Quote:
Originally Posted by Snowbirdtobe
The Villages has received over $361,000,000 in over payments from the FEDS.
The bankruptcy filings has the US taxpayers or Medicare listed as an unsecured creditor due 361 Million US $. Where is that money? That is $6500 per patient.
|
Medical clinics serving mainly Medicare Advantage (MA) patients, such as TVH, generally operate very differently than traditional medical practices/ clinics. OP may be thinking about the business model of traditional medical practices. MA clinics operate differently and it’s complicated.
Perhaps much of the overpayment funds are with the Medicare Advantage insurance company(ies) that TVH works with under contract. The insurance company(ies) likely owes the US government (CMS) the overpayment. (CMS pays the MA insurer, and the insurer pays something to the MA clinic under terms of their contract.) But depending on the contract(s) between TVH and the insurance company(ies), the insurance companies may have the legal right to claw back overpayment funds from TVH for TVH’s mis-coding. Hence, the bankruptcy.
This is a business bankruptcy case so many details of TVH business dealings and contracts are not in the public domain and likely never will be. Speaking simply, business bankruptcy cases are about how much do the creditors and owners get from the bankrupt estate. In this case, the owners of TVH may get nothing for their equity stake after creditors, lawyers, etc get paid.
Don’t expect to see this bankruptcy case on a TV series. CMS overpayments are not rare. Each year, CMS makes billions of dollars of overpayments. And medical provider upcoding is also not rare.
CMS Takes Important Steps to Recover Overpayments from Medicare Advantage-2025-06-05
Medicare Part C Improper Payment Measurement (IPM) | CMS