Delayed Refund of Resident Funds After Medicaid Approval and Death
Penalty
Summary
The facility failed to ensure that all refunds due to a resident representative were issued within 30 days of discharge, as required by policy and regulation. The resident involved was admitted on an unspecified date and later expired at the facility. The resident’s spouse reported by telephone that the facility owed her a refund of $1,546.00 and that she had not yet received it, stating that the facility kept giving her excuses. The Business Office Manager (BOM) confirmed that the resident was Medicaid pending and that the resident representative had been responsible for paying $1,500.00, which was to be refunded once Medicaid was approved, and that the resident ultimately owed no money to the facility once Medicaid coverage began. The BOM stated that refunds are processed by the corporate office, not the facility, and attributed the delay to turnover in the corporate office, with each new staff member restarting the process. The BOM acknowledged that the refund, documented on an invoice as a voucher paid amount of $1,546.00 with payment status listed as “Paid,” was not issued within the required timeframe. This deficiency centers on the facility’s failure to comply with its own refund policy, which required refunds to be issued within the timeframe mandated by federal and/or state law, resulting in a delayed refund to the deceased resident’s spouse despite ongoing communication and confirmation that no balance was owed for the resident’s stay once Medicaid coverage was in place.
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