Watch Out for Group Home Fraud

By July 20, 2009Uncategorized

We agree, at JacksonWhite, that there are many wonderful group homes that provide excellent care.  They meet a niche in the long term care continuum that is certainly a valued addition. However…

If your loved one is in a group home or you are a social worker referring to group home – beware. If the group home is an ALTCS approved home- this means they agree to accept their contracted rate for payment for care under ALTCS. They CAN NOT ask the family to pay more in order for the client to be in the facility under ALTCS.

Please see our latest addition of the Senior News – there is an article about Medicaid Fraud – it will explain Double Dipping and rules against it.

If the group home does not like their reimbursement provided by the Program Contractor or feel that it does not pay enough, the group home can either renegotiate their contract to better reflect their costs or decide to NOT take ALTCS clients.   Please do not be misled,  group homes that agree to take ALTCS recipients are agreeing to allow them to stay for their room and board amount, plus the difference of their contracted rate paid by the ALTCS program.   It is not the families responsibility to pay extra…. ONLY if the client is paying for something outside of the contract terms ( i.e.; private room) can they pay extra.  It CAN NOT be a condition of admittance.

For those Social Workers referring to group homes, please do your clients a favor and check into this before you refer – dont let your clients be misled.  It may be that another type of setting may be better financially – and ethically – for the client.

Check out our newsletter or call JacksonWhite if you need more information!!!