My cousin died in December 2020. We received a notice from FSSA with an Estate Recovery Specialist saying we owed $82,232.59 for services he received from Medicaid. The charges are from November 2013-December 2020. They only include the provider name, etc from November 2013-June 6, 2014. From July 2014-December 2020 all the rest are labeled CAP. The amount billed is always $0 and amount paid can range from hundred's to thousand's of dollars. There are many months that can have up to 7 charges made on the same day with all being billed $0. Example billed on November 1, 2016 billed $0 and being paid $1,188.00 in April 16, 2018
We have been told we have to go to the insurance provider (Anthem) to get EOB but they have said they do not know what we are talking about but will request these are sent. This has been going on since February, 2020 and we still can't get an answer.
The thing is my cousin only went to the DR very rarely, if ever, because he did not believe in Dr's. Also he never took prescription as he felt he could "self treat" with vitamins. He was never in a nursing home or had home health care or any long term health care.
We are willing to pay what is owed but we feel that since no one will give us an EOB that something is not correct. All we want is answers. We are considering turning this over to the AG but know this could take years to come to a conclusion.
Our estate attorney can only say just pay or send to AG. We did contact an estate attorney that has experience with Medicaid and he looked at the paper work and even called Anthem but he said they would not even talk to him.
Thank you for your time...any suggestions are appreciated!
So there is a case file existing and open in probate court (PC), rite?
This atty did and placed the NOC (Notice to Creditors), right? Then that claim or claims need to be validated in some way. Like you want documentation of each & every year cousins or his POA signature on his application or renewal in a Medicaid program that has MERP attached to it.
One issue w probate claims is that there are unscrupulous biz who troll PC and file smallish claims, like for property maintenance, against the estate and the atty or executor does not ask for documentation as to fact on the claim. So it’s gets viewed as valid, even tho it’s not. Those are easy to ferret out.
But Medicaid- as it’s such a huge program and do no real time billing / invoice to those that get services, like what JoAnn wrote - is hard to pin down as to exactly what paid unless it’s LTC Medicaid NH daily room & board charges. But the info is there and the state is required to provide this info in detail under however state has PC / debtor rules & regs.
Medicaid as in state employees likely does not actually do estate recovery for most states…. It’s an outside contractor who does it under state contract and get a fee for administration AND % of recovery. Kinda like what debt collection outfits do. So is it FFSA aka Be Well Indiana actually doing the attempt at debt collection? or is it a special division of the State? Or an outside contractor? It’s IMO kinda important as if it’s an outside contractor, they have to get the state to actually provide the info needed to do the initial NOI (Notice of Intent) to file a claim / lien and then they take that info to do a filing. There is a time lag and with Covid it’s even more convoluted and more opportunities for input to be incorrect.
IMO That atty of yours need to get off their duff and do a Validation of Debt 30 day demand letter if they didn’t do one. If you are named executor, so like you have Letters Testamentary stating you are the executor and it’s an independent administration, you too can do one as well. I’m not an atty but have been executor x 3 and the laws, rules and regulations of PC are really important as to what can happen. Normally claims get time barred for filling based on when NOC were published. So as a first I’d look to see if MERP filed a claim properly & in time…. This you find by looking at the docket report in PC. PC is pretty much all public records, except for minor / incapacitated guardianship hearings, so you can pay a fee and get everything filed. If u don’t have the full docket report and all items filed as per each docket entry, you need to have this.
How was the house sold?
Like sold via a Realtor / open market sale? Not sold to heirs?
Was a title search done? If so, no claim or lien found, right?
OR
was title transferred internally to another family member…. if this was done, who was atty who did the paperwork on this? and notarized documents? and did the filings at the courthouse? Did PC judge need to sign off on allowing the sale & did?
$ was paid to estate from house sale, right? So besides MERP are there other claims? Is Executor filing their own claim(s) as to costs to manage estate? If not, atty needs to ASAP show you how to do this and for every cent, mileage done. Whomever paid funeral cost needs to file claim too. Any $ paid for cousins house upkeep by family too needs to be filed as claim(s). Are you a Level of Claim state for paying claims? If so what is MERPs “standing”? Did any of the heirs able file one of the many exclusions and exemptions to MERP & did atty do this? Stuff like this should have been discussed by atty with you / Executor.
I’m guessing atty kinda clueless & never dealt with MERP, is accurate?
It can be dealt with. Just what depends…. Does your PC do “in chambers” meetings?
Thanks for you feedback!
His father left him his house when he passed in 2003 so yes he had assets. I am sure he is one of the .001% on Medicaid that meets their requirements of over 55, single, no children. So I guess they need someone to pay for everyone else.
He was never in a Nursing Home, or had Home Health care or even meals on wheels, he would never let anyone do anything for him. He did not believe in Dr's or medicine so went very few times in the 7 years. That is the part that is suspicious. He, however, had hundreds of dollars every month for vitamins.
