Potential Fallout - Beyond Healthcare - of TVHC's Massive Medicare Overbilling

[idlewild]

From AI deep research:

Potential Liability of Jennifer Parr & the Morse Family in The Villages Health Overbilling Case

Ownership Structure and Control of The Villages Health System: Bankruptcy filings confirm that The Villages Health System, LLC (TVHS) is closely held and controlled by the Morse family (developers of The Villages). In the Chapter 11 petition, Jennifer L. Parr (a member of the Morse family) is identified as a Manager of The Villages Health Holding Company, LLC – the majority owner of TVHS. Similarly, Mark G. Morse (Jennifer’s brother and a principal in the family business) signed the corporate resolutions both as a Board Member of TVHS and as a Manager of the holding company. These documents make clear that the same individuals behind The Villages development also own and control TVHS, which a court filing emphasizes is a “closely-held family-owned company." In short, the Morse family – through The Villages Health Holding Co. – has majority ownership and operational control over the health system.

Financial Relationship with The Villages Development: The bankruptcy case documents and related disclosures shed light on the intertwined financial relationship between TVHS and the Morse family’s development enterprise. UnitedHealthCare (UHC), the Medicare Advantage insurer for most TVHS patients, revealed in a court objection that it had a special arrangement with The Villages’ owners: UHC prepaid for exclusive rights to use The Villages’ branding and marketing via an affiliate of The Villages (the developer). This indicates that the Morse family’s companies benefited financially from TVHS’s operations by licensing the community’s name and logo. Additionally, public reports suggest that many of the clinics and facilities were built by The Villages’ developer and then leased to TVHS, meaning the health system was effectively paying rent to its owners’ affiliated real estate business. Such self-dealing arrangements underscore how deeply enmeshed the health system’s finances are with the Morse family’s broader business interests.

Disclosures of Overbilling and Alleged Responsibility: In late 2024, The Villages Health System self-reported a massive Medicare billing problem: an internal investigation found that TVHS had logged patient diagnoses that “were not clinically supported or otherwise did not meet Medicare coding and payment guidance,” leading to hundreds of millions in improper payments. By the time of the Chapter 11 filing (July 3, 2025), a preliminary analysis indicated overpayments of at least $350–361 million to TVHS. Court filings show the company openly acknowledged these errors and even notified patients about the issue. Notably, UnitedHealthCare’s filing goes further in characterizing blame: it states that TVHS “admitted to the submission of incorrect information” to insurers and has a “record of corporate misbehavior." UHC points out that the same individuals who own The Villages (the Morse family) also own and control TVHS, insinuating that the development owners were in a position to direct or permit the practices that led to the overbilling. In a striking assertion, UHC’s court submission warns that the Debtor’s officers, directors, and owners (i.e. the Morse family and Jennifer Parr) now “face hundreds of millions of dollars of liability” due to the false Medicare information submitted. This implies that beyond the company’s liability, those in control could be held personally or corporately responsible for the $361 million overbilling, at least in UHC’s view.

Potential Legal Exposures for Jennifer Parr and the Morse Family
Civil Liability and DOJ Inquiry: The bankruptcy documents make clear that federal authorities are involved. TVHS’s filings note it has been in communication with the U.S. Department of Justice (Civil Division) and the HHS Office of Inspector General regarding the overpayments. The company is working “toward a resolution with the U.S. government” to repay the approximately $361 million, which will likely include significant financial penalties. This suggests a potential False Claims Act civil action or similar, which can impose treble damages. While no lawsuit naming individual executives has been filed as of the filings, UHC’s allegation that the owners themselves face liability indicates that Jennifer Parr, Mark Morse, and other insiders could be targets of civil claims – either by the government under the False Claims Act (if they knew about or directed the false billing) or by private parties (such as UHC seeking indemnification). In sum, the civil exposure is substantial, and the DOJ’s involvement confirms that a federal investigation is ongoing (even if currently civil in nature). Any eventual settlement or judgment could potentially seek guarantees or contributions from those in control if misconduct is proven.

Criminal Liability: No direct evidence of a criminal investigation appears in the bankruptcy filings to date – references to DOJ have been explicitly to its civil division. The overbilling has been officially described as “erroneous” or based on misunderstandings of coding guidance, rather than an intentional fraud, and the company self-disclosed the issue. These factors suggest the matter is being handled as a civil regulatory breach. However, the magnitude ($361 million) of the improper claims raises the stakes. If future evidence were to show knowing or willful fraud (for example, if executives pressured clinicians to upcode diagnoses), the Morse family principals could conceivably face criminal health care fraud or false claims charges. So far, there is no indication in the court papers of a criminal referral, but the risk remains if new facts emerge. For now, the legal peril for Parr and the Morse family lies more in civil enforcement (with massive financial and reputational consequences) than in criminal prosecution.

Breach of Fiduciary Duty: As managers and controlling owners of the LLC, Jennifer Parr and the Morse family owed fiduciary duties to the company (and now, in bankruptcy, to its creditors). The court documents do not explicitly accuse them of breaching those duties, but certain facts invite scrutiny. The need to bring in “independent managers” and a new Chief Restructuring Officer to improve compliance after the overbilling was uncovered suggests that previous oversight by insiders was inadequate. If it is shown that the family-controlled board failed to implement proper auditing or compliance controls (allowing the false billing to continue for years), that could be viewed as a breach of their duty of care. Moreover, any self-dealing transactions are a red flag: for instance, if TVHS paid above-market rents or fees to Morse-controlled entities (benefiting the owners while the company racked up liabilities), a creditors’ committee or trustee could argue the insiders breached their duty of loyalty. In the ongoing bankruptcy, stakeholders may investigate whether the owners prioritized their own interests over the company’s solvency. Any such findings could lead to litigation against the Morse family for mismanagement or fiduciary lapses, though no lawsuit of that kind has been filed yet.

Fraudulent Conveyance Concerns: Thus far, the filings have not revealed any specific transfers of assets from TVHS to the owners pre-bankruptcy. However, given the enormous government claim and the family’s control, creditors will likely examine any pre-petition distributions or asset transfers to Morse-family entities. If, for example, significant profits from the overcoding years were upstreamed to The Villages Holding Company or related family trusts, those could be subject to clawback as fraudulent conveyances in bankruptcy (if made when TVHS was insolvent or intended to hinder creditors). Public observers have noted suspicious timing in the Morse family’s financial maneuvers – for instance, a large family-owned asset (a Villages-affiliated bank) was sold not long before the overbilling became public, prompting questions about whether this was done to isolate assets from potential forfeiture or liability. While this is speculative and not documented in the court record, it underscores the concern that any transfer benefiting the owners at the expense of TVHS’s creditors will face scrutiny. The bankruptcy court has strong powers to unwind fraudulent transfers, so if evidence emerges of such transactions, Jennifer Parr and her family could be forced to return funds to the estate.

Department of Justice and Regulatory Actions: In addition to the bankruptcy process, the Morse family must be mindful of parallel government actions. The DOJ civil inquiry (and involvement of HHS OIG) means there is a risk of a False Claims Act case, which could theoretically name individuals (owners or executives) if they were complicit in the false billings. So far, TVHS’s cooperation and self-disclosure may be mitigating factors. Nevertheless, the overbilling is at a scale that has drawn federal attention, and the outcome could include a corporate integrity agreement or other oversight that affects the family’s control over any reorganized health business. If negotiations with DOJ do not resolve the liability, a civil suit could be filed. The Morse family also faces intense scrutiny from private creditors like UHC. UHC’s filings indicate it feels misled and left out, and it may pursue its own legal remedies to recover losses – potentially even alleging fraud or conspiracy involving TVHS leadership. All of these avenues mean Jennifer Parr and her relatives are not shielded simply by putting the company in bankruptcy; their decisions and any knowledge of the overbilling are under the microscope of federal investigators and creditors.

Conclusion
In summary, the bankruptcy documents portray The Villages Health System’s overbilling debacle as a liability largely resting with the company, but they also tie that company inextricably to the Morse family. Jennifer Parr, Mark Morse, and related insiders are documented as the ultimate decision-makers for TVHS, and even the firm’s long-time business partner (UHC) has alleged in court that these owners could personally face “hundreds of millions” in exposure for the false Medicare billings. While no filing to date outright accuses Parr or the Morse family of criminal wrongdoing, the evidence of massive billing irregularities and the close involvement of ownership raise the prospect of significant legal repercussions. They range from civil False Claims Act penalties and DOJ-driven settlements to potential breach of duty or fraudulent transfer claims in the bankruptcy. Any criminal liability would depend on proof of intent and is not asserted so far, but it remains a looming possibility given the scale of the fraud. Going forward, Jennifer Parr and the Morse family will likely be under significant legal pressure: they may need to contribute to any government settlement, justify past transactions, and demonstrate that they did not personally profit from or direct the improper billing. The court filings and exhibits thus far highlight their control over the health system and foreshadow a careful examination of whether that control was misused, making personal or corporate liability a very real concern as this case progresses. Sources: The Villages Health System LLC Chapter 11 Petition & Board Resolutions.


Sources:

The Villages Health Bankruptcy | PDF | Chapter 11 | Unsecured Debt
The Villages Health Bankruptcy | PDF | Chapter 11 | Unsecured Debt (https://www.scribd.com/document/884871596/The-Villages-Health-Bankruptcy)

United HealthCare highly suspicious of proposed sale of The Villages Health - **************.com
https://www.**************.com/2025/07/23/united-healthcare-highly-suspicious-of-proposed-sale-of-the-villages-health/

Bankruptcy of The Villages Health raises many questions - **************.com
https://www.**************.com/2025/08/07/bankruptcy-of-the-villages-health-raises-many-questions/

Villages Health System Sees $350 Million in Medicare Overcharges
Villages Health System Sees $350 Million in Medicare Overcharges (https://www.insurancejournal.com/news/southeast/2025/07/09/830964.htm)

Villages Health company, under fire for Medicare overpayments, files for Chapter 11 bankruptcy
Villages Health company, under fire for Medicare overpayments, files for Chapter 11 bankruptcy (https://www.clickorlando.com/news/local/2025/07/06/villages-health-company-under-fire-for-medicare-overpayments-files-for-chapter-11-bankruptcy/)

[RICH1]

when you pay more for Lawn Service, than your Healthcare..you might need to change priority's

[OrangeBlossomBaby]

when you pay more for Lawn Service, than your Healthcare..you might need to change priority's

No idea what you mean by that.

We pay $50 every 2 months for pesticide application. We mow, edge, and mulch our own lawn, weed our own flowerbeds, do all our own landscaping.

We pay whatever is deducted from one social security check every month for Medicare Advantage, plus I pay $168/month for a crappy "bronze" ACA Florida Blue plan, plus $80 co-pay for every specialist visit and every lab visit except my mammogram. I don't think I get my money's worth, but I don't blame the doctors for that. I blame the for-profit health insurance system in this country.

