I am the POA for my mother who resides in residential nursing care. After the spend down process, she qualified for Medicaid. I neglected to report three of her annuities which yielded about $220 monthly. I cashed some of the checks, and kept the money separate from my own funds, but then decided that I shouldn't cash any more of the checks. Thus, I have a stack of uncashed checks from these companies. After about 2 years, I was contacted about these accounts by the state, and I acknowledged that she was receiving the checks. I then received a request from the local DPW office in Pennsylvania asking for information about these three accounts within 10 days. I had talked with the person who sent me this form and she had not indicated that there was a deadline for my response, nor did her subsequent cover letter indicate that there was a deadline. However, a form attached to her cover letter indicated the deadline. I simply hadn't noticed the deadline on the attachment. When the 10 days lapsed, I received another letter informing me that my mother's medicaid coverage of her nursing care would be terminated. I responded to that letter apologizing for my failure to note the deadline and indicated I would gather the requested information about the three accounts as quickly as possible. I asked for an appeal of the discontinuation and indicated that I was doing so only as a way of requesting an extension to respond to their initial request. I received a notice informing me that I was scheduled for a telephonic Administrative Law Hearing on November 17. (I have no idea what this is and what the process is.) The notice of the Administrative Law Hearing suggested that I contact the Supervisor of the local CAO witihn DPW to see if a quck resolution to this problem might be reached. I kept DPW informed about my progress in gaining this information in several letters. Although I have given DPW 4-5 letters, I have not received a response. Last Friday, I handed in the final bits of information the DPW had requested and twice called the CAO Supervisor requesting to meet with him. His voicemail message indicated that he responds to requests within the following business day. Two days after leaving my two voicemails for him, he has still not responded. I subsequently have noticed that the form that I submitted for my mother's medicaid coverage indicates that it may be a crime to not report all sources of income. Given the lack of response from the CAO and DPW, the scheduled Administrative hearing, and the form that I signed, I am gravely concerned that I have committed an illegal act and could: (a) be fined, (b) go to jail, (c) lose the house that my mother transferred to me after I have lived with her as her caretaker child for more than two years, (d) suffer public humiliation in the newspaper, or (e) lose my job. I can provide many more details about this, if needed. I'm very anxious and would appreciate your advice. Thank you.
State/Country relating to question: Pennsylvania
DearCustomer- You have reason to be concerned since failing to disclose the extra money and cashing some of the checks can be construed as Medicaid fraud. You need to be very careful what you say to anyone about this as you are never required to incriminate yourself and no one will read you any rights until it is too late. The best advice any defense lawyer can offer is to keep quiet and get an attorney. Yes you could be fined and yes you could receive jail and yes you can lose your job. The least amount of evidence you provide to the people asking the better off you will be and frankly I would not say another word to anyone until you have legal counsel. If you cannot afford legal counsel the court will appoint a lawyer but not until you are actually charged with a crime. So in that event you need to remain silent and let them do what they will do. Nothing you say will help you and everything you say will be used against you.
I understand all the facts you have presented but the botXXXXX XXXXXne is that you hid income and allowed your Mom to receive Medicaid and that is likely to be considered as fraud. I doubt there will be a "quick" resolution to the problem but I also understand the predicament with Medicaid being denied. If you can somehow pay the money without comment that might work but, once again, you are taking a big risk talking or doing anything with respect to the authorities.
I'm not trying to scare you but I have to tell you the law as I see it.
David, My anxiety has definitely increased. How do I find out how much is owed and to whom would I make payment? Would it be the amount of the monthly checks and, if so, can I cash them to make this payment? What happens at an Administrative Law Hearing?
I'm very afraid that I've already sunk my ship as I have been very open with DPW, hoping to demonstrate that I'm not attempting to evade the issue. This is my latest response to DPW:
To the CAO Supervisor:
I am continuing to follow up on my letter of initial letter of September 19, which covered with my request for an appeal of the decision to terminate coverage of my mother's residential nursing home care, and my additional correspondence of September 24, 26 30, and October 6. These letters are responsive to one from your caseworker, dated September 15, informing me that my mother's eligibility for Medicaid and Long-term Care Benefits would end on September 29, 2011 because I had failed to respond by September 12, 2011 to her request for information about three of my mother's financial accounts. Your caseworker's letter informed me that I had the right to appeal this decision.
