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I was trying to sign my Mom up for Medicaid, and found out the the Nursing home did already almost 2 years ago. OIG is wanting to do a 5 year look back because I called. She never qualified before now. What do I do? Apparently Medicaid has been paying her bill in full under fraudulent terms and an illegal application since I am her POA and Guardian. Do I reapply, or do the 5 year look back. Do I let the Fraudulent one lapse, or give OIG bank statements that will just show that she didn't financially qualify? I am at such a loss. Also, can the Nursing home kick her out if she has attorney bills to pay from a divorce? She was married to a man that had a lot of money. They knew this, but signed her up anyways because he was refusing to pay them. I just don't know what to do and I can't seem to find anyone to help answer my questions.

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LovingPOA,
Thanks for updating us below. So few return to do that, and it is so appreciated. Know that what you learn on your long and difficult journey can greatly benefit others who come here for help, and we would more than welcome you to stay on Forum when you have any extra time.
Good luck.
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Oh I see why the Post office is involved, they opened her mail without written consent. Actually when someone enters a care facility, that facility is now their home so it should be their legal address. With my Mom, the Medicaid paperwork needed to go to the NH and I gave permission for the NH to open that info. Mom still had a house so I did not do a change of address. I needed the bills to go to her home so I could pay them.

Seems to me from your responses, this NH treated Mom like she had no family. They should have realized that someone would find out. I feel for the employee because they probably just did what theyvwere told to do. I hope that Medicaid fines them big time and can get your money back for you. I hope they are not excepting any Medicaid applications coming from the NH directly.

So wish you good luck.
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Sorry we haven't been able to help but your situation is very complex. It will take a lawyer and Medicaid to figure out what is going on. I too hope Mom got something in this divorce. By DH not being willing to pay for her care, he sort of abandoned her. I don't know why they felt you were not the next person to contact.

Would love for you to update us on how this works out, we learn from others.
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LovingPOA Apr 2023
I will definitely keep everyone updated. Sorry I have been so quiet lately. I have an upcoming OIG court date, and have been dealing with the Federal Postal Police and FBI Fraud department, along with numerous other departments. It is absolute chaos, and I can't find an attorney to help me.

Medicaid is helping, but pressing charges has proven to be very time consuming and financially horrible.

Thanks for everyone's support!
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Wow this is a big mess. Does mom still have assets after the divorce? She is probably going to have to pay back medicaid for the money they shelled out while hubby was not paying her bill. Or maybe the nursing home will since it was fraudulent. I would do my best to make sure that they get in major trouble for that! Whoever did that should be fired and maybe even put in jail!

I assume she has $ still and I would use it to start self pay elsewhere. There is no sense in trying to qualify for medicaid when you know she won't at this time.

Good luck!
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LovingPOA Apr 2023
She has no funding, which is how I found out the Medicaid because I tried to apply for her. There are pending cases now with all of the correct departments. We got lucky because an employee signed her up. Not us as her POAs and Guardians. We got lucky to get our hands on those papers before they disappeared too.
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Contact medicaid (same as medicare contact) and report this fraudulent claim. The Medicare people can open a fraud complaint
Let them know what proof you have.
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LovingPOA Apr 2023
I need to post the number of departments to call for all of this kind of stuff. I did not know there were so many people to report to. It's a long list. Once I get done with my first preliminary hearing next week, I will post some helpful information for everyone.
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Sorry, this is too messed up for us to give you any ideas. You need an Elder Lawyer well versed in Medicaid law.

From conversations we have had on this forum, I don't understand how the NH was able to accomplish what they did. There is a lot of info needed by Medicaid before the application can be finalized. 5 year look back is one. How were they able to get this info. Proof she has no money. Her monthly income can't be higher than the cap. Husband would need to sign that he is not financially responsible for her care.

Really sorry, but there is too much going on here for us to help. Each State Medicaid is different. Each persons finances are different.
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NeedHelpWithMom Mar 2023
It does sound awfully complicated and confusing.
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It sounds as though you believed Mom was being cared for, for free? You weren't paying the bills, were you?

When my mother was placed at a nursing home, I was very pregnant and traumatized. I never had a money conversation except that I was told the Nursing Home was taking care of everything. I am eternally grateful that they lifted the burden off me. Eternally grateful.
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LovingPOA Apr 2023
The NH has been double billing. I pay for a Long Term Care insurance policy on her. I was getting those receipts because it is a plan that I provided to them. They were collecting over $7,000.00 per month from that policy, and then applied for Medicaid on top of that and collecting another $6,000.00 from them, on a Private room. Yesterday I just found out that they were also billing for Physical Therapy visit through a BCBS BCCHP plan they signed her up for, and she is completely immobile and incontinent. They are actually reporting that she is walking in the NH Physical Therapy department. I about fell over when I got those bills. I was on the phone with more Fraud cases today. I have never in my life thought that one NH and Managment would ever do something so criminal in my life to a woman that has the onset of Dememtia. Talk about a Hot Mess.
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Have you contacted the Ombudsman for the Nursing Home about the Medicaid issue?

