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

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

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

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.

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.

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!

Similar experience with my mother at Brookdale. Don't send your aging family member there.

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.

I had a friend who worked at Brookdale AL as an aide, and also took training to dispense medications. She quit after 3 months, she said it was very badly run, too few workers, jobs eliminated and combined, not enough time to devote to patients who needed, for example, help with bathing and dressing in the morning, it was runrunrunrunrun. Very badly run place, she was disgusted and fed up.

I'm just curious; where is this Brookdale located?

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.

Same Experience with Brookdale Pinecrest in Largo FL. The bill quickly goes from $4200 mo to $6900 due to Ala Carte billing. Received a $2800 bill for pharmacy (for 2 months with the current month being $952. Took that bill to CVS (where all prescriptions were filled for past 5 years) and they priced everything out to $198.

I'd take this to the state attorney general's office. They could direct you from there. If fraud is going on you shouldn't need to hire an attorney. Your state should want to know.

We'd love to hear how this goes.
Take care,
Carol

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

Ronman20

They're trying to make a lot of money. Do you have the agreement you or your loved one signed?

Oh my !! After my mother was placed on hospice , I too was informed there would be a minimum 1500.00/mo increase in charges to begin immediately. Not a chance! I will expose them for the greedy frauds they are.. We are already paying over 4700.00/ mo !!! I was suspect of fraud before,and certain of it now.

I will report them to every agency medicare , and area on aging local organization, Does anyone have any other places I should add to that list to report Brookdale to?? This is not right to do to elderly people in their last days of life , nor the families, it is time this gets more attention and some agency steps up to oversee and prevent such a despicable corruption.This type of fraud has become rampant throughout Pa. and probably the entire US.

Assisted Living Elder Abuse! Please Help!
On November 22, 2016, the director of an assisted living institution placed me under threat of being thrown in jail if I should come to visit my mother within their building. Because of calls made from my mother’s emergency pendant being ignored, I asked the director for a copy of my mother’s entire records. The director of the assisted living institution informed me that I only had rights to her medical records. And the director of the assisted living institution stated that she instructs the residents to use their telephone when their emergency call pendants do not gain a response due to the institution being under staffed.
The probable need of the director to protect those records from being seen by me led her to call the police to have me removed from the building two days before Thanksgiving. The director and the head nurse came with the police to my mother’s room and in her presence, began to interrogate and threaten me into submission. The situation has frightened my heart and lung patient 86-year-old frail mother into being afraid to sleep. She tells me that she cannot sleep because she fears what type of threats of physical dangers might come into to her room.
Initially, friction began when I acquired evidence that may indicate the corporation as being involved with what I call, “Creative Billing.” “Creative Billing” includes billing for services not rendered, double billing, and refunds which later become debts. A major prosecuting attorney’s assistant stated that they could not take the case because it only affected one person. I wondered about that answer then, and wonder about it now. If the corporation would show blatant billing issues on my mother’s bill, how many insurance companies and residents are suffering from the same possible financial fraud treatment throughout the United States?
Why would the director of an assisted living institution feel that it is not abusive to have the police brought to one of their resident's rooms to arrest her child for asking for her mother’s records? The records were being requested because calls sent from the resident's emergency call pendant were answered after hours of waiting or not at all. These pendants are used to indicate when a person may be having any type of medical emergency. How many people can find and dial a phone while having a deadly attack of some sort?
Can anyone help me with these types of abuses because one day any one of us could find that he or she needs the services rendered by institutions for the disabled and the elderly. Would you want your life’s savings drained for services that you do not receive while watching your child being threatened jail time for fighting for your rights as a breathing human being?
Sandra Speer
PS: Please share this statement, feel free to contact me directly, or just help me find assistance. Anything that anyone does to help me with this horribly abusive occurrence within an assisted living institution will be appreciated more than anyone could ever imagine!

Throughout the US. Be careful, sometimes Brookdale isnot always
in the name. Do not move in to any of them. They are horrible.

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.

I appreciate all the great advise. But as far as I know, my document gives no indication of what facility I am speaking of.
And if a facility does threaten me with slander, they are admitting to either having similar problems or that they are the institution that I am referring to.

Again, thank you for the response.

Sandra Speer

BEWARE OF BRIGHTEN GARDENS/SUNRISE SENIOR LIVING OR ANYONE OPERATING UNDER PRIME CARE ONE OR PRIME CARE TWO!!!!!!!! They had ONE Doc who makes "rounds" one day a week, but it took me FOUR MONTHS to get ANYONE to sign off on my mother's release forms to move to State Facility- I refinanced my home so many times I may now lose it!!!!!!!!!!!!! They LITERALLY HELD HER HOSTAGE FOR FOUR ADDITIONAL MONTHS WHICH I TOLD THEM I COULD NO LONGER AFFORD!!!!!!!Now they DOUBLE the amount for those 4 months and filed a lien against my house too.........

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.

Do not put your loved one in a Brookdale facility.....my mother was there for two years and I was continually upset about many things.....stealing, over $400 in Christmas presents and personal items, they did nothing about. You would think they were trying to starve the residents with the portions of food served but I watched the platefuls the the help ate. We had old neighbors enter the facility and knock on her door at 2 and 4am in the morning ( we had serious issues with her neighbors before she sold the house) they were able to enter the facility and harass her, using their doorbell ringer on their phone against her door at 4a.m. , I was able to stay with her in her independent living apartment, never eating their food, bringing in my own and food for mom. Brookdale had no one in charge of security and they ignored our issues with harassment from neighbors entering the building. They have billed mom for extra $8500 after she left and billed her for $5000 leaving early. There was mold on the wall where air entering unit, we did not notice it until she moved out and I reported it to the city. I do not know what the $8500 covers but think they are billing her for mold removal. I need help to go after Brookdale for the $8500 they helped themselves to. Mom moved to memory care and has just passed, I have not had the time to attend to this but have been told I need to go after this immediately. suggestions????? Brookdale is just a money hungry facility with twenty year olds doing the work that CNAs should be doing.

When using their own pharmacy that pharmacy should work with Moms insurance. Also, when hospice is involved I would think that some of the care costs go down. Hospice usually have their own aides.