Quote:
Originally Posted by Marmaduke
Okay, so this is may be true.
What a shame they didn't have enough business acumen to have an annual audit by certified auditor.
Even small business operations know to check the books. What am I missing Doc?
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OK, I'll try to explain what happened (and realize that 99% of previous posts are just speculative BS):
Let's give an example: A patient taking aspirin after previous vascular surgery for say carotid occlusion has easy bruising. It gets coded as "acquired platelet dysfunction", which is exactly what it is. Or is it? Depends on interpretation. So the outside auditors for TVH tell them it is absolutely correct to use that code (Yes, they have continuous outside auditing). Then they get into negotiations with Humana, and Humana says that's wrong, you can't use that code in this instance. So TVH self-reports the discrepancy to CMS and this whole thing begins. There's more to it that I'm not at liberty to discuss, but there was
NO INTENT TO DEFRAUD.