Failure to Disclose Charges for Non-Covered Services
Penalty
Summary
The facility failed to notify a resident and their representative of the specific charges for services not covered under their Medicare Managed Care or private pay agreements. Upon admission, the resident received information about daily room rates and a list of potentially chargeable services, but the actual costs for these services were not provided. Staff confirmed that only the daily room and board charges and beauty salon fees were reviewed with residents, and that costs for medical supplies or therapy were not disclosed. When the resident's insurance coverage ended, an Advance Beneficiary Notice of Non-coverage (ABN) was issued, indicating the resident would be responsible for a daily rate, but did not specify charges for additional services such as therapy or medical supplies. The resident and their financial representative believed all previously received services, including therapy, would continue under private pay, as no separate charges were communicated. However, therapy services were discontinued after insurance authorization ended, and the facility did not provide advance notice of separate charges for these services. Staff interviews confirmed that residents only received information about additional charges after incurring them, and that the ABN did not clarify what was included in the daily rate. This lack of transparency led to confusion and unmet expectations regarding the continuation and cost of services.