Went to FSSA twice and first time they said they didn't know what this was but would give to supervisor. Second time they said get a lawyer. We tried but to no avail.
No one, not even Anthem, which was his provider, will give us any information. Have called at least 6-7 times since February and they keep saying "they will request" but have never received anything from them.
Again all we want is an explanation of benefits because there is no way Medicaid paid $82K out. Our estate lawyer says pay it, or go to the AG which could take years! I really think it is a shame that his parents worked all their life for the "American Dream to own a House" for this to happen. And the worse part is he never had a clue this was going to happen with numerous discussions with him.
Why will no one give us a EOB? That is all we are asking is proof what and who they paid. Someone got the money? I don't think anyone would just get a bill for $82K with no explanation and pay it?
Again thank you for all your advice. We are getting desperate for some answers.
If you were on Medicaid prior to the date, you were grandfathered in and MERP could not happen. There actually are folks who are long term disabled & on Medicaid prior to DRA, so no MERP. Although the states or the outside contractor seem to file MERP NOIs to anyone who dies & was on Medicaid. Truly it falls to family or an atty who truly know Medicaid regs, to go after this exclusion to MERP. But if they applied for a new Medicaid program after DRA, they are subject to MERP rules. If your brother possibly was on a program for eons, pre Indiana DRA, he might fall into that grandfathered category. It’s something to look into.
Again, whomever in the family who paid a penny on funeral, property maintenance, atty fees, xeroxing, mailing a letter, buying a light bulb for the front porch, needs to pull those receipts together and file a claim in probate to be paid from the $ the estate has from the house sale. If Indiana allows for executor you bill time or bill based on % of assets, Executor needs to do that.
MERP is an unsecured creditor for probate. There is no reason why you, your family cannot themselves become creditors for probate as well. Just sayin’…..
You are getting the letters, calls, etc as MERP is hoping to find someone in his family or an heir to his estate as per his will to do what is needed to settle his estate and sell assets so MERP can try to get 82k.
lots of folks die with no estate, or their estate is a barely enough to cover funeral costs, for those there is no recovery as no estate.
If they were on LTC Medicaid (so they were a resident of a facility like a NH which Medicaid paid for), the could have at the most 2k in assets and a home (as a home remains an exempt asset during their lifetime but becomes an asset of their estate after death).
If he was any type of community based Medicaid programs, like he went to a PACE center or he had Medicaid as his secondary insurance, he could have more assets plus a home, car, land. If he wasn’t in a facility, then he was enrolled in some sort of community based Medicaid program back in 2013.
The community based stuff is sticky as often it is beyond not clear that estate recovery is part of the program. If he was low income,, he might have gotten enrolled on Medicaid as an offshoot of his getting SNAP or getting on a transportation service paid by the city / county. For NH admits, the application is several pages and has it - usually in a box on its own page - it’s pretty upfront. But community programs run a huge gamut. So….. Has the state provide you with documentation from 2013 and every year after showing his signature (or his dPOA is he was unable to sign) to enroll in a program AND the detailed information as to Indiana MERP system attached to his becoming enrolled in the specific program? If not, I’d like manana do a demand letter asking for this documentation of his enrollment with MERP requirements with his signature for each and every year since 2013 to be provide to you within 30 days. You are basically asking for a validation of debt. Send it certified mail with the return registered card. I bet they will only have info on 2018, 2019.
so when your cousin died in Dec, 2020, did he die with any assets that would / could / should become his estate?
Like he died owning a home, a car, a life insurance policy that had his estate as the beneficiary (not you as a beneficiary but his estate)?
If he did die owning assets. what is the status of those assets right now….. like was probate opened and a Notice to Creditors posted; was the house / car sold and if so how was the title transferred & to whomever and where did $ from the Act of Sale go?
It seems no one wants to talk now that we the hard questions are being asked, like proof.
I know I can do a hearing but how can you win with no proof of money spent because no one will provide it.
To me it doesn't matter what Medicaid is billing for. Family is not responsible for your cousins debt. Medicaid has to try and recoup what they put out. All you need to prove is he has no money. And if he does have money, once his bills are paid, the balance can go to Medicaid. Doesn't seem your lawyer knows how Medicaid works.
FAMILY IS NOT RESPONSIBLE!
If there is a problem with the billing, thats for Medicaid to figure out. Maybe someone made a mistake somewhere in the acct# and cousins acct was being billed in error. Not ur problem. This is the problem with Medicaid, the person covered gets no statements.
Please note that it is THE ESTATE that may owe these monies, not you personally.
Can the FSSA agent tell you what Medicaid was billing for?
Have you contacted the FSSA office directly?
https://www.in.gov/fssa/ompp/medicaid-estate-recovery/
He was alone for the last 7 years and my parents were the only one he would let in the house, and he only called them to take him to ER 3X in 7 years.
Could it be because he had a house that Medicaid is taking advantage of the situation?