Lodi Nursing: Medicare Notice Violation Risks Bills - CA
Resident 2 at Lodi Nursing & Rehabilitation continued receiving care after his Medicare Part A skilled services coverage ended on July 23, but facility staff failed to issue the mandatory Skilled Nursing Facility Advance Beneficiary Notice that would have informed him of his financial liability for continued services.
The resident had 46 Medicare days remaining when his skilled care coverage ended, according to his Medicare eligibility benefits document reviewed by inspectors. Without the required notice, he remained unaware of his right to appeal the coverage decision and his potential responsibility for paying out-of-pocket for ongoing care.
"The SNF ABN notice should have been issued to Resident 2 when his skilled services coverage ended on July 23 and he continued to remain at the facility," the facility's Admissions Coordinator told inspectors during an interview on August 6. "Without the SNF ABN, the resident might not know his rights."
The Social Services Director confirmed during the same day that Resident 2 was discharged from Medicare Part A services on July 23 but remained in the facility as a long-term care resident. A review of his medical record showed no indication the required notice was ever provided.
Federal regulations require nursing homes to inform Medicare beneficiaries of their potential financial liability before providing services that Medicare typically doesn't cover. The notice must be issued at least three days before the last covered day to give residents time to understand their options and file appeals if necessary.
The Director of Nursing acknowledged the facility's failure during her interview with inspectors. She confirmed Resident 2's last Medicare-covered day was July 23 and that the facility should have provided the advance notice three days earlier.
"The SNF ABN notice should be given to residents three days before the last covered day, so the residents knew their rights and had a chance to appeal," the Director of Nursing stated. She confirmed the notice was never provided to Resident 2.
The nursing director warned that failing to provide the required notice "could lead to unexpected billing for the residents."
Resident 2 was originally scheduled for discharge but instead transitioned to long-term care status while continuing to receive services at the facility. This transition from Medicare-covered skilled care to private-pay or Medicaid-covered custodial care represents a critical juncture where residents need advance warning about their changing financial obligations.
The facility's own policy, titled "Advance Beneficiary Notices," requires staff to inform Medicare beneficiaries of potential payment liability. The policy specifically states that liability notices must be issued before providing items or services usually paid for by Medicare or custodial care services.
For Medicare Part A services, the facility policy mandates using the official Skilled Nursing Facility Advance Beneficiary Notice form, designated as Form CMS-10055 by the Centers for Medicare and Medicaid Services.
Inspectors found the violation placed Resident 2 at risk for making uninformed decisions about his care and finances. Without understanding his coverage status, he couldn't evaluate whether to appeal the Medicare decision, seek alternative arrangements, or prepare for potential out-of-pocket expenses.
The failure represents a breakdown in the facility's Medicare notification procedures that could affect any resident transitioning from skilled care coverage to long-term custodial care. Medicare Part A typically covers skilled nursing facility stays for up to 100 days per benefit period, with varying levels of patient responsibility depending on the length of stay.
When Medicare coverage ends but residents remain in the facility for continued care, they become responsible for paying privately or qualifying for Medicaid coverage. The advance beneficiary notice serves as a crucial safeguard, ensuring residents understand this financial transition and can make informed decisions about their care.
State inspectors classified the violation as having minimal harm or potential for actual harm, but noted it affected Resident 2's ability to understand his rights and financial obligations. The finding emerged during a complaint investigation conducted on September 8, focusing on the facility's Medicare benefit notification procedures.
The violation highlights ongoing challenges nursing homes face in managing complex Medicare coverage transitions while ensuring residents receive proper advance notice of their changing financial responsibilities.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Lodi Nursing & Rehabilitation from 2025-09-08 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: Official federal inspection data from the Centers for Medicare & Medicaid Services (CMS).
Editorial process: AI-synthesized regulatory data, reviewed for accuracy by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: June 20, 2026 · Our methodology
LODI NURSING & REHABILITATION in LODI, CA was cited for violations during a health inspection on September 8, 2025.
A review of his medical record showed no indication the required notice was ever provided.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.