[ThirdOfFive]

I put the over-under for this thread to be locked at 4:00 PM EST 8/18/25.

[Bill14564]

AI hallucinates enough when you ask it for straight facts. Asking it for speculation?!

[Rainger99]

If what AI said is accurate, that might explain why the golf courses are in such bad shape!

[dewilson58]

My barber's ex-wife's sister's mechanic knows more than AI.

I'll wait for a good source.

:posting:

[idlewild]

I put the over-under for this thread to be locked at 4:00 PM EST 8/18/25.

It probably will be - or deleted - but I hope not. I'm not trying to stir up controversy here, and everyone should be entitled to his/her own opinion.

While the Villages is a great place to live and the Developer has provided a wonderful community for many - and should be handsomely rewarded for it - my personal view is that they're also taking advantage of some "Midwest nice" naivety and incredibly bullying, often to their own customers and advocates (SEE: Bogus Drone Cease and Desist Letters). And when a party owes $300M to the federal government which is only self-reports months after a newly formed Department of Government Efficiency gains "access to key data systems within Health and Human Services, including Medicare and Medicaid records, as it looks for waste and fraud in federal health spending" and then sells off a major asset before filing for bankruptcy protection, that's a bit of smoke worth investigating - especially when it may have longer term impact on both home values and the quality/cost of maintenance services ongoing.

Again, just my two cents.

[Rainger99]

I put the over-under for this thread to be locked at 4:00 PM EST 8/18/25.

I did not see any political references in the OP.

[Dond1959]

Very detailed post. However, you forgot to define what an LLC means:
Definition of LLC
A Limited Liability Company (LLC) is a specific type of business structure in the United States that combines elements of both corporations and partnerships.
Key Features
Limited Liability: Owners, known as members, are protected from personal liability for the company's debts and obligations. This means that personal assets are generally safe from business creditors.
Pass-Through Taxation: LLCs typically do not pay federal taxes at the entity level. Instead, profits and losses are passed through to the members, who report them on their personal tax returns.
Flexibility: LLCs offer flexibility in management and organization. They can be managed by members or designated managers, and there are fewer formalities compared to corporations.

So, protection from personal liability. The main reason to set up an LLC.

[Rainger99]

So, protection from personal liability. The main reason to set up an LLC.

But not always. At the Philosophy Club lecture, the speaker mentioned something called piercing the corporate veil.

Piercing the Corporate Veil: LLC & Corporation Risks | Wolters Kluwer (https://www.wolterskluwer.com/en/expert-insights/piercing-the-veil-of-small-business-what-the-owners-of-llcs-and-corporations-need-to-know)

[Dond1959]

But not always. At the Philosophy Club lecture, the speaker mentioned something called piercing the corporate veil.

Piercing the Corporate Veil: LLC & Corporation Risks | Wolters Kluwer (https://www.wolterskluwer.com/en/expert-insights/piercing-the-veil-of-small-business-what-the-owners-of-llcs-and-corporations-need-to-know)

Directly from your article under Conclusion:
By incorporating or forming an LLC, businessmen and women should be able to limit their personal liability to their investment.

Is anything in the world 100%, no of course not. But it is very, very unlikely there will be any personal liability to the main owners or the developers other businesses. So there should be no impact to future development or other businesses. I know a lot of people want to see the developers main representatives burn in hell, but unfortunately for them it’s not going to happen.

[golfing eagles]

It probably will be - or deleted - but I hope not. I'm not trying to stir up controversy here, and everyone should be entitled to his/her own opinion.

While the Villages is a great place to live and the Developer has provided a wonderful community for many - and should be handsomely rewarded for it - my personal view is that they're also taking advantage of some "Midwest nice" naivety and incredibly bullying, often to their own customers and advocates (SEE: Bogus Drone Cease and Desist Letters). And when a party owes $300M to the federal government which is only self-reports months after a newly formed Department of Government Efficiency gains "access to key data systems within Health and Human Services, including Medicare and Medicaid records, as it looks for waste and fraud in federal health spending" and then sells off a major asset before filing for bankruptcy protection, that's a bit of smoke worth investigating - especially when it may have longer term impact on both home values and the quality/cost of maintenance services ongoing.

Again, just my two cents.

EXCEPT:

1) Something happened. Whatever it was, and it going to be a factual event. "Opinion" won't matter

2) TVH self-reported well, before DOGE was even formed.

[golfing eagles]

I put the over-under for this thread to be locked at 4:00 PM EST 8/18/25.

43 minutes to go. Did you take the over or under?????

[collie1228]

Lots of speculation and “what-if’s” in the post.

[collie1228]

I won’t bet the over/under, but I will bet that Mark Morse won’t have a live presentation to residents this year.

[HappyTraveler]

Notably, UnitedHealthCare’s filing goes further in characterizing blame: it states that TVHS “admitted to the submission of incorrect information” to insurers and has a “record of corporate misbehavior." UHC points out that the same individuals who own The Villages (the Morse family) also own and control TVHS, insinuating that the development owners were in a position to direct or permit the practices that led to the overbilling.

Well, I'll just add this. Have a friend here who in the course of a regular annual exam or something specific, I don't know - they wanted to scan his lungs because he used to be employed in the chemical industry.

Not a bad idea to do that but, he was surprised when he looked at his later billing or records and noticed they'd stated he had previously smoked for 25 years. When, in fact, he had only smoked for 5. When he inquired about that inaccuracy, they implied that it was for his benefit so that the scans would be covered by insurance.

Hhmm, not really, it was for their benefit. Billing....

[ScottFenstermaker]

Contrary to some of the earlier posts, utilizing an LLC will not protect its owners from criminal and civil liability in case of fraud. For example, Bernie Madoff's company was an LLC, and he ended up with a 150-year prison sentence and a huge civil judgment.

[Haggar]

Very detailed post. However, you forgot to define what an LLC means:
Definition of LLC
A Limited Liability Company (LLC) is a specific type of business structure in the United States that combines elements of both corporations and partnerships.
Key Features
Limited Liability: Owners, known as members, are protected from personal liability for the company's debts and obligations. This means that personal assets are generally safe from business creditors.
Pass-Through Taxation: LLCs typically do not pay federal taxes at the entity level. Instead, profits and losses are passed through to the members, who report them on their personal tax returns.
Flexibility: LLCs offer flexibility in management and organization. They can be managed by members or designated managers, and there are fewer formalities compared to corporations.

So, protection from personal liability. The main reason to set up an LLC.

LLC's can be reported to the IRS in the following manners:

If a single member LLC can be reported on a personal return.

If multiple members:

As a partnership - pass through taxation
As a S Corp - require less than 100 members - pass through taxation
As a C Corp - taxed at the corporate level by federal and states- then issues dividends which are then taxed to the members.

As to "piercing the corporate veil" can be done by any creditor in the following circumstances There may be more!

A co-mingling of personal and company assets and funds - the courts have held when this happens it blurs the distinction of a separate entity and so allows a "piercing"
In circumstance where the members have not executed due diligence or committed fraudulent or criminal practcies

[BrianL99]

Contrary to some of the earlier posts, utilizing an LLC will not protect its owners from criminal and civil liability in case of fraud. For example, Bernie Madoff's company was an LLC, and he ended up with a 150-year prison sentence and a huge civil judgment.

The talk of an LLC shielding the owners, is nonsense.

The legalese mantra is "piercing the corporate veil", as was pointed out.

There are some actions that are commonly used to pierce the corporate veil. Intermingling of funds, similar board members/corporate officers, "insider trading (doing business with related entities") and breach of fiduciary responsibility.

Most every time the Morse family, the Developer or the various entities are described, writers seem to have the need to describe everything as "closely held" ... because they are closely held.

I don't think there's any way to predict where this is going to shake out, but you can be sure, no one is going to be completely protected by a LLC entity.

[Dond1959]

Contrary to some of the earlier posts, utilizing an LLC will not protect its owners from criminal and civil liability in case of fraud. For example, Bernie Madoff's company was an LLC, and he ended up with a 150-year prison sentence and a huge civil judgment.

No one is alleging fraud at this time. I know you are the head of the “burn them at the stake” club but it is laughable to think the Morse kids had any idea that this was occurring. I am sure they felt they had capable people running the Villages health care business but there were errors made in billing for a huge amount. None of us here have a clue on what HHS and United Healthcare will do, but the bankruptcy judge has a clear understanding of what will be done under a Ch 11. And it will not come back to the Morse family with any personal liability. If it does they need to fire all the legal counsel they have hired to keep them personally out of these types of messes.

[Aces4]

No one is alleging fraud at this time. I know you are the head of the “burn them at the stake” club but it is laughable to think the Morse kids had any idea that this was occurring. I am sure they felt they had capable people running the Villages health care business but there were errors made in billing for a huge amount. None of us here have a clue on what HHS and United Healthcare will do, but the bankruptcy judge has a clear understanding of what will be done under a Ch 11. And it will not come back to the Morse family with any personal liability. If it does they need to fire all the legal counsel they have hired to keep them personally out of these types of messes.

I also don't think the Morse adult offspring, (kids???) are as naive/innocuous as some would like to believe. I'll wait and see how this all shakes out.

[HappyTraveler]

No one is alleging fraud at this time. I know you are the head of the “burn them at the stake” club but it is laughable to think the Morse kids had any idea that this was occurring. I am sure they felt they had capable people running the Villages health care business but there were errors made in billing for a huge amount. None of us here have a clue on what HHS and United Healthcare will do, but the bankruptcy judge has a clear understanding of what will be done under a Ch 11. And it will not come back to the Morse family with any personal liability. If it does they need to fire all the legal counsel they have hired to keep them personally out of these types of messes.

...but it is laughable to think the Morse kids had any idea that this was occurring. It isn't remotely laughable and, imo, naive to think that they wouldn't know. In every company or organization the buck always stops at the top dogs desk. They have ultimate responsibility.

...they had capable people running the Villages health care
See comment #17. There's a big clue. Multiply that by many.

[spinner1001]

@OP -

Please post your AI prompt to get that AI response.

Biased prompts lead to biased AI results. Your AI result seems biased to me.

[josephchiro]

From AI deep research:

Potential Liability of Jennifer Parr & the Morse Family in The Villages Health Overbilling Case

Ownership Structure and Control of The Villages Health System: Bankruptcy filings confirm that The Villages Health System, LLC (TVHS) is closely held and controlled by the Morse family (developers of The Villages). In the Chapter 11 petition, Jennifer L. Parr (a member of the Morse family) is identified as a Manager of The Villages Health Holding Company, LLC – the majority owner of TVHS. Similarly, Mark G. Morse (Jennifer’s brother and a principal in the family business) signed the corporate resolutions both as a Board Member of TVHS and as a Manager of the holding company. These documents make clear that the same individuals behind The Villages development also own and control TVHS, which a court filing emphasizes is a “closely-held family-owned company." In short, the Morse family – through The Villages Health Holding Co. – has majority ownership and operational control over the health system.

