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Originally Posted by golfing eagles
The answer to the first part is easy---TVH did not think it was "overbilling", TVH and their consultants believed their billing was acceptable for years and years. Then, in negotiation with Humana, there was a difference of opinion triggering a requirement to self-report the potential irregularities to CMS. It looks like he bureaucratic paper pushers at CMS saw "big" bucks and took the opinion that the billing was erroneous. Unfortunately for TVH, the diagnostic codes are extremely vague in some regards and CMS gets the final opinion (unless a court rules otherwise). Some people think that there is some "pile of money" under some Morse's mattress. That would be extremely naive. Their revenue was expected by them, not "excess". It was used in the usual manner---salaries, equipment, rent, utilities, insurance, etc. There would need to some forensic accounting to see what, if any distributions to shareholders have been paid and to whom. (The "family" only owns about 60% of the shares)
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You don't know that. You berate others in this thread for posting conjecture, and here you are doing the same.
And even if it were true, why were they so uneducated/careless in their responsibilities? How can thousands of other Medicare Advantage plans operate correctly while they didn't?