Q: I have documentation that some nursing homes if not all do not refund to the residents, overpayments of their private
pay for room and board and nursing services when admitted to a hospital, 3 days or longer, or in an associated Rehabilitation medical facility which is paid by Medicare. In other words, Medicare and or Medicaid pay for the resident's room and board and other covered services by Medicare paid medical and rehab services while the resident is away from the nursing home. The nursing home gets paid by both Medicare and the nursing home resident for the same room and board and services. This is an abomination, especially when the resident was admitted to the hospital with a serious medical condition due to the negligence and malpractice of the nursing home. Is this called Medicare fraud, or Medicaid fraud, or both?
A: Sounds like both. You may need to report this to both agencies.
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