Inaccurate Management of Resident Funds
Penalty
Summary
The facility failed to maintain an accurate and up-to-date system for managing residents' personal funds, affecting three residents. The review of accounts for these residents showed discrepancies between the cost of care withdrawn from their personal funds and what was determined by Medicaid Access eligibility. Additionally, Social Security direct deposits for January and February 2025 were not reflected in the accounts, leading to concerns about the accuracy of the residents' balances. Interviews with residents and their representatives revealed concerns about potential fraudulent activity and inaccuracies in the resident trust fund accounts. One resident expressed worry about the accuracy of her balance after noticing irregularities in the payments for her room and board. Another resident's representative suspected fraudulent activity after a significant amount was withdrawn from the account without authorization. A grievance was filed by another resident requesting a report of fund transactions, which led to the discovery of an unexplained cost of care payment. The Nursing Home Administrator acknowledged the inaccuracies in the Resident Fund Management System (RFMS) and noted that the Business Office Manager, who was responsible for handling the resident trust accounts, had recently left the position. The facility was unable to provide a policy on the accounting of residents' personal funds or any corrective action taken to address the irregularities in the resident trust fund accounts during the survey.
Plan Of Correction
Resident #3, #5, and #6 cost of care was verified with the Medicaid access eligibility portal and verified to match the Resident Fund Management Services (RFMS). A finance coordinator was hired on to ensure oversight and maintenance of the Resident Fund Management Services. Social Security deposits were found, added to account, and balanced for Residents #3, #5, and #6. Resident #5 cost of care payment of $3,015.60 was verified and accurate. Resident #5 patient liability for 2025 was updated based off of the Medicaid Access system. Resident #3 RFMS account was reconciled and patient liability amount updated. Resident #6 RFMS account was reconciled, patient liability updated, and debit was explained to resident and responsible party. All residents with personal funds accounts were audited to ensure the correct resident cost of care was accurate and in Resident Fund Management Services. Findings were corrected and accounts reconciled to reflect accurate amounts and balances. Residents that have been discharged for the past 30 days, accounts were closed out in RFMS and refunds sent to responsible party/resident. Quality measure audit tool was completed on all active residents with a personal funds account to ensure the facility is maintaining a system that assures a full and complete and separate accounting according to general accounting principles of each resident's personal funds entrusted to the facility on the resident's behalf. The Nursing Home Administrator was re-educated by the COO to ensure the facility is maintaining a system that assures a full and complete and separate accounting according to general accounting principles of each resident's personal funds entrusted to the facility on the resident's behalf. The Nursing Home Administrator or designee will complete quality reviews weekly for 4 weeks, then monthly for 2 months thereafter to ensure ongoing and sustained compliance. Findings from the quality review audits will be reviewed and discussed by the Quality Assurance Performance Improvement (QAPI) Committee monthly for 2 months. Non-compliance will be reviewed by the QAPI committee with direct changes to the plan as deemed necessary to ensure ongoing and sustained compliance.