Legal Question in Civil Litigation in California
Anyone interested in filing a class action suit on behalf of people whose property and assets have been seized ( estate recovery) to cover Medicare expenses ? The government published a GAO report in 2010 indicating that Medicar is "vulnerable to fraud" and that it guesses that that fraud costs taxpayers BILLIONS. No remedies were offered . My mother exceeded her "cap" in her final days although her heirs were unable to access explanations of her billing ( breach of HIPAA. Countless inquiries died on people's desks and even though Ma was covered by Medicare, Social Security and Secure Horizons, she was billed an additional $20,000- without explanation/explication for her care. Her skilled nursing facility was hit with 85+ complaints during the time she was there and Medicare continued to PAY for the shoddy care she received. Medicare also continued to pay for the indigent alcoholic in the bed next to her who never paid a dime into the system. THe remedy is thelifting of the lein on her property and return of all monies submitted against that lein. This is a textbook RICO case and when I contacted the California Attorney General, I was blown off - twice- and referred to all those agencies I listed as unresponsive. If the government concedes that it cannot monitor its program and pisses away BILLIONS of taxpayer dollars on Medicare fraud, then it cannot legitimately seize assets from those who have paid into the system.
2 Answers from Attorneys
Unfortunately what you suggest in the end is not feasible. It is the law that requires the estate through estate claim and liens to cover the expenses of Medicaid. You claim that if they cannot monitor the program the they can't seize money, however it is not fair for the taxpayers to pay all the costs of a skilled nursing facility if the person or later on the persons estate has the means to pay the facility. My guess is that this was Medicaid and not Medicare as Medicare does not pay for nursing facility. Medicaid is a needs based program funded by the Feds with State matching money and is an entitlement program. There is no paying into Medicaid.
Unfortunately and you may not like the term but Medicaid is welfare and Congress wrote this program to have those in need be covered but not be a total cost to the taxpayers, so you either need to get Congress to change the statute or you need to private pay at the facility.
The indigent alcoholic is covered just like the middle class individual who has a home but can't afford to pay for the facili ut of their own pocket. It is a means tested program.
Medicare does not cover long term care. Nursing homes are subject to review and each state has a Program Integrity Unit or Inspector General that looks at overfilling on Medicaid. The California AGs office wil blow you off because it is the state's responsibility to collect the money
Sorry but the assets of your loved one are subject to the claims of the state. If you disagree with the amount that would be challenged by the executor in the claims process to reduce the amount of the claim.
I have to agree. There is no class action here against the government.
If you believe that your mother's estate has been overcharged, you can pursue that directly with the government. If you believe that the nursing home overbilled the government or was negligent in caring for your mother, then you may be able to pursue the nursing home for the loss. Indeed, if the statute of limitations has not run, that is most likely your best source of relief. This is particularly true as to the unexplained $20K in charges . Financial elder abuse is a serious matter. I have pursued this type of claim, and it is perhaps the easiest one for your mother's estate to pursue.
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