My prior letters have detailed information about my delay in responding and have documented my efforts to acquire the requested information. In response to your caseworker's letter of September 15, I wrote her on September 19, and hand delivered that letter to the DPW office on that date. My September 15 letter documented the following points:
In response to my letter of September 19, I received a form letter which, curiously, was dated September 14--the day before your caseworker sent me her original letter notifying me of the intent to discontinue my mother's care and five days before I placed my request for an appeal in the mailbox at the DPW office. This letter arrived in my mailbox on September 26, perhaps because it had been incorrectly addressed to a different house number. That letter encouraged me to contact a CAO Supervisor in an effort to seek a faster resolution of this problem. In response to that notice, and as directed by that notice, I called the CAO at about 12:15 on September 26th to speak with a CAO Supervisor. After talking to the person who picked up my call, I was switched to your caseworker's voicemail and left a message for her. I did not receive a response and, therefore, wrote another letter on September 26 that was also hand-delivered to the CAO office on that date.
My letter of September 26, which was hand delivered to the DPW Office on that date, was intended to demonstrate that I was actively engaged in an effort to provide the information requested in your caseworker's initial correspondence. My letter of September 26 contained the following information:
I have never received a response, by letter or telephone, to my letter and telephone call of September 26.
On September 30, I wrote a letter to the CAO Supervisor and hand-delivered it to the DPW office. This letter provided the following information:
On October 6, I again wrote the CAO Supervisor. However, this time I mailed the letter as my schedule did not permit me to hand deliver it. In my letter of October 6, I indicated that:
When I did not receive additional information from Prudential within 3-5 business days, I again contacted them. On my most recent call on October 19, I was informed that they had already sent me their response. When I told them that I had not received their information, they agreed to fax it to me. I received their fax when I returned home from work on October 19. Given my schedule on October 20, I could not get the attached information to you on that date. However, all of the information contained in the response from Prudential is appended to this letter.
As you will note from the dates specified in this letter, from beginning to end, obtaining information from these three companies required 23 business days, not 10. Thus, I could not have responded to your caseworker's request for this information within the 10 business days that were originally allowed. It simply would not have been possible to meet your caseworker's original deadline.
Given that you now possess all the required information, and it has been documented that it would have been impossible to meet the original deadline for discontinuation of coverage for my mother's nursing home care, I ask you to accept this information and work out the amount of payment that you are owed for my mother's past care and what her future monthly payments should be. If you are willing to do so, I would like to discontinue my request for an Administrative Law Hearing about this matter.
Regardless of your decision, I very much would appreciate your response to this letter. I can be contacted via any of the methods shown below.
Thank you for your consideration.
Your letters seem to more concentrated on the dates to reply and not on the fact that you have all these checks or cashed any checks. What you have told me is not want you want to tell but an attorney. All of this correspondence about when you had to reply etc is not what you need to be worried about. The problem is if you failed to notify Medicaid of the additional income. I'm not certain what you filled out in the beginning but if you failed to disclose all of your Mom's assets or income then that is where the problem lies. The best way to solve it is to get them the money meaning all of the payments from the annuities. What I hope will happen is that they will consider this an error on your part since you didn't keep the money ore even cash most of the checks which would indicate that you didn't use the money for yourself or for anyone else.
The problem still is that they can consider you to have committed fraud. It's sort of like robbing a bank and then taking back the money. The Robbery still occurred. I know this is frightening but I'm only trying to help and telling you that it is important to get legal counsel before you talk about the situation. It is almost impossible to walk in with all these checks and then try to explain why they have been held by you and why the extra income was not reported. An attorney can try to make a deal whereby you turn over the money, get your Mom back on Medicaid and there be no prosecution of you. That is what I would try to do if you were my client. Hopefully if they can get the money they will consider this to be a mistake on your part since you didn't use the funds for your own benefit and kept the money and the checks separate.
25 years experience practicing attorney
DISCLAIMER: Answers from Experts on JustAnswer are not substitutes for the advice of an attorney. JustAnswer is a public forum and questions and responses are not private or confidential or protected by the attorney-client privilege. The Expert above is not your attorney, and the response above is not legal advice. You should not read this response to propose specific action or address specific circumstances, but only to give you a sense of general principles of law that might affect the situation you describe. Application of these general principles to particular circumstances must be done by a lawyer who has spoken with you in confidence, learned all relevant information, and explored various options. Before acting on these general principles, you should hire a lawyer licensed to practice law in the jurisdiction to which your question pertains.
The responses above are from individual Experts, not JustAnswer. The site and services are provided “as is”. To view the verified credential of an Expert, click on the “Verified” symbol in the Expert’s profile. This site is not for emergency questions which should be directed immediately by telephone or in-person to qualified professionals. Please carefully read the Terms of Service (last updated February 8, 2012).