Financial Relationship with The Villages Development: The bankruptcy case documents and related disclosures shed light on the intertwined financial relationship between TVHS and the Morse family’s development enterprise. UnitedHealthCare (UHC), the Medicare Advantage insurer for most TVHS patients, revealed in a court objection that it had a special arrangement with The Villages’ owners: UHC prepaid for exclusive rights to use The Villages’ branding and marketing via an affiliate of The Villages (the developer). This indicates that the Morse family’s companies benefited financially from TVHS’s operations by licensing the community’s name and logo. Additionally, public reports suggest that many of the clinics and facilities were built by The Villages’ developer and then leased to TVHS, meaning the health system was effectively paying rent to its owners’ affiliated real estate business. Such self-dealing arrangements underscore how deeply enmeshed the health system’s finances are with the Morse family’s broader business interests.

Disclosures of Overbilling and Alleged Responsibility: In late 2024, The Villages Health System self-reported a massive Medicare billing problem: an internal investigation found that TVHS had logged patient diagnoses that “were not clinically supported or otherwise did not meet Medicare coding and payment guidance,” leading to hundreds of millions in improper payments. By the time of the Chapter 11 filing (July 3, 2025), a preliminary analysis indicated overpayments of at least $350–361 million to TVHS. Court filings show the company openly acknowledged these errors and even notified patients about the issue. Notably, UnitedHealthCare’s filing goes further in characterizing blame: it states that TVHS “admitted to the submission of incorrect information” to insurers and has a “record of corporate misbehavior." UHC points out that the same individuals who own The Villages (the Morse family) also own and control TVHS, insinuating that the development owners were in a position to direct or permit the practices that led to the overbilling. In a striking assertion, UHC’s court submission warns that the Debtor’s officers, directors, and owners (i.e. the Morse family and Jennifer Parr) now “face hundreds of millions of dollars of liability” due to the false Medicare information submitted. This implies that beyond the company’s liability, those in control could be held personally or corporately responsible for the $361 million overbilling, at least in UHC’s view.

Potential Legal Exposures for Jennifer Parr and the Morse Family
Civil Liability and DOJ Inquiry: The bankruptcy documents make clear that federal authorities are involved. TVHS’s filings note it has been in communication with the U.S. Department of Justice (Civil Division) and the HHS Office of Inspector General regarding the overpayments. The company is working “toward a resolution with the U.S. government” to repay the approximately $361 million, which will likely include significant financial penalties. This suggests a potential False Claims Act civil action or similar, which can impose treble damages. While no lawsuit naming individual executives has been filed as of the filings, UHC’s allegation that the owners themselves face liability indicates that Jennifer Parr, Mark Morse, and other insiders could be targets of civil claims – either by the government under the False Claims Act (if they knew about or directed the false billing) or by private parties (such as UHC seeking indemnification). In sum, the civil exposure is substantial, and the DOJ’s involvement confirms that a federal investigation is ongoing (even if currently civil in nature). Any eventual settlement or judgment could potentially seek guarantees or contributions from those in control if misconduct is proven.

Criminal Liability: No direct evidence of a criminal investigation appears in the bankruptcy filings to date – references to DOJ have been explicitly to its civil division. The overbilling has been officially described as “erroneous” or based on misunderstandings of coding guidance, rather than an intentional fraud, and the company self-disclosed the issue. These factors suggest the matter is being handled as a civil regulatory breach. However, the magnitude ($361 million) of the improper claims raises the stakes. If future evidence were to show knowing or willful fraud (for example, if executives pressured clinicians to upcode diagnoses), the Morse family principals could conceivably face criminal health care fraud or false claims charges. So far, there is no indication in the court papers of a criminal referral, but the risk remains if new facts emerge. For now, the legal peril for Parr and the Morse family lies more in civil enforcement (with massive financial and reputational consequences) than in criminal prosecution.

Breach of Fiduciary Duty: As managers and controlling owners of the LLC, Jennifer Parr and the Morse family owed fiduciary duties to the company (and now, in bankruptcy, to its creditors). The court documents do not explicitly accuse them of breaching those duties, but certain facts invite scrutiny. The need to bring in “independent managers” and a new Chief Restructuring Officer to improve compliance after the overbilling was uncovered suggests that previous oversight by insiders was inadequate. If it is shown that the family-controlled board failed to implement proper auditing or compliance controls (allowing the false billing to continue for years), that could be viewed as a breach of their duty of care. Moreover, any self-dealing transactions are a red flag: for instance, if TVHS paid above-market rents or fees to Morse-controlled entities (benefiting the owners while the company racked up liabilities), a creditors’ committee or trustee could argue the insiders breached their duty of loyalty. In the ongoing bankruptcy, stakeholders may investigate whether the owners prioritized their own interests over the company’s solvency. Any such findings could lead to litigation against the Morse family for mismanagement or fiduciary lapses, though no lawsuit of that kind has been filed yet.

Fraudulent Conveyance Concerns: Thus far, the filings have not revealed any specific transfers of assets from TVHS to the owners pre-bankruptcy. However, given the enormous government claim and the family’s control, creditors will likely examine any pre-petition distributions or asset transfers to Morse-family entities. If, for example, significant profits from the overcoding years were upstreamed to The Villages Holding Company or related family trusts, those could be subject to clawback as fraudulent conveyances in bankruptcy (if made when TVHS was insolvent or intended to hinder creditors). Public observers have noted suspicious timing in the Morse family’s financial maneuvers – for instance, a large family-owned asset (a Villages-affiliated bank) was sold not long before the overbilling became public, prompting questions about whether this was done to isolate assets from potential forfeiture or liability. While this is speculative and not documented in the court record, it underscores the concern that any transfer benefiting the owners at the expense of TVHS’s creditors will face scrutiny. The bankruptcy court has strong powers to unwind fraudulent transfers, so if evidence emerges of such transactions, Jennifer Parr and her family could be forced to return funds to the estate.

Department of Justice and Regulatory Actions: In addition to the bankruptcy process, the Morse family must be mindful of parallel government actions. The DOJ civil inquiry (and involvement of HHS OIG) means there is a risk of a False Claims Act case, which could theoretically name individuals (owners or executives) if they were complicit in the false billings. So far, TVHS’s cooperation and self-disclosure may be mitigating factors. Nevertheless, the overbilling is at a scale that has drawn federal attention, and the outcome could include a corporate integrity agreement or other oversight that affects the family’s control over any reorganized health business. If negotiations with DOJ do not resolve the liability, a civil suit could be filed. The Morse family also faces intense scrutiny from private creditors like UHC. UHC’s filings indicate it feels misled and left out, and it may pursue its own legal remedies to recover losses – potentially even alleging fraud or conspiracy involving TVHS leadership. All of these avenues mean Jennifer Parr and her relatives are not shielded simply by putting the company in bankruptcy; their decisions and any knowledge of the overbilling are under the microscope of federal investigators and creditors.

Conclusion
In summary, the bankruptcy documents portray The Villages Health System’s overbilling debacle as a liability largely resting with the company, but they also tie that company inextricably to the Morse family. Jennifer Parr, Mark Morse, and related insiders are documented as the ultimate decision-makers for TVHS, and even the firm’s long-time business partner (UHC) has alleged in court that these owners could personally face “hundreds of millions” in exposure for the false Medicare billings. While no filing to date outright accuses Parr or the Morse family of criminal wrongdoing, the evidence of massive billing irregularities and the close involvement of ownership raise the prospect of significant legal repercussions. They range from civil False Claims Act penalties and DOJ-driven settlements to potential breach of duty or fraudulent transfer claims in the bankruptcy. Any criminal liability would depend on proof of intent and is not asserted so far, but it remains a looming possibility given the scale of the fraud. Going forward, Jennifer Parr and the Morse family will likely be under significant legal pressure: they may need to contribute to any government settlement, justify past transactions, and demonstrate that they did not personally profit from or direct the improper billing. The court filings and exhibits thus far highlight their control over the health system and foreshadow a careful examination of whether that control was misused, making personal or corporate liability a very real concern as this case progresses. Sources: The Villages Health System LLC Chapter 11 Petition & Board Resolutions.


Sources:

The Villages Health Bankruptcy | PDF | Chapter 11 | Unsecured Debt
The Villages Health Bankruptcy | PDF | Chapter 11 | Unsecured Debt (https://www.scribd.com/document/884871596/The-Villages-Health-Bankruptcy)

United HealthCare highly suspicious of proposed sale of The Villages Health - **************.com
https://www.**************.com/2025/07/23/united-healthcare-highly-suspicious-of-proposed-sale-of-the-villages-health/

Bankruptcy of The Villages Health raises many questions - **************.com
https://www.**************.com/2025/08/07/bankruptcy-of-the-villages-health-raises-many-questions/

Villages Health System Sees $350 Million in Medicare Overcharges
Villages Health System Sees $350 Million in Medicare Overcharges (https://www.insurancejournal.com/news/southeast/2025/07/09/830964.htm)

Villages Health company, under fire for Medicare overpayments, files for Chapter 11 bankruptcy
Villages Health company, under fire for Medicare overpayments, files for Chapter 11 bankruptcy (https://www.clickorlando.com/news/local/2025/07/06/villages-health-company-under-fire-for-medicare-overpayments-files-for-chapter-11-bankruptcy/)


The doctors sign the office visit notes and are responsible for the charges to the patient/insurance company. They absolutely should know what level of care is necessary for the coding submitted.

[golfing eagles]

The doctors sign the office visit notes and are responsible for the charges to the patient/insurance company. They absolutely should know what level of care is necessary for the coding submitted.

Not even close to how it works for MA plans and TVH

[Kelevision]

My barber's ex-wife's sister's mechanic knows more than AI.

I'll wait for a good source.

:posting:

AI just wrote me an entire full length script with a pitch deck. I doubt your ex-wife’s sisters mechanic can do that. I think you should venture out into ChatGPT

[elle123]

From AI deep research:

Potential Liability of Jennifer Parr & the Morse Family in The Villages Health Overbilling Case

Ownership Structure and Control of The Villages Health System: Bankruptcy filings confirm that The Villages Health System, LLC (TVHS) is closely held and controlled by the Morse family (developers of The Villages). In the Chapter 11 petition, Jennifer L. Parr (a member of the Morse family) is identified as a Manager of The Villages Health Holding Company, LLC – the majority owner of TVHS. Similarly, Mark G. Morse (Jennifer’s brother and a principal in the family business) signed the corporate resolutions both as a Board Member of TVHS and as a Manager of the holding company. These documents make clear that the same individuals behind The Villages development also own and control TVHS, which a court filing emphasizes is a “closely-held family-owned company." In short, the Morse family – through The Villages Health Holding Co. – has majority ownership and operational control over the health system.

