Improper Use of Resident Personal Funds for Medicaid-Covered Services
Penalty
Summary
The facility failed to ensure that a resident's personal funds were not used to pay for items or services covered by Medicaid. According to the facility's Financial Responsibility Agreement and Medicaid guidelines, residents eligible for Medicaid should not be charged for medical or personal supplies routinely supplied to all residents, and their Personal Needs Allowance (PNA) should not be used for items or services paid for by Medicaid. Despite this, a resident who had been on Medicaid since admission had $1,086.20 deducted from her personal trust account for room and board, which should have been covered by Medicaid and her social security income. The resident's trust account was subsequently depleted, with no deposits made since her admission, and she did not receive her monthly PNA due to issues with social security checks not being delivered to the facility or the facility not being set as her payee. The business office manager confirmed that the resident's Medicaid and social security should have covered her room and board, and that the resident had not received her $60 monthly PNA for the past year. The deduction from the resident's trust account for room and board was made at the direction of her financial power of attorney, but this action was inconsistent with Medicaid regulations. The resident reported having no money for personal expenses, relying only on occasional bingo winnings or gifts from friends, and her trust account balance was reduced to one cent.