Quote:
Originally Posted by Joecooool
OK -
"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."
Conjecture. Unless you work for TVH (which seeing how you are in all the post about them carrying their water wouldn't be a surprise) you have no knowledge what they "thought" when they were billing.
"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)"
More conjecture. Unless you are their accountant. you have no clue what they spend their money on.
And you chose to ignore the most important part of my post -
"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?"
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I'll amplify the first part----their doctors did not know there was overbilling. While I doubt it, somebody higher on the food chain may have been in a position to manipulate the billing.
Second---what do you think medical practices spend their money on? It's not jet skis and ice cream floats. There is no conjecture about what medical practice expenses consist of. The unknown factor is any potential distributions, but I addressed that.
Third--"uneducated/careless in their responsibilities"---almost too inane to deserve a response, but....if they believe they are billing correctly, and if their consultants believe they are billing correctly, how are they careless? And speaking of conjecture, how do YOU know other practices aren't in the same boat????
PS: I have no affiliation with TVH, I've been retired for over 10 years