Financial Relationship with The Villages Development: The bankruptcy case documents and related disclosures shed light on the intertwined financial relationship between TVHS and the Morse family’s development enterprise. UnitedHealthCare (UHC), the Medicare Advantage insurer for most TVHS patients, revealed in a court objection that it had a special arrangement with The Villages’ owners: UHC prepaid for exclusive rights to use The Villages’ branding and marketing via an affiliate of The Villages (the developer). This indicates that the Morse family’s companies benefited financially from TVHS’s operations by licensing the community’s name and logo. Additionally, public reports suggest that many of the clinics and facilities were built by The Villages’ developer and then leased to TVHS, meaning the health system was effectively paying rent to its owners’ affiliated real estate business. Such self-dealing arrangements underscore how deeply enmeshed the health system’s finances are with the Morse family’s broader business interests.

Disclosures of Overbilling and Alleged Responsibility: In late 2024, The Villages Health System self-reported a massive Medicare billing problem: an internal investigation found that TVHS had logged patient diagnoses that “were not clinically supported or otherwise did not meet Medicare coding and payment guidance,” leading to hundreds of millions in improper payments. By the time of the Chapter 11 filing (July 3, 2025), a preliminary analysis indicated overpayments of at least $350–361 million to TVHS. Court filings show the company openly acknowledged these errors and even notified patients about the issue. Notably, UnitedHealthCare’s filing goes further in characterizing blame: it states that TVHS “admitted to the submission of incorrect information” to insurers and has a “record of corporate misbehavior." UHC points out that the same individuals who own The Villages (the Morse family) also own and control TVHS, insinuating that the development owners were in a position to direct or permit the practices that led to the overbilling. In a striking assertion, UHC’s court submission warns that the Debtor’s officers, directors, and owners (i.e. the Morse family and Jennifer Parr) now “face hundreds of millions of dollars of liability” due to the false Medicare information submitted. This implies that beyond the company’s liability, those in control could be held personally or corporately responsible for the $361 million overbilling, at least in UHC’s view.

Potential Legal Exposures for Jennifer Parr and the Morse Family
Civil Liability and DOJ Inquiry: The bankruptcy documents make clear that federal authorities are involved. TVHS’s filings note it has been in communication with the U.S. Department of Justice (Civil Division) and the HHS Office of Inspector General regarding the overpayments. The company is working “toward a resolution with the U.S. government” to repay the approximately $361 million, which will likely include significant financial penalties. This suggests a potential False Claims Act civil action or similar, which can impose treble damages. While no lawsuit naming individual executives has been filed as of the filings, UHC’s allegation that the owners themselves face liability indicates that Jennifer Parr, Mark Morse, and other insiders could be targets of civil claims – either by the government under the False Claims Act (if they knew about or directed the false billing) or by private parties (such as UHC seeking indemnification). In sum, the civil exposure is substantial, and the DOJ’s involvement confirms that a federal investigation is ongoing (even if currently civil in nature). Any eventual settlement or judgment could potentially seek guarantees or contributions from those in control if misconduct is proven.

Criminal Liability: No direct evidence of a criminal investigation appears in the bankruptcy filings to date – references to DOJ have been explicitly to its civil division. The overbilling has been officially described as “erroneous” or based on misunderstandings of coding guidance, rather than an intentional fraud, and the company self-disclosed the issue. These factors suggest the matter is being handled as a civil regulatory breach. However, the magnitude ($361 million) of the improper claims raises the stakes. If future evidence were to show knowing or willful fraud (for example, if executives pressured clinicians to upcode diagnoses), the Morse family principals could conceivably face criminal health care fraud or false claims charges. So far, there is no indication in the court papers of a criminal referral, but the risk remains if new facts emerge. For now, the legal peril for Parr and the Morse family lies more in civil enforcement (with massive financial and reputational consequences) than in criminal prosecution.

Breach of Fiduciary Duty: As managers and controlling owners of the LLC, Jennifer Parr and the Morse family owed fiduciary duties to the company (and now, in bankruptcy, to its creditors). The court documents do not explicitly accuse them of breaching those duties, but certain facts invite scrutiny. The need to bring in “independent managers” and a new Chief Restructuring Officer to improve compliance after the overbilling was uncovered suggests that previous oversight by insiders was inadequate. If it is shown that the family-controlled board failed to implement proper auditing or compliance controls (allowing the false billing to continue for years), that could be viewed as a breach of their duty of care. Moreover, any self-dealing transactions are a red flag: for instance, if TVHS paid above-market rents or fees to Morse-controlled entities (benefiting the owners while the company racked up liabilities), a creditors’ committee or trustee could argue the insiders breached their duty of loyalty. In the ongoing bankruptcy, stakeholders may investigate whether the owners prioritized their own interests over the company’s solvency. Any such findings could lead to litigation against the Morse family for mismanagement or fiduciary lapses, though no lawsuit of that kind has been filed yet.

Fraudulent Conveyance Concerns: Thus far, the filings have not revealed any specific transfers of assets from TVHS to the owners pre-bankruptcy. However, given the enormous government claim and the family’s control, creditors will likely examine any pre-petition distributions or asset transfers to Morse-family entities. If, for example, significant profits from the overcoding years were upstreamed to The Villages Holding Company or related family trusts, those could be subject to clawback as fraudulent conveyances in bankruptcy (if made when TVHS was insolvent or intended to hinder creditors). Public observers have noted suspicious timing in the Morse family’s financial maneuvers – for instance, a large family-owned asset (a Villages-affiliated bank) was sold not long before the overbilling became public, prompting questions about whether this was done to isolate assets from potential forfeiture or liability. While this is speculative and not documented in the court record, it underscores the concern that any transfer benefiting the owners at the expense of TVHS’s creditors will face scrutiny. The bankruptcy court has strong powers to unwind fraudulent transfers, so if evidence emerges of such transactions, Jennifer Parr and her family could be forced to return funds to the estate.

Department of Justice and Regulatory Actions: In addition to the bankruptcy process, the Morse family must be mindful of parallel government actions. The DOJ civil inquiry (and involvement of HHS OIG) means there is a risk of a False Claims Act case, which could theoretically name individuals (owners or executives) if they were complicit in the false billings. So far, TVHS’s cooperation and self-disclosure may be mitigating factors. Nevertheless, the overbilling is at a scale that has drawn federal attention, and the outcome could include a corporate integrity agreement or other oversight that affects the family’s control over any reorganized health business. If negotiations with DOJ do not resolve the liability, a civil suit could be filed. The Morse family also faces intense scrutiny from private creditors like UHC. UHC’s filings indicate it feels misled and left out, and it may pursue its own legal remedies to recover losses – potentially even alleging fraud or conspiracy involving TVHS leadership. All of these avenues mean Jennifer Parr and her relatives are not shielded simply by putting the company in bankruptcy; their decisions and any knowledge of the overbilling are under the microscope of federal investigators and creditors.

Conclusion
In summary, the bankruptcy documents portray The Villages Health System’s overbilling debacle as a liability largely resting with the company, but they also tie that company inextricably to the Morse family. Jennifer Parr, Mark Morse, and related insiders are documented as the ultimate decision-makers for TVHS, and even the firm’s long-time business partner (UHC) has alleged in court that these owners could personally face “hundreds of millions” in exposure for the false Medicare billings. While no filing to date outright accuses Parr or the Morse family of criminal wrongdoing, the evidence of massive billing irregularities and the close involvement of ownership raise the prospect of significant legal repercussions. They range from civil False Claims Act penalties and DOJ-driven settlements to potential breach of duty or fraudulent transfer claims in the bankruptcy. Any criminal liability would depend on proof of intent and is not asserted so far, but it remains a looming possibility given the scale of the fraud. Going forward, Jennifer Parr and the Morse family will likely be under significant legal pressure: they may need to contribute to any government settlement, justify past transactions, and demonstrate that they did not personally profit from or direct the improper billing. The court filings and exhibits thus far highlight their control over the health system and foreshadow a careful examination of whether that control was misused, making personal or corporate liability a very real concern as this case progresses. Sources: The Villages Health System LLC Chapter 11 Petition & Board Resolutions.


Sources:

The Villages Health Bankruptcy | PDF | Chapter 11 | Unsecured Debt
The Villages Health Bankruptcy | PDF | Chapter 11 | Unsecured Debt (https://www.scribd.com/document/884871596/The-Villages-Health-Bankruptcy)

United HealthCare highly suspicious of proposed sale of The Villages Health - **************.com
https://www.**************.com/2025/07/23/united-healthcare-highly-suspicious-of-proposed-sale-of-the-villages-health/

Bankruptcy of The Villages Health raises many questions - **************.com
https://www.**************.com/2025/08/07/bankruptcy-of-the-villages-health-raises-many-questions/

Villages Health System Sees $350 Million in Medicare Overcharges
Villages Health System Sees $350 Million in Medicare Overcharges (https://www.insurancejournal.com/news/southeast/2025/07/09/830964.htm)

Villages Health company, under fire for Medicare overpayments, files for Chapter 11 bankruptcy
Villages Health company, under fire for Medicare overpayments, files for Chapter 11 bankruptcy (https://www.clickorlando.com/news/local/2025/07/06/villages-health-company-under-fire-for-medicare-overpayments-files-for-chapter-11-bankruptcy/)
So will these criminals repay the $350 million stolen in their Medicare fraud scheme? Will they be appropriately prosecuted considering the magnitude of this fraud? Let's see how it all plays out.

[BrianL99]

AI just wrote me an entire full length script with a pitch deck. I doubt your ex-wife’s sisters mechanic can do that. I think you should venture out into ChatGPT

& our Grandparents didn't think rock & roll would last.

... we thought Rap wouldn't last.

[asianthree]

I won’t bet the over/under, but I will bet that Mark Morse won’t have a live presentation to residents this year.

He wasn’t in person last year. There was only a video, which is the first time of no in person occurrence.

[Cliff Fr]

You might want to research what happened with Rick Scott's medicare fraud situation.

[golfing eagles]

So will these criminals repay the $350 million stolen in their Medicare fraud scheme? Will they be appropriately prosecuted considering the magnitude of this fraud? Let's see how it all plays out.

Interesting, EXCEPT:

They are NOT criminals
They did NOT "steal" anything
There is NO accusation of fraud except on TOTV
There is NO prosecution planned

Amazing where some people get their bizarre ideas from

[Ellwoodrick]

My complements to Idlewild. Something not often found on TOV a well thought out, well researched and well written Post.

Just had to say.....

[golfing eagles]

My complements to Idlewild. Something not often found on TOV a well thought out, well researched and well written Post.

Just had to say.....

Except, AI is just a very sophisticated computer program, so as the old saying goes---"Garbage in, garbage out"

[Ken D.]

I did not see any political references in the OP.
So, who owns Talk of The Villages platform?

[revfiddle]

Thanks for posting. Interesting, and will have implications for all in the TV.

[Rocksnap]

OP
Wow! Thanks for your thorough and informative detective work. I’m not looking for anyone to get into trouble. It will be interesting just how this whole thing unfolds. And even more interesting how the Bank side of things was sold off just before this whole thing was announced. That alone appears to look like guilt. As you would think that aspect would be a tightly held money/deal maker for the TV machine.
There are a lot of moving parts here. It will be interesting just how this all unfolds. I’m thinking the Morse family has a little pucker factor going on right now.

