Where can you report Assisted Living Billing Fraud and abuse of policy? We cannot afford an attorney. - AgingCare.com

Where can you report Assisted Living Billing Fraud and abuse of policy? We cannot afford an attorney.

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Mom has been living in a Brookdale Senior Living facility for over a year and it has been great. In December the AL facility added personal care services such as providing medication dispencing services (which required using thier pharmacy) and then they started adding one charge after another. The pharmacy's first month bill was six pages and they charged for individual pills ($1570) , which after many calls and complaints they adjusted the bill. This is what mom used to spend in a year. Last week mom was admitted to hospice. Yesterday when leaving the AL facility with the Hospice staff, the Brookdale nurse director pulled me aside and advised me that because mom is now under hospice care they would have to charge her for additional services as per thier policies (bathing, grooming, toiletry,dressing). None of these services have they provided, Mom has been and continues to do all of these tasks herself, hospice assised her with a bath yesterday for the first time she had help. After many complaints and charges that have been adjusted that where incorrect we have decided to move mom. I am filing complaints and will advise eveyone who will listen. This is greed and they are not forthcoming with thier service charges. January 31st I provided 30 days notice and stated mom would be out by March 1st as per the lease. Now Feb 22 they advise this is a short month and so I assume they are wanting to charge for two additional days. I have had several charges reversed in the past several months that where incorrect. How many people are these companies taking advantage of, who should or can I report this to. It is elder fraud and abuse and I am sure many have been taken advantage of that do not have a family member looking at these bills and charges in detail. . Thier pharmacy charged my mother for individual pills in December rather than 30 day supplies. RX services has taken advantage and made errors on bills which after my complaining they have credited and made corrections. I cannot afford an attorney so I fight all these battles myself. I am moving mom to another AL facility. Hospice has only been involved for the past week. I want to report the fraud and abuse of charges and billing errors that I have fought to get corrected to other families, so they are not overcharged by these companies. Loosing your mother is hard enough and being taken advantage of in this time is very upsetting. Any Suggestions. I have filed a complaint with the Assisted Living Corporate office, next I will write a comlaint to RX services. But will these comlaints be ignored? And yes after 6 years I have caregiver burnout....

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I'd contact your long-term care ombudsman. Go online to www.ltcombudsman.org and type in the zip code of the assisted living. You'll find a contact. This person is your representative. They are very knowledgeable and should be able to give you some guidance.
Carol
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Reply to Carol Bradley Bursack
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Sacline - Well it's great that your are moving your mom to another facility. Regarding "fraud", whether or not fraud can be found to be occurring will depend on a # of factors. I have dealt with a Stark Law complaint with providers & facility - it's still in discovery so I can't go into details but here are things I have found:

1. How the facility or the provider is being paid will be #1 for importance:
1 a. If the service was being paid via MediCARE, then you can go on-line to the CMS site, to file a complaint. Now in order to do so effectively you have to have specific documentation as to procedure, date, etc. CMS (which is Centers for Medicare & Medicaid) really does look at these complaints filed. CMS has an outside vendor - HMS - who does fraud and compliance and they are very, very good at this and have algorithms that match up complaints to providers and patterns of fraud. It is not a quick process but if fraud is found, you can pretty well be assured that someone is going to jail on federal charges. Hospice is a MediCARE paid entitlement so CMS can get involved for the parts of care that they paid for. If you have the documentation to provide to CMS, they will send a detailed questionnaire to the facility and it easily will take them days to submit the information required (not requested but required) or they will be put on the CMS naughty list.

1 b. If the service was being paid for by MedicAID, then you can contact the local ombudsman within your local Area on Aging and they usually in turn will contact the Medicaid compliance section of state government that does Medicaid. Most AL is not paid for by Medicaid, BUT if your mom's was, then you can do this. Then like for CMS, they will get a detailed questionnaire, etc.

1. c Now if the services were private pay, then it's going to be harder to prove "fraud". If it's private pay, then whatever the contract that your mom or you or whomever signed her into the AL will determine what the AL can charge for and how. So if their "advance notification" is 1 month or 30 days or whatever will be determined by the contract between you and the AL. It will not be written to your benefit either. One person's greed may well be another person's profit margin. AL is usually private pay and so realistically the only way to sue will be by having an attorney do so for you.

1. d. If the service was being paid for by a health care insurer. If say Blue Cross Blue Shield paid for stuff, and you have a papertrail to provide to them, they will do their own investigation. It seems that they will do a clawback on all amounts paid for everything for the insuree's stay @ the facility, while the investigation is going on too, which really pisses off the facility. So you want to make sure that mom has moved before your do this.

2. Most IL & AL have a residents council, which is a forum for you to present your complaint. By & large, I have found these are toothless with anything medical but are good for community issues (like residents who take stuff or do inappropriate things). There should be a bulletin board with info on the council posted.

Regarding AL's, most are private pay and are for profit. Doing a 30 day blister pack for prescriptions may be cheaper and more efficient, but the AL does not need to do run med's this way. If they want to have a contract with a pharmacist to do an in-house pharmacy who's rates are not competitive with what WalMart or Target charges for med's, the AL can do this. If the pharmacy want to charge $ 50 for a 30 supply of .81 mg baby aspirin, (that you could buy for $ 2.00) they can. If the AL wants to hire an outside physical therapist to work with residents who charges more than Medicaid or Medicare would ever pay for, the AL can do this. Their ability to do this - and usually at-will - should be in the contract. When my mom was in IL, the IL went from no charge for car parking space for residents who still had a car to charging $ 100 a month for "space". A 30 day notice was enclosed in my mom's bill and that was that. If you didn't like it, then either you got rid of the car or moved.

