Failure to Ensure Accurate Billing and Timely Refunds for Private Room Charges
Penalty
Summary
The facility failed to ensure accurate billing and timely refunds for a resident who was admitted and later discharged after a short stay. The resident’s family member requested a private room and paid $3,720 as requested by the facility, with the understanding that all other charges would be covered by Medicare and supplemental insurance. Despite this, the family member later received a bill for over $56,000, reflecting an erroneous charge for 484 days of private room care, when the actual stay was only 22 days. The family member contacted the facility multiple times regarding the excessive bill. Upon review, the Business Office Manager confirmed that a billing entry error had occurred, resulting in the resident being billed for far more days than were actually provided. Documentation showed that the bill was sent to collections for the unjustified amount. Eventually, a partial refund of $992 was issued to the resident. The facility’s admission agreement stated that overpayments would be refunded as soon as possible after insurance claims were verified and paid, but the refund was not provided in a timely manner.