[ZPaul]

Bad timing for this problem to come up given the weaker real estate market. Sale of banking assets improved liquidity of developer family. Having worked in Healthcare finance, regulations are more complex than the IRS rules and as subject to interpretation. Much bigger operators have run into similar problems. Attempt to sell healthcare operations always triggers buyer's due diligence reviews. Due diligence process tries to dig up any potential problems so buyer will not need to deal with them. Normal on healthcare acquisition to question all medicare/medicaid reimbursement filings and look for anything that could be interpreted as subject to challenge. The Morse family got in way over their heads getting into healthcare. The fact that they tried to sell the operation pretty much proves that they were not aware of the issues. It would most likely never have been detected without the due diligence process. Biggest concern right now is a very large bill suddenly due at a time when cashflow from new development is weak.

Existing village operations should be safe as they are organized into resident owned homes and common areas owned by Districts. These entities are legally independent and are not involved in the Healthcare dispute. Potential impact on new development areas where developer cash problems could slow down lot sales/construction and buildout of promised common areas, although new common areas partly shielded by Development District structure. Unlikely to be able to do any new Development District Bonds until everything sorted out since bondholders hate uncertainty.

[Rainger99]

Not even close to how it works for MA plans and TVH

If that is not how it works, can you explain how it works?

It appears to be very complicated and it even appears that TVH didn’t understand how it works or they wouldn’t be in Chapter 11.

[Annie66]

Except, AI is just a very sophisticated computer program, so as the old saying goes---"Garbage in, garbage out"

It's so easy to throw shade. How about explaining specifically what you saw in his post that was objectionable or false?

[Annie66]

Just speculating here ..... Is it conceivable that the Morse family will have to sell off other segments of The Village's infrastructure to pay off a possible civil judgement against them? What negative impact(s) do you think would affect our quality of life?

[Justputt]

Not even close to how it works for MA plans and TVH

Actually, it's pretty close. There's a professional (doctor) and technical (facility) component to billing in many cases (some have prof or tech only). The doctor makes the diagnosis and determines the course of care, consult notes, treatment plan, etc. that are used to obtain the prior authorization, when needed. For there to be this much money involved this would almost have to be a systemic problem. On the other hand, if this is a coding dispute, this could be a greedy auditor trying to get a percentage of the recovered billing. Before I retired, "Medicare" claimed we improperly used a treatment technique known as IMRT on nearly all our cases, so we had a RAC audit, and they wanted to claw back virtually all the money. We appealed all the cases and only lost one that was a close call on medical necessity. The key is having 100% of the supporting documentation before ever submitting a charge. We had weekly charge reviews where staff looked at every charge to make sure it fit and there was supporting documentation.

[golfing eagles]

If that is not how it works, can you explain how it works?

It appears to be very complicated and it even appears that TVH didn’t understand how it works or they wouldn’t be in Chapter 11.

I'd love to but it would take hours of typing. The short version is that the doctors don't code CPT, just ICDM-10. They are employees who would benefit very little from making patients appear sicker than they really are. In addition, to suggest that 60 or 70 doctors could agree upon a criminal plan to defraud Medicare is insane---you put 10 doctors in a room and ask what 1 + 1 equals, you get 10 different answers. The ICDM-10 codes (7 digits with 2-digit modifiers) are absolutely ridiculous, very vague, and basically designed by government and insurance industry bean counters who have no idea about medicine but are collecting "data" for God knows what purpose. The majority of TVH patients have Medicare Advantage plans form either UHC or Florida Blue, which pays them a monthly stipend for each patient, and is adjusted for risk and severity of illnesses. CMS then pays the MA intermediary. But also realize that TVH is an ACO, which means when you go to, let's say the dermatologist, their fee comes out of TVH's pocket. So maybe people can understand if TVH might be unhappy with any dermatology practice that charges them triple the going rate. (hint, hint)

I have no idea what actually took place, but I highly doubt some type of widespread criminal conspiracy.

Now, what are the realistic possibilities?

Providers may have told to code as aggressively as possible without violating what they believe to be the correct guidelines. However, TVH has outside consultants look at their charges on a regular basis so this very issue does not occur, but apparently that didn't work out too well. Once negotiations for an acquisition by Humana took place, there may have been a difference of opinion as to coding methodology, which triggered self-reporting to CMS, MONTHS BEFORE DOGE EVEN EXISTED. Based on 35 years experience, this is my favored option

Somebody much higher on the TVH food chain was able to enter diagnoses and billing codes that were not supported by the documentation. But such a person would have to have a WHOLE LOT to gain considering the downside risk since that would be a fraudulent criminal act.

There is a remote possibility that there was a systemic computer glitch that resulted in overbilling---but I find this the least likely.

So, bottom line, I don't know, no one posting on TOTV knows, and we will just have to wait to see the eventual outcome. But my main reason for posting so audaciously is that I find it disingenuous to accuse any party of criminal fraud based on uniformed speculation and lead the "torches and pitchforks" brigade. like some on this site continue to do, although I acknowledge that most of them are just parroting what they have heard and read from others

[Bill14564]

It's so easy to throw shade. How about explaining specifically what you saw in his post that was objectionable or false?

That was a very, very long post. To explain specifically what, if anything, was incorrect would require knowing details of the situation that have either not been made public or are difficult to understand.

What I am concerned about is using AI as an authoritative source. AI doesn't think, AI regurgitates and amplifies. AI doesn't analyze multiple sources to determine what the truth is, AI generates words that are consistent with the sources it has ingested. If the data it has ingested is accurate then the words it generates have a good chance of being accurate. If the data it has ingested is inaccurate, incomplete, or just speculation then the words it generates will be inaccurate, incomplete, or just plain wrong (garbage in, garbage out).

AI also amplifies. It puts words together into meaningful sentences that answer a question. If details are missing or if it needs an example it will create sentences to add those. The additional sentences will be on topic and will look correct but they are amplification of the sources, not the results of critical thinking. As has been seen in reporting on some AI-generated court filings and research papers, the AI output can be pure hallucination.

As a starting point for follow-on, in-depth research, an AI-generated post is great.

As an assertion to be taken as fact, an AI-generated post is concerning.

[golfing eagles]

Actually, it's pretty close. There's a professional (doctor) and technical (facility) component to billing in many cases (some have prof or tech only). The doctor makes the diagnosis and determines the course of care, consult notes, treatment plan, etc. that are used to obtain the prior authorization, when needed. For there to be this much money involved this would almost have to be a systemic problem. On the other hand, if this is a coding dispute, this could be a greedy auditor trying to get a percentage of the recovered billing. Before I retired, "Medicare" claimed we improperly used a treatment technique known as IMRT on nearly all our cases, so we had a RAC audit, and they wanted to claw back virtually all the money. We appealed all the cases and only lost one that was a close call on medical necessity. The key is having 100% of the supporting documentation before ever submitting a charge. We had weekly charge reviews where staff looked at every charge to make sure it fit and there was supporting documentation.

Sorry, but wrong. What was described isn't far off for procedures like an MRI, where there is in fact a technical and professional component. But that in no way applies to the E&M codes used in primary care and other specialties. Furthermore , those E&M codes apply to billing for traditional Medicare, but not for Medicare Advantage Plans which are capitated. Please don't contribute to the plethora of misinformation already floating around this site.

[biker1]

The Villages (aka "the developer") essentially owns the commercial properties, the Championship Golf Courses, and the amenities (rec centers, executive golf, pools, pickleball courts, etc.) that have not yet been sold to the CDDs. These amenities are in the newer sections as it takes a couple of years before the CDDs take ownership. Pretty much everything else is under the control of the CDDs or County.

Just speculating here ..... Is it conceivable that the Morse family will have to sell off other segments of The Village's infrastructure to pay off a possible civil judgement against them? What negative impact(s) do you think would affect our quality of life?

[golfing eagles]

It's so easy to throw shade. How about explaining specifically what you saw in his post that was objectionable or false?

Simple, 2 letters----AI

Again, AI is not an authoritarian source, it is a computer program, and I stand by my post----garbage in, garbage out. Not in all cases, but how can we know the difference?

[drducat]

What is concerning is the lack of movement with the negotiations with DOJ and CMS. The penalties involved are could exceed $500 million to a billion alone...time will tell. The we have United stirring the pot also. The rush needed is to maintain the assets ( patients) will leave during next Medicare Advantage sign up period.

[MandoMan]

Thanks for your post!
A great many hospitals, nursing homes (Yes, including you, Rick Scott), and doctors’ offices have been upcoding for decades. I think it was around 1983 that the government began reviewing the days patients stayed in the hospital and denying bills when patients were in the hospital longer than they needed to be. (My father-in-law was Chief of Medicine at a large hospital at the time, and I well remember the conversations about it around the dinner table.)

“ The federal government's involvement in influencing hospital length of stay to control costs began in earnest with the implementation of the Inpatient Prospective Payment System (IPPS) for Medicare in 1983.
Prior to this, hospitals were reimbursed on a retrospective cost basis, which meant they were paid for whatever they spent. This system offered little incentive to control costs, leading to rapidly increasing healthcare expenditures.
The IPPS, utilizing Diagnosis-Related Groups (DRGs), shifted the payment model to a prospective system. Under this system, hospitals receive a fixed payment for a patient's entire hospital stay, based on the DRG assigned to the patient's illness or procedure. If the hospital discharges the patient before exhausting the Medicare payment, they keep the difference. Conversely, if the hospital's expenses exceed the fixed payment, they must absorb the additional costs. This system incentivized hospitals to manage length of stay more efficiently to avoid exceeding the DRG-based payment and ensure their financial viability.” This is why your hospital wants to send you home as soon as possible.

Hospitals and doctors suddenly found their profits evaporating. They had two options, and many or most used both. One was upcoding diagnoses and the treatment provided. The other was itemizing bills. Hospital managers and doctors attended thousands of seminars about the latest ways to do this and what codes to use that were less likely to be denied. If you actually looked at an itemized statement of a hospital bill, you might discover that you were being billed $10 for a 25¢ box of tissues or $20 for an aspirin taken from a bottle. A bottle of IV fluid, essentially water with sugar or salt or something in it, might be billed at up to $1,000 when the hospital actually pays $20 for it. As insurance companies caught on and questioned bills, new upcoding codes were found and used. I think that is essentially what was done here at The Villages. Upcoded codes were used and paid for by the government, and of course this upcoding is always fraudulent, even if it isn’t questioned. If a company realizes it is likely to be found out, it may confess.

