Failure to Timely Refund Discharged Resident's Positive Account Balance
Penalty
Summary
The facility failed to refund a positive account balance to a discharged resident or their representative within 30 days of discharge, as required by regulations. The resident, who had severe cognitive impairment due to Alzheimer's Disease and other medical conditions, was discharged home with Medicaid as the primary payor. Despite multiple requests from the resident's guardian and confirmation of the refund amount and address, the facility did not issue the refund in a timely manner. Facility staff acknowledged the existence of a positive balance in the resident's account and confirmed that the refund had not been processed. The business office staff indicated that their usual practice was to wait until all payor sources had paid before issuing refunds, and at the time of review, some claims remained open. The facility's own policy stated that refunds would be issued in accordance with state and federal guidelines, but this was not followed in this case.