Complaint Investigation Report

Allegation: Staff billed resident for services not being rendered by staff.

On 10/30/2024, LPA L. Alexander interviewed Witness (W1). W1 stated that R1’s care plan increased from $15,000.00 to $20,000.00. W1 reported that they were billed for 30 days but only paid for 5 days, at approximately $6,000.00. W1 stated that facility only discussed points but never discussed the money.

On 10/31/2024, LPAs Alexander and Doidge interviewed Staff (S1, S2 and S3). S2 stated that R1’s Individualized Service Assessment dated 03/18/2024 totaled 324 points. S2 reported completing a reassessment on 08/06/2024, which resulted in 447 points. S2 explained that once the assessment is completed, the billing department calculates the rate. S2 stated they contacted W1 via email to discuss the new assessment and requested a care conference, but W1 did not respond. S3 reported that they complete resident billing each month. S3 explained that when a new assessment is completed, they enter the total points into the billing system, which calculates the updated rate. S3 stated that they attempted to explain the charges to W1 by phone, but W1 became upset and disconnected the call. S3 further reported that the Responsible Party (RP) removed R1 from the facility on 08/26/2024. S3 also stated: The August billing statement dated 07/18/2024 totaled $15,498.76. A new assessment completed on 08/22/2024 changed the rate to $353.13 per day. This rate applied to the period 08/22/2024 through 09/30/2024 (40 days). Adjustments were made to the account, resulting in a credit of ($6,654.96).

Based on interviews and records reviewed, the allegation that staff billed the resident for services not being rendered is unsubstantiated .