On the other hand, consider this. The Villages Health System might charge $5,000 for an MRI, which is about what other facilities are charging. However, that doesn’t mean the government is actually paying it. I’ve had several MRIs and CT scans here and other places in the past five years, and Medicare and my Blue Cross/Blue Shield plans combined may pay $150 of that $5000 bill and refuse to let me be billed for the rest. I had a major surgery this year with a total bill of $130,000. The hospital and doctors received only $15,000! Now, the hospital submitted a detailed and outrageous list of charges. But Medicare said “We’re giving you this and no more.” So the itemized list meant nothing. And this included using that super expensive Da Vinci Robot and everything.

Consider that the Villages Health System was upcoding, but it was also struggling with the fact that most of its patients are on Medicare or Medicare Advantage Plans, so it can be hard to pay the bills.

Remember, this is Chapter 11 bankruptcy. The company isn’t broke. It’s just trying to get some space and time and protection from creditors to readjust and survive. Those buildings and services will still be there.

[golfing eagles]

What is concerning is the lack of movement with the negotiations with DOJ and CMS. The penalties involved are could exceed $500 million to a billion alone...time will tell. The we have United stirring the pot also. The rush needed is to maintain the assets ( patients) will leave during next Medicare Advantage sign up period.

Do we even know if the $361 million number being floated already includes interest and penalties?

And do we know what's the level of involvement of DOJ, if any????

[Joecooool]

The family will make a golden statue, and this will all go away.

It's a big club, and you ain't in it.

[TomSpasm]

I will say that I was always amazed at the number of issues documented, sometimes the same issue documented more than once, on my Villages Health records, making it seem like I was a total wreck when I was actually doing very well.

[biker1]

I am no longer a patient of The Villages Health (PCP) because I had to leave when I turned 65 and did not opt for a Medicare Advantage Plan. Otherwise, I would still be a patient as I was happy with my PCP. It isn't clear to me that a significant number of people will leave during the next Medicare Advantage open season. Since you pretty much need a PCP for Medicare Advantage, I guess some people might think that the whole operation will collapse and I better leave now and find a new PCP before the onslaught of people looking for new PCPs. I suspect most people will stay the course and continue with The Villages Health until forced to make a change.

What is concerning is the lack of movement with the negotiations with DOJ and CMS. The penalties involved are could exceed $500 million to a billion alone...time will tell. The we have United stirring the pot also. The rush needed is to maintain the assets ( patients) will leave during next Medicare Advantage sign up period.

[Rainger99]

Simple, 2 letters----AI

Again, AI is not an authoritarian source, it is a computer program, and I stand by my post----garbage in, garbage out. Not in all cases, but how can we know the difference?

AI may not be authoritative - but the website that has all of the TVH bankruptcy filing uses AI to summarize the documents.

And major companies are spending billions to develop AI. There must be something there!

[Jerry101]

My barber's ex-wife's sister's mechanic knows more than AI.

I'll wait for a good source.

:posting:

… does the mechanic work on golf carts?!?!? Will he come to my home?!?!? 🏡

[Rainger99]

CMS then pays the MA intermediary. But also realize that TVH is an ACO, which means when you go to, let's say the dermatologist, their fee comes out of TVH's pocket. So maybe people can understand if TVH might be unhappy with any dermatology practice that charges them triple the going rate.

So, bottom line, I don't know, no one posting on TOTV knows,

Thanks for the explanation. However, you mentioned a new term - ACO which is an Accountable Care Organization. I had never heard of that term until your post so I had to google it.

How does that affect payments from Medicare or UHC??

[golfing eagles]

AI may not be authoritative - but the website that has all of the TVH bankruptcy filing uses AI to summarize the documents.

And major companies are spending billions to develop AI. There must be something there!

Of course there's something there-----$$$$$

Now, is the product all it's cracked up to be? We'll see. But for now it's just regurgitating bits and pieces of an internet search and piecing it together in a nice package with a bow. But is it accurate? Depends. Again, garbage in, garbage out.

As far as spending billions in R&D, I give you the Edsel, Solyndra and Betamax:1rotfl::1rotfl::1rotfl:

[Justputt]

Sorry, but wrong. What was described isn't far off for procedures like an MRI, where there is in fact a technical and professional component. But that in no way applies to the E&M codes used in primary care and other specialties. Furthermore , those E&M codes apply to billing for traditional Medicare, but not for Medicare Advantage Plans which are capitated. Please don't contribute to the plethora of misinformation already floating around this site.

The wording below by Luria is vague enough "did not appear to be supported by a sufficiently documented clinical basis" that this could be more about a lack of documentation than incorrect entries. We won't know until there are more details presented. I also wonder how much this has to do with the changes made in 2018, 2021, etc. regarding documentation and whether the entire staff kept up with the changes. I know from nearly 40 years in radiation oncology there are more than a small number of people that have different options on coding matters.
Outpatient E/M Coding Simplified | AAFP (https://www.aafp.org/pubs/fpm/issues/2022/0100/p26.html)

Lastly, in the physician groups I've worked with, they not only selected the ICD code, but they also itemized the codes that would be charged (both for pre-auth and giving the patient their good faith estimates for care) as well as dictated the documentation justifying all charges.

"TVH Chief Restructuring Officer Neil Luria said in a July 3 court filing that last year the company hired outside law firms and FTI Consulting Inc. to evaluate the accuracy of the health-care provider’s coding and to investigate any potential over-payments related to Medicare.

That investigation “identified codes TVH submitted that did not appear to be supported by a sufficiently documented clinical basis,” Luria said. The inquiry also identified amendments to patient medical records “appear to have been inconsistent with [the Centers for Medicare and Medicaid Services] guidance and based on a misunderstanding of the relevant guidance on medical record amendments, including when it is appropriate to amend a patient record more than 90 days after an encounter,” he said."

[golfing eagles]

Thanks for the explanation. However, you mentioned a new term - ACO which is an Accountable Care Organization. I had never heard of that term until your post so I had to google it.

How does that affect payments from Medicare or UHC??

It defines which entities are taking the risk and what set of Draconian rules they must follow. I believe they in turn have to pay the subspecialty consults out of their own pocket (part of the assumed risk) This is one reason (hypothetically) that they are unhappy about what a certain practice was (over)charging them for services rendered.

[Ponygirl]

I am so sorry to ask this perhaps dumb question

So TVH did not accept Medicare patients then shouldn’t they be charging the private MA insurers for patient care not Medicare

I apologize in advance if this is a ridiculous question

[golfing eagles]

The wording below by Luria is vague enough "did not appear to be supported by a sufficiently documented clinical basis" that this could be more about a lack of documentation than incorrect entries. We won't know until there are more details presented. I also wonder how much this has to do with the changes made in 2018, 2021, etc. regarding documentation and whether the entire staff kept up with the changes. I know from nearly 40 years in radiation oncology there are more than a small number of people that have different options on coding matters.
Outpatient E/M Coding Simplified | AAFP (https://www.aafp.org/pubs/fpm/issues/2022/0100/p26.html)

Lastly, in the physician groups I've worked with, they not only selected the ICD code, but they also itemized the codes that would be charged (both for pre-auth and giving the patient their good faith estimates for care) as well as dictated the documentation justifying all charges.

"TVH Chief Restructuring Officer Neil Luria said in a July 3 court filing that last year the company hired outside law firms and FTI Consulting Inc. to evaluate the accuracy of the health-care provider’s coding and to investigate any potential over-payments related to Medicare.

That investigation “identified codes TVH submitted that did not appear to be supported by a sufficiently documented clinical basis,” Luria said. The inquiry also identified amendments to patient medical records “appear to have been inconsistent with [the Centers for Medicare and Medicaid Services] guidance and based on a misunderstanding of the relevant guidance on medical record amendments, including when it is appropriate to amend a patient record more than 90 days after an encounter,” he said."

Now that post I pretty much agree with. And therein lies the problem---rules and guidelines that are subject to interpretation. Always a formula for problems. When you get caught driving 50 in a 35 zone, the facts are the facts. When the law specifies a mandatory $300 fine, that's it. But when you use the ICDM-10 code for "former smoker", it opens a whole can of worms---how many years smoking?, how long ago did they quit?, how many packs/day?, any COPD?, any thin section chest CT indicated?, how often?. And they key question: Was it "documented". Bottom line: a thousand thing happen in a routine office visit and nobody can "document" them all, which leads to the secondary issue----the idiotic assertion forced on the medical profession by bureaucrats, lawyers and insurance companies---if it wasn't written, it didn't happen. NONSENSE. I shaved this morning. I didn't write it down, so therefore I didn't shave???

So, bottom line, all the hoopla comes down to who wrote what, who interpreted which guideline correctly, which reviewers and bureaucrats are involved and whether or not there was any intent involved.

Everyone seems to want a crucifixion, except maybe the people who are alive and well today because of TVH.

[Rainger99]

I am so sorry to ask this perhaps dumb question

So TVH did not accept Medicare patients then shouldn’t they be charging the private MA insurers for patient care not Medicare

I apologize in advance if this is a ridiculous question

I have the same question. I can’t figure out why Medicare was overcharged. It seems that the advantage insurers were the ones that were overcharged. Although no one has explained whether increasing RAF scores increases payments to UHC or to TVH of to both.

[Rainger99]

I contacted UHC to get my RAF score and they told me to contact TVH. I contacted TVH and they told me that they don’t calculate RAF scores. I have not contacted Medicare but google says that they don’t tell you your score!

I am in excellent health. Yearly physical and I see a dermatologist about twice a year (although my wife thinks I have an unhealthy obsession with the internet).

I think I should be a 1 RAF (or lower) but if they don’t tell me the score, how can I know if I am being upcoded?

Does anyone know how to get an RAF score?

[Bill14564]

I contacted UHC to get my RAF score and they told me to contact TVH. I contacted TVH and they told me that they don’t calculate RAF scores. I have not contacted Medicare but google says that they don’t tell you your score!

I am in excellent health. Yearly physical and I see a dermatologist about twice a year (although my wife thinks I have an unhealthy obsession with the internet).

I think I should be a 1 RAF (or lower) but if they don’t tell me the score, how can I know if I am being upcoded?

Does anyone know how to get an RAF score?

Honest question that should require some introspection: What would you do with the score if you had it?

Would you tell Medicare that they recorded it incorrectly?
Would you tell your MA plan that they calculated it incorrectly?
Would you tell your physicians that they documented (coded) your care incrorrectly?
Are you qualified to do any of the above?

You get a yearly physical and see a dermatologist twice a year. I get a yearly physical but don't see a dermatologist at all. Given that you visit an office three times as often as I do (or more if you have to contact the PCP for the dermatologist referral) shouldn't your score be higher than mine? I honestly don't know the answer to that which is why I would not think to ask about my score.

[golfing eagles]

I contacted UHC to get my RAF score and they told me to contact TVH. I contacted TVH and they told me that they don’t calculate RAF scores. I have not contacted Medicare but google says that they don’t tell you your score!

I am in excellent health. Yearly physical and I see a dermatologist about twice a year (although my wife thinks I have an unhealthy obsession with the internet).

I think I should be a 1 RAF (or lower) but if they don’t tell me the score, how can I know if I am being upcoded?

Does anyone know how to get an RAF score?

