Yes I see your point. I do wonder how the audit process did not catch the coding issues mentioned much sooner. Where did all the "extra" money go? Why did TVH not look into why there was so much more money coming in those 4 yrs?
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Originally Posted by golfing eagles
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.
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