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PROBLEMATIC BILL FROM SENIOR CARE FACILITY

Dear Consumer Ed:

I live in a senior care facility. They are attempting to make me pay for services that I did not receive. What recourse do I have?

Consumer Ed says:

If you have been unable to resolve the billing dispute with your senior care facility verbally, the next step is to write a letter stating your complaint. Sometimes businesses are more responsive to letters, and a written letter offers a paper trail if your issue does end up going to litigation later. Sample complaint letters are available online at the Attorney General’s Consumer Protection Division website.

If, after receiving your letter, the facility still refuses to correct the issue, there are a number of avenues you can pursue to try to resolve the situation:

  • First, you may want to contact the Georgia Long Term Care Ombudsman’s office, which is tasked with providing advocacy and informal resolution of concerns of residents in long-term care facilities.
  • You can also file a complaint with the Georgia Attorney General’s Consumer Protection Division and with the Better Business Bureau.
  • If you are on Medicaid and believe that the facility is billing for services or medication that they did not provide or which you did not need, or if you believe they are double-billing or over-billing, you should report the incident to the Georgia Attorney General’s Medicaid Fraud Division by calling (404) 458-2878,  664 or by emailing report_medicaid_fraud@law.ga.gov.
  • Long term-care is generally not covered by Medicare, but Medicare Part A (Hospital Insurance) will cover skilled nursing care on a short-term basis if certain conditions If Medicare is covering all or a portion of the care you are receiving and you believe the facility is billing for services or supplies they never gave you, this may be considered Medicare fraud. You can report the fraud to Medicare at 1-800-MEDICARE (1-800-633-4227) or by visiting the website of The U.S. Department of Health & Human Services – Office of the Inspector General.
  • You may want to contact a private attorney for an explanation of your legal recourse and options.
  • Finally, if you believe the facility is providing poor quality care or is guilty of elder abuse, which includes financial exploitation, you can report it to the Georgia Department of Community Health’s Healthcare Facility Regulation Division at 1-800-878-6442 or via their online complaint form.

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