No. But let me pose this question: Is anyone paying more, OUT OF POCKET, based upon a higher RAF??? Because under such a system, I want way more than a safe driver discount since I have never been in an accident in 50 years of driving. I want cheaper beer since I don't abuse it. I want zero school tax since I don't have kids in schools. Etc, etc.

Bottom line, this is a very complex (and unnecessary) system that basically functions as an employment vehicle for thousands of petty functionaries in the Federal Government. So no one should counter that they are paying more because of so-called "fraud" (which isn't the case with TVH) when they are supporting the salaries of thousands of useless workers who nitpick medical records that they couldn't possibly understand to justify their own existence. They will ALWAYS find something. Sort of like they phrase "I'm here from OSHA and I'm here to help". Get your checkbook ready if you ever hear that.

[golfing eagles]

Honest question that should require some introspection: What would you do with the score if you had it?

Would you tell Medicare that they recorded it incorrectly?
Would you tell your MA plan that they calculated it incorrectly?
Would you tell your physicians that they documented (coded) your care incrorrectly?
Are you qualified to do any of the above?

You get a yearly physical and see a dermatologist twice a year. I get a yearly physical but don't see a dermatologist at all. Given that you visit an office three times as often as I do (or more if you have to contact the PCP for the dermatologist referral) shouldn't your score be higher than mine? I honestly don't know the answer to that which is why I would not think to ask about my score.

Exactly! It is useless, extraneous information for the medical consumer that really doesn't involve or impact them. I doubt that CMS, an MA plan, or TVH would waste time and resources to have a method of informing them of a score that really isn't much of their business in the first place.

[BrianL99]

So, who owns Talk of The Villages platform?

It's not very hard to find that information, but I doubt the Moderators would find it appropriate for discussion on here.

[HappyTraveler]

It's not very hard to find that information, but I doubt the Moderators would find it appropriate for discussion on here.
Why not? It shouldn't be a secret. So, spill names, please.

[Rainger99]

Honest question that should require some introspection: What would you do with the score if you had it?

Would you tell Medicare that they recorded it incorrectly?
Would you tell your MA plan that they calculated it incorrectly?
Would you tell your physicians that they documented (coded) your care incrorrectly?
Are you qualified to do any of the above?

You get a yearly physical and see a dermatologist twice a year. I get a yearly physical but don't see a dermatologist at all. Given that you visit an office three times as often as I do (or more if you have to contact the PCP for the dermatologist referral) shouldn't your score be higher than mine? I honestly don't know the answer to that which is why I would not think to ask about my score.

The main reason is curiosity. I am curious to find out how healthy Medicare has me coded. I think I am in fantastic health but I would like to know if Medicare agrees with me. I would expect a less than 1.0 so if it were significantly higher than 1, I might ask Medicare to review my records to see if they are accurate. I believe in transparency.

Don't you like to know your credit score? It used to be difficult to get your credit rating, but it is much easier now. That is important because if there are mistakes, it really impacts you. Several years ago, I checked my credit rating and they had someone with a similar name but it wasn't me. I asked them to change it.

A week ago, I had never heard of RAF scoring. However, since RAF rating appears to be one of the major factors in TVH bankruptcy, I am concerned that my RAF might be inflated.

Also, I am in Advantage right now and I am considering moving to Medicare next year. However, if I have an elevated RAF score, it might prevent me from transferring.

I found this article on the internet. Check out how complicated it is!!

Diagnosis Coding for Value-Based Payment: A Quick Reference Tool | AAFP (https://www.aafp.org/pubs/fpm/issues/2018/0300/p26.html)

[Bill14564]

The main reason is curiosity. I am curious to find out how healthy Medicare has me coded. I think I am in fantastic health but I would like to know if Medicare agrees with me. I would expect a less than 1.0 so if it were significantly higher than 1, I might ask Medicare to review my records to see if they are accurate. I believe in transparency.

Don't you like to know your credit score? It used to be difficult to get your credit rating, but it is much easier now. That is important because if there are mistakes, it really impacts you. Several years ago, I checked my credit rating and they had someone with a similar name but it wasn't me. I asked them to change it.

A week ago, I had never heard of RAF scoring. However, since RAF rating appears to be one of the major factors in TVH bankruptcy, I am concerned that my RAF might be inflated.

Also, I am in Advantage right now and I am considering moving to Medicare next year. However, if I have an elevated RAF score, it might prevent me from transferring.

I found this article on the internet. Check out how complicated it is!!

Diagnosis Coding for Value-Based Payment: A Quick Reference Tool | AAFP (https://www.aafp.org/pubs/fpm/issues/2018/0300/p26.html)

My credit score affects my wallet, my RAF does not.
Things that affect my credit score are objective, things that affect my RAF are subjective. I can argue one but I’m not qualified to argue the other.

This is beyond what I have looked into but I believe RAF, a number used for reimbursing MA plans, has no meaning on “regular” Medicare.

[Rainger99]

My credit score affects my wallet, my RAF does not.
Things that affect my credit score are objective, things that affect my RAF are subjective. I can argue one but I’m not qualified to argue the other.

This is beyond what I have looked into but I believe RAF, a number used for reimbursing MA plans, has no meaning on “regular” Medicare.

It might not affect your wallet, but if they have you listed as a smoker and you are not, would you want to correct that?

And it might affect Medicare's wallet - which we are all paying for.

It would be nice if the doctor (or insurance company or medicare) showed you the records that they based your score on so that you could have some idea if they are accurate.

[Bill14564]

It might not affect your wallet, but if they have you listed as a smoker and you are not, would you want to correct that?

And it might affect Medicare's wallet - which we are all paying for.

It would be nice if the doctor (or insurance company or medicare) showed you the records that they based your score on so that you could have some idea if they are accurate.

No, I would not care (primarily because I would not know).

My being listed as a smoker would be a very, very small potato seed in the grand scheme of things. It may or may not be caught in an audit but the cost of finding and correcting it would be far more than the cost of the incorrect entry.

[Wrhobson]

It probably will be - or deleted - but I hope not. I'm not trying to stir up controversy here, and everyone should be entitled to his/her own opinion.

While the Villages is a great place to live and the Developer has provided a wonderful community for many - and should be handsomely rewarded for it - my personal view is that they're also taking advantage of some "Midwest nice" naivety and incredibly bullying, often to their own customers and advocates (SEE: Bogus Drone Cease and Desist Letters). And when a party owes $300M to the federal government which is only self-reports months after a newly formed Department of Government Efficiency gains "access to key data systems within Health and Human Services, including Medicare and Medicaid records, as it looks for waste and fraud in federal health spending" and then sells off a major asset before filing for bankruptcy protection, that's a bit of smoke worth investigating - especially when it may have longer term impact on both home values and the quality/cost of maintenance services ongoing.

Again, just my two cents.

So, they have somehow "misplaced" $361 million? That may be an indication of the altitude this family lives in.

[tophcfa]

No. But let me pose this question: Is anyone paying more, OUT OF POCKET, based upon a higher RAF???

I think the answer would be indirectly, it would be taxpayers like you and me???

[ScottFenstermaker]

Medicare law firm soliciting business in The Villages. I wonder if TVHS doctors are starting to lawyer up. Click here:

federal-lawyer.com | 520: Web server is returning an unknown error (https://federal-lawyer.com/healthcare/the-villages/)

[golfing eagles]

The main reason is curiosity. I am curious to find out how healthy Medicare has me coded. I think I am in fantastic health but I would like to know if Medicare agrees with me. I would expect a less than 1.0 so if it were significantly higher than 1, I might ask Medicare to review my records to see if they are accurate. I believe in transparency.

Don't you like to know your credit score? It used to be difficult to get your credit rating, but it is much easier now. That is important because if there are mistakes, it really impacts you. Several years ago, I checked my credit rating and they had someone with a similar name but it wasn't me. I asked them to change it.

A week ago, I had never heard of RAF scoring. However, since RAF rating appears to be one of the major factors in TVH bankruptcy, I am concerned that my RAF might be inflated.

Also, I am in Advantage right now and I am considering moving to Medicare next year. However, if I have an elevated RAF score, it might prevent me from transferring.

I found this article on the internet. Check out how complicated it is!!

Diagnosis Coding for Value-Based Payment: A Quick Reference Tool | AAFP (https://www.aafp.org/pubs/fpm/issues/2018/0300/p26.html)

If you want to know how healthy you are, it would be better to ask your doctor. I would not rely on some bureaucratically derived fudge number.

[golfing eagles]

I think the answer would be indirectly, it would be taxpayers like you and me???

Then read the sentences that followed that post

[golfing eagles]

It might not affect your wallet, but if they have you listed as a smoker and you are not, would you want to correct that?

And it might affect Medicare's wallet - which we are all paying for.

It would be nice if the doctor (or insurance company or medicare) showed you the records that they based your score on so that you could have some idea if they are accurate.

The place to correct that would be with your doctor and your chart, NOT Medicare.

[golfing eagles]

Medicare law firm soliciting business in The Villages. I wonder if TVHS doctors are starting to lawyer up. Click here:

federal-lawyer.com | 520: Web server is returning an unknown error (https://federal-lawyer.com/healthcare/the-villages/)

Doubt it. The physicians are employees, and only a few hold private shares in TVH, and then only for about 0.04%

[kkingston57]

My barber's ex-wife's sister's mechanic knows more than AI.

I'll wait for a good source.

:posting:

Assume that this is a court filing and is a public record.

[Rainger99]

The place to correct that would be with your doctor and your chart, NOT Medicare.

Does your doctor or insurance company give you a list of the codes that they file with Medicare?

[golfing eagles]

Does your doctor or insurance company give you a list of the codes that they file with Medicare?

Never looked, but since I’ve known him for 40 years, I don’t have to. Besides, I know all the applicable codes anyway

[ScottFenstermaker]

Doubt it. The physicians are employees, and only a few hold private shares in TVH, and then only for about 0.04%

Their exposure would be if they participated in illegal up coding.

[Caymus]

The main reason is curiosity. I am curious to find out how healthy Medicare has me coded. I think I am in fantastic health but I would like to know if Medicare agrees with me. I would expect a less than 1.0 so if it were significantly higher than 1, I might ask Medicare to review my records to see if they are accurate. I believe in transparency.

Don't you like to know your credit score? It used to be difficult to get your credit rating, but it is much easier now. That is important because if there are mistakes, it really impacts you. Several years ago, I checked my credit rating and they had someone with a similar name but it wasn't me. I asked them to change it.

A week ago, I had never heard of RAF scoring. However, since RAF rating appears to be one of the major factors in TVH bankruptcy, I am concerned that my RAF might be inflated.

Also, I am in Advantage right now and I am considering moving to Medicare next year. However, if I have an elevated RAF score, it might prevent me from transferring.

I found this article on the internet. Check out how complicated it is!!

