Quote:
Originally Posted by BrianL99
I've asked the question a couple of times.
The only scenario that seems to make sense, is TVH is some sort of "Licensee" of the various insurance companies and they bill Medicare directly, as the Provider.
As you point out, if UHC, Humana or FB was the "Provider", they would be the one that owe the money.
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It’s confusing, see the above post (#137). TVH is the provider or medical services and determines the diagnostic codes that are submitted to CMS. Based on the diagnostic codes, CMS makes the payments to the patients Medicare Advantage insurer. According to Florida Blue, typically 90% of those payments are passed through to the provider, which is TVH in this case. So in this case, the biggest creditor, which is Medicare (via CMS), is due back 90% of any overpayments collected by the debtor/provider (TVH). I guess theoretically, the MA insures (United Health Care, Florida Blue, Humana) are on the hook to pay back the other 10% of the overpayments to CMS that were not passed through to TVH, but as far as I can tell that isn’t part of the bankruptcy case in question.