How med's or services are run in a NH is totally different than an IL or AL, as most NH have Medicaid and Medicare paid residents and the NH have to watch costs as their reinbursement is set on state & federal reimbursement rates and not negotiable. So no $ 50 baby aspirin. And the NH is subject to lots more review by the feds and the state. Personally, if at all possible I would look into having your mom in a NH rather than an AL if it seems she is going to need alot of care, medications, services etc. Even if that means doing a spend-down to get her financially qualified for Medicaid and working with non AL physicians to get her medically qualified for a NH. I moved my mom from IL to a NH (without her being hospitalized before the move to NH). It can be done but you kinda have to be creative to do this. What I have found is that most AL are free standing private pay facilities without an adjacent NH, so they want & need your parent to stay there forever on private pay. Good luck.
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Reply to igloo572
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Just saw this and hope it's not moot, but, as a Hospice RN I am shocked that your bills went up. The Medicare Hospice Benefit includes all medications related to the terminal illness, supplies (such as gloves, incontinent supplies, dressings), Durable Medical Equipment, and a Nurse's Aid (that deal with assistance in Activities of Daily Living such as bathing), among the many other services. These that I have outlined should cause a DECREASE in your costs.
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Reply to GAHospiceRN
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Assisted Living places are just money hungry that will take in nursing home patients, if they can get enough money, or need to fill their "census". Care be damned and "hey, lets run a shift with 2 non licensed workers, and 53 residents. Don't worry about them not getting their meds. Most can't remember anyways"! Oh yeah, but they need to beware of Nanny Cams and resident's children who are medical professionals! Gotchha!
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Reply to DaddyNurseGuy
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I am just starting to discuss final billing with Brookdale Senior Living. My mom was placed under Brookdale Hospice in September, 2015 for "suspected" cancer based on pain complaints. In January, the Brookdale facility nurse and hospice nurse insisted that mom had to move from Independent Living to AL, over her objections. I felt if we didn't move her, they would insist she move to another facility. She was in AL beginning February 1 and dead March 6, one week after the six month hospice Medicare period expired. We tried to have personalized living services provided in IL, but they were very unreliable. I think now Brookdale didn't want that as an option. They wanted her in AL so that she wasn't going to breakfast or lunch with friends, so they could control her meds. Financially, I discovered $5400 in overpayments that weren't credited to her in any of her records. I found them by examining her checkbook. She didn't receive invoices in January or February for her December or January personalized living services in Ind L, so I'm waiting for her final bill with no way to dispute any of those charges. I assume they will bill her for supplies, services, for which Medicare paid hospice and we will have no way of knowing. Do NOT place your beloved senior parents in a Brookdale facility.
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Reply to Dotter
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We had mom at Brookdale Basset Park adult home and it was a great place. The head nurse was a great guy. The billing maven was always ready to answer questions. We did use their pharmacy and they controlled all meds per NYS law. If your complaints are not answered, complain to your state office of long term care, most have an 800 number to call.
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Reply to pamstegma
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Don't place yourself or your loved one in a care facility which is publicly traded on the NY Stock Exchange. Profits, not their residents, not their employees, are what count to the corporate heads and their investors. Its just the nature of capitalism.
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Reply to KevinBHudson
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I have had the same experience as soon as my mom went on hospice all the rates went up expect the services stayed the same good luck
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Reply to trunner0
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I'm getting bills from Brookdale Senior Living with unforeseen & unexpected additional expenses... Dealing with a $9000+ with no explanation of what these extra expenses are for! Waiting for a Call Back now... Are they needlessly "Trying to Piss their Customers Off" or What? I'll keep you posted :p
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Reply to Ronman20
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Sandra, first, contact the Admins (see the "contact us" link at the bottom of the page) and ask to have your name deleted. Not only is it unwise generally to provide personal information, it's especially unwise because of the allegations you're making and the advice you're seeking.

I doubt that admins of ALs facilities read threads on this forum, but if one or someone who knows you and your mother should read the post and advise the admins at the AL facility your mother is in, you could be considered to be making slanderous libelous statements.

Second, your situation involves more than a few factors, and I'm only addressing one now. You write of concerns for others in similar situations, and ask about remedies.

I don't know if this particular statute has been amended or is still in effect, but there used to be a process called qui tam litigation. An individual can sue on behalf of her/himself as well as the federal government, assuming federal funds are involved. (That would have to be determined for this particular facility.)

If successful, the individual receives a portion of the monetary damages against the facility.

Being a qui tam plaintiff is not easy though; you're really sticking your neck out, as would a whistleblower who could sue under the qui tam statute.

On a second issue, I would research local district and circuit court indices (which sometimes can be done online) to find out if there are existing or previous lawsuits against this facility.

I would also contact the local ombudsperson and ask for his/her assistance. If you tackle a corporate entity, it helps to have some "big guns" on your side.
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Reply to GardenArtist
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