representative, or estate, as applicable, any deposit or charges already paid, less the facility’s per diem rate, for the days the resident actually resided or reserved or retained a bed in the facility, regardless of any minimum stay or discharge notice requirements. The facility must refund to the resident or resident representative any and all refunds due the resident within 30 days from the resident’s date of discharge from the facility. F571 says that the facility must not impose a charge against the personal funds of a resident for any item or service for which payment is made under Medicaid or Medicare (except for applicable deductible and coinsurance amounts).
Discussion Points
- Review policies and procedures regarding managing and promptly refunding accounts receivable credit balances on the accounts of deceased or discharged residents and for the proper logging of expenses.
- Train appropriate staff on your policies and procedures for logging expenses and issuing refunds. Ensure staff are not charging residents for items and services which are covered under Medicaid or Medicare and that accurate records are kept.
- Periodically audit to ensure that billing for services does not violate state or federal laws. Also audit to ensure refunds are issued promptly and that documentation is accurate and complete.
*This news alert has been prepared by Med-Net Concepts, LLC for informational purposes only and is not intended to provide legal advice.*
