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Originally Posted by melpetezrinski
Here is an excerpt from what I just received from The Villages Health (“TVH”) "we discovered a problem with some of our Medicare billing practices. Upon discovering a potential problem with our Medicare billing this past Fall, TVH hired outside consultants to conduct an in-depth review of our coding and billing practices. Based on our investigation, we determined that
beginning in 2020, TVH implemented certain billing processes and practices that were not consistent with Medicare payment policies. This resulted in TVH receiving more money from the Medicare program than if billed correctly.
With these consultants, we are now working to identify the financial impact of these billing errors and are in the process of repaying the Medicare program for any overpayments that resulted from the billing issue. In addition to
starting work with relevant government agencies to return the overbilled Medicare funds, we have also already begun to implement a range of new internal safeguards to assure that an error such as this will not recur. The occurrence of these errors has since been self-reported to the proper U.S. government agencies, and we expect a smooth process as we work diligently to make right with the Medicare program itself—all with the goal of continuing to provide you with the best possible care you’ve rightfully come to expect from all of us at TVH."
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Oftentimes it’s not the provider that discovered they were billing incorrectly as it’s CMS that flags them based on billings. TV says they are working with federal agencies which I’m certain they are based on overpayments. There is a possibility that an investigation has been opened up and the charges for services that shouldn’t have been billed are being considered as a civil fraud matter by DOJ. Sounds like they may have billed for services not rendered, or unnecessary tests and put in an incorrect diagnosis (in the OP’s case diabetes) to justify that. It will be interesting to see how this ends up playing out.