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Originally Posted by BrianL99
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?
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I am surprised that no one - the Villages, the government, the Insurance Companies, the attorneys or anyone else has issued any kind of statement explaining how the over-billing happened.
Or that details have not leaked.