By Jeffrey J. Downey, Attorney
Nursing home billing can be confusing, especially for families new to long-term care. Understanding the financial implications and how to address potential fraud and neglect is essential for managing costs and protecting your loved ones. Additionally, it’s crucial to be aware of your legal rights and seek compensation if your loved one has suffered personal injury or abuse while a resident of a nursing home or assisted living facility.
The Basics of Nursing Home Billing
If you are on Medicare, it provides limited coverage for nursing home care—up to 100 days after a three-day hospital stay and a referral for skilled care. Medicaid offers broader coverage but requires residents to meet specific income and asset criteria.
Private pay becomes the primary choice for those without these options, which can quickly lead to significant financial burdens. When transferred to a nursing home from a hospital, a social worker will typically explore your eligibility for transfer and qualifications for Medicare/Medicaid. It’s important to research the prior performance of the nursing homes that are recommended to make an informed choice. If a patient is on Medicaid and looking for long term placement in a nursing home, the choices are often limited and the facilities are usually poorly rated. Check out Nursing Home Compare on Medicare.gov for information about nursing homes.
Identifying and Addressing Nursing Home Neglect
If you have suffered injury due to nursing home neglect and you file a lawsuit, Medicare and/or Medicaid will seek to recover a lien for any medical bills they paid for treatment of your injuries. If you paid privately, you may be able to leverage a write off as part of a broader settlement of your claim.
Nursing home neglect can have serious consequences for residents, including physical, emotional, and financial harm. They can also cause increased charges, like hospital treatment for a pressure wound. Common signs of neglect include:
- Pressure Ulcers (Bed Sores)
- Unexplained Injuries
- Dehydration and Malnutrition
- Poor Hygiene
- Falls causing injury
- Untreated infections and sepsis
- Emotional Withdrawal or Depression
If neglect is suspected, document incidents with photos and notes, and consider reporting your concerns to the appropriate authorities, such as the local licensing authority. However, before you file a formal complaint, contact an experienced nursing home abuse lawyer like Jeffrey Downey, for a free consultation. Government agencies investigating nursing homes and assisted living facilities are often overburdened and may look for ways to deny a complaint without a full investigation. Having an attorney help you frame the complaint to support specific regulatory violations will increase the chance that your complaint is taken seriously.
Negotiating Nursing Home Bills Due to Neglect
When neglect occurs, families may face increased medical costs. Negotiating these bills is possible, especially with evidence of neglect. Here are the steps to follow:
- Gather Evidence: Collect documentation of neglect, including photos and medical records.
- Request an Itemized Bill: Identify discrepancies or unjust charges linked to neglect.
- Engage in Direct Communication: Contact the billing department with your concerns and request a reduction or waiver.
- Consult with an Attorney: If negotiations stall, an attorney can provide legal advice and help you navigate complex situations.
In some cases, the threat of legal action can motivate nursing homes to settle disputes out of court, protecting your financial interests and ensuring accountability.
Most patients without Medicare, Medicaid or health insurance will be hard pressed to afford a nursing home visit. In fact, unpaid medical expenses is one of the most common reasons that people file for bankruptcy.
Handling nursing home billing and addressing neglect can be challenging. Understanding your rights, recognizing signs of neglect, and documenting incidents are vital steps to mitigate costs and ensure your loved ones receive proper care. Consulting with a malpractice attorney specializing in nursing home neglect can strengthen your case and help you secure justice and compensation.
Understanding Medicare Fraud
Many larger nursing home changes have been prosecuted for nursing home billing fraud, which can involve up-coding, worthless services or billing for services that were never provided. All Medicare patients should review their Explanation of Benefit forms to see what Medicare is paying for. People who file complaints for Medicare fraud under the False Claims Act can get a share of the government’s recovery if the lawsuit is successful. If you have questions about Medicare fraud, call the law office of Jeffrey J. Downey for a free consultation.
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Handling cases in Virginia, Maryland and Washington D.C.
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Law Office of Jeffrey J. Downey
8300 Greensboro Drive, Suite 500
Mclean, VA 22102
Phone: 703-564-7318
Email: jdowney@jeffdowney.com
On the web at jeffdowney.com