Have you checked with the Surrogate's Court to see if your guardianship is in effect? Or has the Nursing Home been granted guardianship?
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LovingPOA Mar 2023
They have not filed for Guardianship. We have the State filed Papers. We are the State Filed Durable POAs, Healthcare POAs, and Guardians. That is why there is an open Fraud case going on.

The Ombudsman is new to her position, so she can only answer so many questions.
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I suspect that the NH has filed for guardianship in court and it has been awarded.
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Frebrowser Mar 2023
That would answer a number of questions.

Irregular admission paperwork, so maybe no copy of POA on file, and a spouse that won’t pay the bill.

But wouldn’t the new guardian have gathered control of the income and assets that the (old?) POA has been using to pay legal bills?
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I just replied back under your response to me. I’m so sorry that you are going through this mess.
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LovingPOA Mar 2023
Thank you so much. I'm so frustrated and angry at this facility. I tried to get them to help me and answer some questions, and their Corporate Legal team sent me an email that they have nothing to say to me.
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Have you spoken to the nursing home about why they made this decision without discussing it with you first?

Or a better idea is to have an attorney communicate with them about it.

Good luck with resolving this matter.
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LovingPOA Mar 2023
I tried to talk to them. Their Legal Team at Corporate sent me an email stating that they did not have anything to say to me.

It took more 4 months, $10,000.00 in attorney fees, and the Illinois State Ombusdmen to even get her medical records, because they found out their computer program had a safety net, and all of their records that they thought they had deleted were still able to be retrieved.

Now as her Healthcare POA they won't even communicate with me, and I can't get another facility to take her because I'm literally in limbo with her Medicaid. I'm sorry for the long rant. I really just don't know what to do.
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That is a mess.

You need to consult with a Medicaid expert in your state. Explain why you believe she wouldn’t qualify then but should now, what you thought was happening with the billing for the two years, and give them a copy of the nursing home contract and their Medicaid application if possible. You signed the contract as POA, so you should have a copy, right?

You should also gather records for the last five years, maybe seven if salvaging the old application might be a good idea.

The nursing home won’t want to keep her if the bill isn’t being paid. If they can’t kick her out, they’ll look for a reason to send her to the ER and refuse to take her back.

Once she is on Medicaid, almost all of her income will go to pay for her care, except for a small personal needs amount for discretionary spending. Nothing will be available for house bills if she is in facility care.
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LovingPOA Mar 2023
OIG knows that she doesn't qualify, and no, the facility didn't have me sign her application because they were in lockdown because of Covid. I have the original application and it says that my Mom is Married and that she is a Private Pay. OIG isn't concerned about the Fraud in this department. Someone else is looking into that mess, but why do the look back when I know that she is just going to get denied. When her and her ex husband got divorced 4 months ago, they were still bringing in over $8,000,00 a month from Social Security and their Pension accounts, and he had over $500,000.00 is 401Ks, Pensions, Stocks, etc.

I'm not sure why I need to do the 5 year look back when I can give them all of this information showing that they illegally signed her up. The insurance Medicaid care plan coordinator even filed fraud charges against them. I just don't understand or know what to do.
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Is your Mom suffering from dementia? Because if she is not, but told the Nursing Home that she has no money left, they could well easily help her apply for Medicaid. And those funds may go directly to her Nursing Home. Go into the administration office and find out what has been happening and for how long, and let them know your Mom DOES have assets, I am thinking.

You might want to pass this whole thing past an elder law attorney first to see what he or she advises. This could be a mess, however it happened.

I wish you luck. I hope you will return and update us about exactly what happened and exactly what Medicaid will now want you to do to rectify the situation.
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LovingPOA Mar 2023
She was deemed unable to make an Financial, Legal, or Medical decisions by a doctor, 3 years after the POA documents were done, and the facility was aware of this also. The Administrator of the Nursing Home knew that my Mom was married, and did not qualify for Medicaid, but got tired of fighting her husband for her Private Pay Room Rate. The Admin. signed my Mother up leaving all of her Admin information on the application that my Mom didn't sign. They have admitted to the Police that they have been illegally opening all of my Mom's mail and shredding all EOBs and Insurance cards, so I never found out that she was on Medicaid.

It's been an absolute nightmare. I have all the proof, but why do the 5 year look back? I know that she isn't going to qualify because of her husband's income. But she put on the application the My Mom was Never married, never owned a home, hadn't filed taxes in 5 years, and didn't own a vehicle. All of which was completely untrue, and have email back and forth about Mom's Long Term Care insurance and no payments from her husband. I even asked them once about Medicaid qualifications once they got divorced and they said that we could discuss how to get her signed up them. SHE ALREADY WAS. Now I can't move her and OIG is wanting a 5 year look back. She isn't going to qualify, and I never signed a single document, and neither did my Mom.

Do I just tell OIG there's no reason for the financial look back and apply from the date her divorce was finalized, or what? It's such a mess.
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