The nursing home is over-billing. Can they do this?

Paul - NAMI involved....so you're in NYS? If so, realize that Medicaid rules for NY are structured quite differently than how most other states do their Medicaid program. Most states require the spend down done before Medicaid will take application to be processed (pending) and then once impoverished the application done & they pay the NH their monthly income as required by Medicaid copay requirment while they are Medicaid Pending. My understanding is that NYS Medicaid - as the cost of services is so much higher & complex - allows for application to be done and processed with $ to be paid by whatever amount is the NAMI determination. The NH gets paid the NAMI but the amount to be paid is whatever the state determined. I'd bet there is a notice from NYS on the breakdown of NAMI in the first letter that mentions the 21k first mo payment. NH could be just following the figure state gave them for NAMI due.

If my understanding of this is correct, then the answer to your ?'s should come from the state as to whether the NAMI paid was correct. I'd suggest you get the info from the state, compare the figures and if looks like repayment due, then send a registered letter to the NH with a 30 day notice of refund to be paid. There could be a sticky in that whatever funds need to be paid to the "estate of" and there needs to be executor named with Letters Testamentary issued to get this done.

But I'd bet that as they were Eventually Medicaid approved, the NAMI paid was right.

Also do you know the status of their PNA? Nys - I think - has pna at $ 50 a mo. Personal needs allowance, it's $ that is the resident gets to keep each month & not paid to NH. If the NH was getting paid all his monthly income the PNA amount was set into a personal needs trust account there at the NH. Like for my mom in TX pna was $ 60, so every mo all her monthly income (like SS) was paid to the NH for her Medicaid SOC (share of cost) EXCEPT for $60. PNA if there were funds in the account at the time of death, that $ should be paid to the estate or perhaps to whomever name was on file for this.