Talk of The Villages Florida - View Single Post - Potential Fallout - Beyond Healthcare - of TVHC's Massive Medicare Overbilling
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Old 08-22-2025, 08:50 PM
OrangeBlossomBaby OrangeBlossomBaby is offline
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Originally Posted by IPrescribeWine View Post
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Nearly EVERY MAJOR insurer has been caught with their hand in the cookie jar with “overbilling” (fraud) with adding unsupported risk scores. Don’t believe me? Then google “which insurers have been caught for fraud with medicare advantage risk scores”. One of the biggest offenders is United Health. The difference for TVH is that they can’t pay the fines and so had to file for bankruptcy.

Google another: OIG report finds insurers collected billions in questionable MA payments.

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I’m not implying that TVH did this, only that other insurers did. But this article from WSJ outlines how United Health and other insurers hired ARNP’s to do home visits and pressured them to add “questionably” supported diagnoses (inflating risk scores). Each ARNP visit was estimated to inflate yearly payments by $2500-ish per patient. Google: The one hour nurse visits that let insurers collect $15B from medicare
TVH isn't an insurer. It's a medical practice. United Health is an insurer. If insurers are committing fraud, that's nothing to do with TVH, because TVH isn't an insurer.
Totally different topic.