Medicaid is a useful resource for paying for the great expense of long-term care. Only the truly needy qualify; strict Medicaid rules dictate asset and income thresholds, along with penalties for certain transfers.  In addition to the traditional criminal penalties that come with Medicaid fraud, there may be a finding of unjust enrichment in civil court.

An Oregon court recently issued an opinion regarding Medicaid fraud accountability and repercussions. The key players in this case were Larisa’s Home Care LLC, an adult foster care provider (the facility); Prichard, the resident; and Gardener, Prichard’s son and power of attorney.

Prichard was a resident of the facility. Her son, and power of attorney, applied for Medicaid benefits on her behalf and Prichard was approved. These benefits allowed her to receive services from the facility at a discounted rate. Unbeknownst to Prichard, her son had made fraudulent claims on her Medicaid application. Prichard’s son had been transferring funds from his mother, as her power of attorney, to himself over several years, yet stated on her Medicaid application that she had not made any transfers within the look-back period. Upon learning this information, the facility sought equitable relief for the difference between the Medicaid rate and the private pay rate from Prichard’s estate.

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