Failure to Provide Accurate Insurance Coverage Information to Resident
Penalty
Summary
The facility failed to provide accurate and timely communication regarding insurance coverage for a resident's stay and services. The resident, who had diagnoses including osteomyelitis of the left ankle and foot, anemia, metabolic encephalopathy, and chronic atrial fibrillation, was admitted and later discharged after a period of care. During the stay, the Business Office Manager informed the resident's representative that Medicare would cover the stay and that there would be no private pay responsibility. However, it was later discovered that the resident had exhausted Medicare benefits, resulting in a significant outstanding balance for the period of care. The Business Office Manager acknowledged that the information about insurance coverage was confusing and that the resident's representative was not made aware of the financial responsibility until after the services had been provided. This lack of accurate and timely communication prevented the resident and their representative from making an informed decision about continuing the stay or considering alternative care and financial options.