Can a nursing home be sued for incorrectly filling out a Medicaid application? - AgingCare.com

Can a nursing home be sued for incorrectly filling out a Medicaid application?

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I thought that's what I understood from an elder law attorney my mom consulted with. Bad decisions were made, including allowing the nursing home to file for Medicaid when my dad's short-term rehab turned into long-term custodial care.
That was almost 3 years ago and we still haven't seen the application that was submitted, despite their claims that they gave Mom a copy of everything

..........VENTING TIME: This is the same group that claimed they'd given her a full financial statement; had to get that through an attorney and guess what? it was WRONG, left out 3 payments they received. VENTING TIME ENDED........

The attorney said something about the facility being liable since they gave themselves the responsibility of filing for Medicaid and then did nothing when questions surfaced. That's actually beyond what they're supposed to do, according to their own admission agreement.

I think seeing the submitted application would answer a question or two that has gone unanswered these past 2 years. If anyone has any idea how to do that, I'd appreciate it. At the time, the Medicaid contact person said to get the copy from the nursing home because she couldn't give out a copy of a State document. And of course the nursing home just changed the subject whenever it came up. I'm sure something wasn't right with that application!

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Thanks for the feedback all. That's my point exactly - we could've filed for Medicaid on our own but my mom was talked into allowing the NH to do it. Bad decision on her part, mistake on my part for not completing the online application and deferring her decision - I'll never forgive myself.

After this experience, I can't advocate enough home care for those eligible and thankfully Medicaid and Medicare are leaning in that direction. Medicaid (various State medical assistance programs) was a customer of the company I use to work for and I tend to think in terms of protecting it from misuse and waste, which I think is the case with my parents. My mom was in the hot seat; it was difficult to get her to let me shoulder some of the load when it came to my dad's care. But that didn't happen then so we only have now to work with.

I'm getting a second opinion from another elder law attorney. To be clear, I'm not looking for money and am not interested in simply hurling accusations; something wasn't done properly, my mom was left hanging by those who should've helped her and we both want it cleared up. To that end I've also reached out to various State offices so they can use our case to review their processes.
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Hi ravensdottir,

You said:

"The attorney said something about the facility being liable since they gave themselves the responsibility of filing for Medicaid and then did nothing when questions surfaced. That's actually beyond what they're supposed to do, according to their own admission agreement."

Like one person already said I've never heard of a NH taking on the responsibility of applying for Medicaid on behalf of a resident. My dad's NH guided me and was supportive but applying was my responsibility only. And while the facility may be liable for mistakes made in the application process I wouldn't think they are legally liable. However, I'm not an attorney so you should double check to see.

My dad was in a NH. I went through the Medicaid process. We had to pay the nursing home out of my dad's monthly income as well. The person we dealt with was the bookkeeper at the NH, Marie *rolls eyes*. And I discovered that at my dad's NH (and this may be true for other NH's) the right hand had no idea what the left hand was doing. We had to submit info to the social worker and then Marie *rolls eyes* would call and say we still needed to submit that info and we'd tell Marie *rolls eyes* that we had already submitted it to the person we were told to submit it to, go and find the social worker and get it from her. This happened over and over. It finally got to such a ridiculous point that when the NH needed something from us we'd tell them that we had already submitted it (when we hadn't) and we'd just let them chase their tails. In the end it never made any difference and my brother and I were exhausted. I thought caregiving was hard but having a loved one in a NH is a full-time job. In the beginning I was doing it all myself until I finally broke down and called my brother, sobbing. He had no idea what I had been going through and he jumped in immediately and took some of the burden off of my shoulders. Everything at that damned NH seemed so complicated and convoluted it was ridiculous, they had no idea what they were doing. Once my brother jumped on board we split the tasks. He would deal with the nursing home and I'd deal with all things medical concerning my dad. It worked out very well.

See if you can get someone to help you with all of this. A NH is a monster of inefficiency and will drive you to the brink of insanity.
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6County is spot-on with their answer!

2 years…well probably beyond statute of limitations for legal. 2 years gave family plenty of time to send a certified letter to the NH or their corporate office to get a copy of all the admissions documents & contracts. You can do this now but fully expect a research & copy fee for this. As an aside, if you have been the DPOA and now 2 years later sue the NH and it goes to court, you could well find your parent legally become a "ward of the state" with a state appointed guardian till the suit is settled as you did not do the required fiduciary duty required of a DPOA.

To paraphrase 6County…..the Medicaid application & it's required documentation is ultimately the responsibility (& therefore the liability) of the Medicaid applicant or their DPOA, MPOA or other assigned family member or friend. It is the applicant or their assigns who are the only ones who can get their SS, retirement, medical records, etc, not the NH. If something was omitted or underreported, it is up to the applicant or their assigns to correct or do whatever needed for compliance.
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Something sounds odd but in most cases, the only reason facilities assist in filling out Medicaid applications is if there is no one else to assist. Medicaid application is the responsibility of a spouse, family or Power of Attorney. There is privileged information the facility has no right to access, but I have seen social service staff assist a spouse submit information that was provided to them.
Medicaid's computers identify accounts associated with a Social Security number(s) including DMV records, banking and real estate and will be questioned about transfers to ensure they are legitimate. The alternative to applying for Medicaid is private pay which depending on the state or facility, could be anywhere from $4,000 to $7,000 + per month. No private facility can provide service without funding for very long without closing their doors. The Spousal impoverishment Act is in place to protect the spouse remaining at home and only requires your father qualify for Medicaid, allowing your mother to retain up to a certain level of assets. This act is in place to protect the spouse at home so they aren't left destitute but only allows of the home and one vehicle to be retained.Medicaid can and will place a lean on the property after the spouse eventually dies. There are other specifics but that's the general. Medicaid and the facility are bound by HIIPA laws protecting privacy and cannot release the information you discussed except to a legal power of attorney.
Remember, ultimately, it is the responsibility of the individual to file for Medicaid, not the facility, so in my opinion of suing the facility for assisting in filling out Medicaid application, it's not likely unless there is criminal intent. Medicaid verifies information and usually request additional information for any questionable deposits or disbursements before Medicaid is approved.
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