What Should I Do if I Suspect Medicaid will be Defrauded?

 In Long-Term Care Planning
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Photo by Dillon Kydd on Unsplash

Question:

If someone is in a nursing home on Medicaid and they own a home, if said home is now being sold, how does one report to Medicaid that the home is sold? I have searched all over for this answer in the State of Wisconsin. Someone is in control of her stuff and I feel that this person will not be sincere in letting the state know that the home has been sold because it is all about money to her.

Response:

I can’t tell you about Wisconsin in particular, but as you suggest, the sale of the home must be reported to the Medicaid agency. Whoever represents the person in the nursing home has this legal responsibility to report any change in the Medicaid beneficiary’s financial situation. Failure to report the sale is fraud and the responsible person could be prosecuted. Anyone receiving the proceeds also could be sued either by the state or by the facility if the Medicaid coverage is lost and the nursing home is not paid, though they would be subject to a civil suit, not criminal prosecution.

That describes the legal responsibilities and liabilities of the person in charge of the nursing home resident’s affairs, but not your role as an observer. Legally, unless you’re one of the people who might receive funds from the sale of the house, you have no role. Third parties uninvolved do not have any obligation to report and it can be difficult for them to do so not having the appropriate contact information for the local Medicaid agency. As bureaucracies, they can be difficult to contact. The problem would be for people receiving proceeds of the sale who might be subject to claim by the state or the facility. They should not spend that money. In your shoes, I think I’d just let everyone concerned know the legal situation and the potential consequences and leave it up to them to follow through (or not).

 

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