Quote:
Originally Posted by CoachKandSportsguy
The medical records by individual which was over coded is not available under the freedom of information act, that would be a patient privacy issue.
so even if they were available, not sure you can determine which was uploaded and which wasn't to get through the formulas to get to the overpayment amount. . .
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It should all be available via FOI, other than patient names. If it was submitted to Medicare, it's a public document and subject to disclosure, with identifying information redacted.
There have been some posters who should have reasonable knowledge of what's been going on with TVH, but some media reports, suggest TVH's actions were more nefarious. I have no real clue how all this happened, but $361M seems far beyond a "misunderstanding" or "computer glitch". I have a former golfing partner who lost his medical license and served a significant prison sentence, for "over billing Medicare" and that was 7-8 years ago, before the Feds got real serious about routing out abuse.
"The Villages Health System LLC, which operates clinics for retirees living in the Villages in Central Florida, said in a July 3 court filing that it
logged patient diagnoses that “were not clinically supported or otherwise did not meet Medicare coding and payment guidance.”"
(
Villages Health System Sees $350 Million in Medicare Overcharges)
Call me crazy, but that sounds dangerously close to an admission of guilt.