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Should case manager refund medicare payment?

My grandma has been in a foster care home for the six months. In August, she qualified for Medicaid. Her current case manager refused to re-imburse my Mom for fees paid for Grandma in August. He was paid for August twice, both by my Mom and by Medicaid. Under pressure he reimbursed us the Medicaid payment (smaller of the two) he should have refunded us the private payment and kept the Medicaid because starting in August Medicaid was primary payer. Is this legal or is my Mom out the money she paid for Grandma's care?
Status: Open    Jan 11, 2016 - 09:57 PM

Medicare/Medicaid, Elder Law

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Expert Answers

Jan 20, 2016 - 07:03 AM

In most cases a Medicaid provider must accept the amount of the Medicaid payment and not ask for any more money. In most cases the amount the facility is allowed to charge is the same amount that Medicaid will pay. Call the local Medicaid office. If the facility is defrauding Medicaid it needs to be reported. Also you can contact an attorney who does work called Qui Tam or whistleblower actions. If there is fraud and the attorney wins you will get a protion of the recovered money for reporting it.
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