Quote:
Originally Posted by drducat
CMS and DOJ Collaboration:
The DOJ’s takedown was supported by CMS, which prevented $4 billion in fraudulent payments and revoked billing privileges for 205 providers. CMS’s role in identifying TVH’s overpayments suggests that the agency is already involved, which could lead to a DOJ investigation if evidence of fraud (e.g., intentional misrepresentation or kickbacks) is found.
The DOJ’s Health Care Fraud Data Fusion Center, established in 2025, uses AI and advanced analytics to detect emerging fraud schemes, increasing the likelihood that large overpayments like TVH’s would be flagged for review.
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TVH has NOT BEEN FLAGGED FOR REVIEW. I don't know how much clearer this can be stated.
The DoJ is not investigating TVH. This is an issue that was resolved LAST YEAR. It's old news, Medicare already knows about it, they already knew about it, because TVH told them about it.
The repayment of the overpayments had already been in progress before the current announcement of Humana buying TVH and TVH filing for Chapter 11.