Quote:
Originally Posted by Rainger99
The goal seems to be to get as much money from Medicare and spend as little money on medical treatment.
There was an article in the NY Times on October 8, 2022, discussing how the MA insurers were being sued for adding additional illnesses to their patients' records. However, it said nothing about how doctors or clinics were benefiting from the HCC codes and RAF scores.
Perhaps there is something in the contracts between TVH and the MA insurers that would explain this. Hopefully, it will come out in the bankruptcy proceeding or the Villages Daily Sun.
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This is strictly a guess. I have no 1st hand knowledge, but based on what I'm reading and hearing about this situation, this is my speculation (for whatever that's worth).
The only way that TVH can be responsible, is if they were billing Medicare, directly. Which means that TVH was the "provider" and not the insurance company. It seems like the arrangement between the Insurer & the Provider, is not what many presume it to be. The Insurer may only be responsible for providing management of the subscriber/provider relationship and supplying the over-riding financial backing for the Group Practice.
Sort of like the Insurance company is a "back-stop", that provides high-level oversight and protection from catastrophic losses.
...either that, or TVH is simply paying the Insurance company to use it's name and their business is essentially self-contained?