Quote:
Originally Posted by JustSomeGuy
Every year they must create a budget. First year of over charges, no matter the reason, even if everything added up, someone would have seen that they exceeded their expected office visits by 100% and revenues by a similar amount using the above example. Big red flag missed... or ignored (likely). Next year they use those over inflated "codings" to set the budget.... and so on. Funds were used (Hmmm) for salaries and offices to handle the workload of the miss coded visits. If that were the case those seeking care would have seen almost half the appointment slots unused (if the villages healthcare did not know there was an error), doctors seeing half the expected appointments and half empty waiting rooms... every year since the first miscoding (which in the example double counted appointments, half bogus).
If they used the funds for other purposes, profit, overpaid the doctors and staff or overpaid on rent and did not expand staff and doctors then the funds disappear but patients notice no over staffing. The organization "knew" something was wrong since they were doing twice the business with the same staff.
If any other non-government business did this someone would be found at fault.
If they truly thought the billings were correct then those who will still be using the "new company" should see the staff (including Doctors) reduced significantly and offices downsized or closed since they inflated the workload and income by miscoding as noted in the example above.
Someone got the hundreds of millions they can't repay and which caused the bankruptcy. Time will tell who. If they do not cut the number of Doctors and staff, then it went somewhere else and that needs to be investigated.
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Wrong, wrong and even more WRONG.
They did not believe there were "overcharges", therefore they did not exceed their expected revenue. And the "number of visits" is irrelevant with MA plans. I don't understand why this concept is so difficult to grasp, their budget was based on the LEGITIMATE expectation of revenue based on their number of patients and diagnostic mix, with outside consultants indicating that their coding was OK. There is nothing "extra". There is no slush fund or secret account. Nobody got hundreds of millions. There is no charge of fraud and no investigation because it is NOT NEEDED. Apparently, they have agreed to a settlement of what CMS considers a mistake in coding.