OKLAHOMA CITY (CN) – Unified Life Insurance cheated thousands of nursing home residents by charging them $720 a year for dental coverage they almost surely won’t need, and for which they can receive only $2,000 in benefits, according to a federal class action.
Unified Life Insurance Co. and third-party administrator Sterling Health Services are accused of scheming to “illegally bilk thousands of aged Oklahoma nursing home residents receiving Medicaid assistance out of their personal funds, under the guise of providing them dental insurance,”
The class claims that most nursing home residents do not need extensive dental care because most have “few or no teeth, and quite often utilize dentures.”
Named plaintiff Carla Childs says the defendants charged her late mother $720 a year for a mere $2,000 in coverage, including denture-related coverage that Oklahoma nursing home residents get free through Medicaid.
Childs says the plan is illegal because premiums are collected from the residents’ personal funds, not from the nursing facility’s “daily rate for routine services.”
Childs says Oklahoma Medicaid regulations prohibit charging residents’ personal accounts for “routine services,” including “dentures and related services,” and require nursing facilities to pay for such services, or for insurance for such services, out of the “daily rate for routine services.”
Federal Medicaid regulations prohibit use of a long-term-care resident’s personal funds for any item or service that Medicaid or Medicare pays for, according to the complaint.
In the lengthy list of routine services included in the Oklahoma Medicaid regulations, only dentures and related services and certain vision services contain this specific restriction on payment source, Childs says.
“It is obvious the Oklahoma Health Care Authority, by promulgating such a clear and specific restriction, has either experienced unscrupulous dental or vision care suppliers or insurers in the past, or realizes such suppliers or insurers can easily exploit the vulnerability of elderly or aged nursing facility residents, or their representatives,” the complaint states.
The class seeks certification, equitable relief and damages. It is represented by Ray Maples of Edmond, Okla.