Failure to Timely Refund Resident Share of Cost After Death
Penalty
Summary
The facility failed to follow its own policy and procedures regarding the timely refund of a resident's share of cost overpayment after the resident's death. Specifically, business office records showed that $187.97 was owed to the deceased resident's family, but this amount was not returned within the 60-day timeframe required by the facility's policy. The Business Office Manager (BOM) acknowledged being unaware of why the refund had not been processed, and both the BOM and the Administrator confirmed during interviews and record reviews that the refund remained outstanding beyond the policy's deadline. The resident involved had been admitted in 2020 with a diagnosis including encephalopathy and was documented as having full cognitive understanding at the time of assessment. The facility's own records indicated the overpayment and the requirement for a refund, and the issue was first raised by a complainant inquiring about the refund. The facility's policy, consistent with CMS regulations, required overpayments to be refunded within 60 days of identification, but this was not adhered to in this case.