Diagnosis Coding for Value-Based Payment: A Quick Reference Tool | AAFP (https://www.aafp.org/pubs/fpm/issues/2018/0300/p26.html)

I wonder who has access to RAF scores. Insurance companies? Advertisers? Data breaches are very common.

[shut the front door]

I won’t bet the over/under, but I will bet that Mark Morse won’t have a live presentation to residents this year.

Won't surprise me one bit. I also wasn't surprised when they dropped the annual survey. They simply don't care, and that is their right.

[tophcfa]

Medicare law firm soliciting business in The Villages. I wonder if TVHS doctors are starting to lawyer up. Click here:

federal-lawyer.com | 520: Web server is returning an unknown error (https://federal-lawyer.com/healthcare/the-villages/)

Never a good sign when the vultures start circling looking for road kill.

[Biskopski]

Thank you for this excellent summary and explanation of events.
Initial reports indicated that the overbilling took place from 2020 to 2024.
As a past business owner if my bottom line started showing extraordinary profits I would have investigated to see what change caused this additional income. So how can a successful company such as they, not have known where the extra profits were being reaped from? A prudent person would deduct they knew.

[idlewild]

@OP -

Please post your AI prompt to get that AI response.

Biased prompts lead to biased AI results. Your AI result seems biased to me.


"You said:
can you read this?
ChatGPT said:

I can’t directly open that ************** article link, but I can help in two ways:

If you paste the text of the article here, I can read and analyze it for

You said:
https://www.**************.com/2025/07/23/united-healthcare-highly-suspicious-of-proposed-sale-of-the-villages-health/
ChatGPT said:

Absolutely—I can read and interpret that article for you. Here's a breakdown of what it says and what it could mean:

Article Overview: “United HealthCare highly suspicious of proposed sale of The Villages Health”

Published: July 23, 2025 on **************.com

Key Highlights:

UnitedHealthcare’s Surprise and Lawsuit
UnitedHealthcare (UHC), once a close partner with The Villages Health, claims to have been blindsided by the sudden Chapter 11 bankruptcy filing on July 3. It says the timing and haste surrounding the filing felt strategic—not transparent.

**************.com
+2
LinkedIn
+2
**************.com
+2
**************.com
+2

Long-Standing Ties and Prepayments
The article outlines a decades-long relationship: UHC insured Medicare Advantage plans using The Villages’ branding and paid in advance for exclusive marketing and intellectual property licensing rights.

**************.com
**************.com
+1

Allegations of Corporate Misconduct
In its court filing, UHC accuses The Villages Health of a “record of corporate misbehavior,” referencing the system’s own admission that it submitted incorrect billing data to insurers. The federal government claims $361 million is owed due to Medicare overbilling—a central driver of the bankruptcy.

**************.com
+12
**************.com
+12
**************.com
+12

Alleged Exclusion from Key Processes
UHC asserts it might be the system’s largest non-government creditor, yet it was reportedly excluded from sale discussions. The insurer describes the lack of communication as "remarkable" and highly questionable.

**************.com
+9
**************.com
+9
**************.com
+9
**************.com
+1

Acceleration of the Sale Process
UHC implies the bankruptcy may have been engineered to push a rapid sale to Humana’s CenterWell, potentially shielding insiders (family ownership controlling both the developer and the health system) from liabilities tied to fraud allegations.

X (formerly Twitter)
+8
**************.com
+8
**************.com
+8

Analysis & What It Might Mean

Legal and Ethical Concern:
UHC’s tone and wording indicate deep distrust. The insurer believes the system may be deliberately hastening a sale to avoid deep legal or financial repercussions—and that key stakeholders, like UHC, were sidelined.

Intra-entity Dynamics:
The Villages Health and its developer appear closely intertwined—potentially complicating both liability and valuation in the sale. UHC’s exclusion raises red flags about transparency and due diligence practices.

Creditor Positioning:
As a prepaying partner with substantial reach (branding and marketing), UHC clearly views itself as having both financial and strategic claims that were ignored during this process, potentially weakening negotiations or liability resolution.

What’s the Broader Takeaway?

Self-Interest vs. Community Trust:
Residents, who rely on this system for care, understandably feel betrayed—many have voiced a strong demand for transparency and accountability following the fraud allegations and the nearly simultaneous sale attempt.

**************.com
+8
**************.com
+8
**************.com
+8
YouTube
+5
X (formerly Twitter)
+5
LinkedIn
+5

Negotiation Leverage:
UHC is likely positioning itself in court to gain leverage—either in negotiating liabilities or in opposing the sale under fiduciary or contractual obligations.

Potential Unraveling:
With federal fraud liabilities (hundreds of millions) looming, insider-controlled acceleration of asset transfer raises legitimate questions about legal exposure escape strategies.

Summary Table:
Issue Implication
UHC’s exclusion from sale discussions Possible breach of integrity or contractual obligations
Speed of sale post-bankruptcy May serve to shield insiders from liability
Fraud exposure of $361M High-stakes risk, attracting scrutiny from creditors and regulators

Let me know if you’d like to explore court documents, community letters, or how this aligns with previous healthcare fraud settlements and acquisitions. Happy to dive deeper!

You said:
[yes please look at the documents here and specifically what liability the family who owns the villages development (jennifer parr and the morse family) may be subject to include criminal.[/B]

ChatGPT said:

To investigate potential liability—including criminal—of the Morse family and Jennifer Parr in connection with The Villages Health's Medicare/Medicaid overbilling and sale, could you please share:

Which specific documents or filings you'd like me to examine? (e.g., bankruptcy court filings, DOJ statements, investor communications)

Are you interested in just criminal exposure, or also civil liability and regulatory implications?

Should the focus be limited to the July 2025 events, or include prior activities/history related to the development and healthcare system?

Once I have that, I’ll begin detailed research and document analysis.

You said:
The Villages Health System, LLC (https://cases.stretto.com/thevillageshealth/)
ChatGPT said:

Great, I’ll review the documents available at the bankruptcy case site for The Villages Health to determine what potential liability—civil or criminal—may exist for the Morse family and Jennifer Parr, especially in relation to Medicare/Medicaid overbilling.

I’ll focus on identifying any filings, exhibits, or disclosures that indicate direct involvement, fiduciary breaches, fraudulent conveyances, or potential Department of Justice interest. I’ll let you know as soon as I have a comprehensive summary.

Research completed in 3m · 14 sources · 35 searches

Potential Liability of Morse Family and Jennifer Parr in The Villages Health Bankruptcy

Potential Liability of Jennifer Parr & the Morse Family in The Villages Health Overbilling Case
Ownership Structure and Control of The Villages Health System

Bankruptcy filings confirm that The Villages Health System, LLC (TVHS) is closely held and controlled by the Morse family (developers of The Villages). In the Chapter 11 petition, Jennifer L. Parr (a member of the Morse family) is identified as a Manager of The Villages Health Holding Company, LLC – the majority owner of TVHS
scribd.com
. Similarly, Mark G. Morse (Jennifer’s brother and a principal in the family business) signed the corporate resolutions both as a Board Member of TVHS and as a Manager of the holding company
scribd.com
scribd.com
. These documents make clear that the same individuals behind The Villages development also own and control TVHS, which a court filing emphasizes is a “closely-held family-owned company”
**************.com
**************.com
. In short, the Morse family – through The Villages Health Holding Co. – has majority ownership and operational control over the health system.

Financial Relationship with The Villages Development

The bankruptcy case documents and related disclosures shed light on the intertwined financial relationship between TVHS and the Morse family’s development enterprise. UnitedHealthCare (UHC), the Medicare Advantage insurer for most TVHS patients, revealed in a court objection that it had a special arrangement with The Villages’ owners: UHC prepaid for exclusive rights to use The Villages’ branding and marketing via an affiliate of The Villages (the developer)
**************.com
. This indicates that the Morse family’s companies benefited financially from TVHS’s operations by licensing the community’s name and logo. Additionally, public reports suggest that many of the clinics and facilities were built by The Villages’ developer and then leased to TVHS, meaning the health system was effectively paying rent to its owners’ affiliated real estate business
**************.com
. Such self-dealing arrangements underscore how deeply enmeshed the health system’s finances are with the Morse family’s broader business interests....."


I've posted the rest of this last bit, reformatted, in my initial post. And, yes, while I did specifically ask about the implications, including criminal (the bolded bit above), the model performed deep research on the case documents and summarized that assessment.

I get that no model is perfect, and they are largely skewed by prompts, but as I've stated before, given their drone pilot antics, I am skeptical and I wanted to better understand how this may impact home values and the Villages more broadly.

[Aces4]

Sorry, but wrong. What was described isn't far off for procedures like an MRI, where there is in fact a technical and professional component. But that in no way applies to the E&M codes used in primary care and other specialties. Furthermore , those E&M codes apply to billing for traditional Medicare, but not for Medicare Advantage Plans which are capitated. Please don't contribute to the plethora of misinformation already floating around this site.

Maybe he didn't contribute to misinformation anymore than some are trying to whitewash the whole mess. NO ONE, including Drs., know the answers at this point and we may never know since there is a whole subset of rules that those in power can manipulate. It is what it is, I suggest going out to play and not waste your last years watching this miserable debacle.

[golfing eagles]

Their exposure would be if they participated in illegal up coding.

Somehow, I doubt 50 or 60 doctors collaborated in a Medicare fraud, especially when they had little to gain

[Normal]

I'll wait for a good source.

:posting:

Here is pulled from a court record, it’s credible.

In a court document, UnitedHealthcare claims that it had taken seven weeks since the bankruptcy filing for it to be disclosed that The Villages Health paid out in a “three-year period from 2022 to 2024, a very substantial portion of $183 million, consisting of $64.2 million in ‘tax-related distributions’ and $118.8 million to pay down a supposed ‘line of credit with its major shareholder’ – to members of the Morse family, who own and control The Villages through various corporate entities.” UnitedHealthcare also charges that The Villages Health “claims not to know” how much money it distributed to shareholders in 2020 and 2021. UnitedHealthcare further contends that the $118.8 million purportedly spent paying down the line of credit was actually “disguised equity distributions” paid to the Morse family. During those years, The Villages Health also was paying roughly $10 million in annual rent to The Villages Operating Co. for the use of the clinics.

[RoseyRed]

AI hallucinates enough when you ask it for straight facts. Asking it for speculation?!
Agreed a lot of assumptions along with a lot of suspicious financial transactions. How does the revenue increase that much, and they not catch the billing errors much quicker? The sell of several entities adds to the big gray cloud over the Morse family. The insurance sell was a few years back, but the bank and health entities are quite recent. Does anyone remember the news article on one of the family members purchasing a very expensive home a few months back or does my memory fail me?

[golfing eagles]

Here is pulled from a court record, it’s credible.

In a court document, UnitedHealthcare claims that it had taken seven weeks since the bankruptcy filing for it to be disclosed that The Villages Health paid out in a “three-year period from 2022 to 2024, a very substantial portion of $183 million, consisting of $64.2 million in ‘tax-related distributions’ and $118.8 million to pay down a supposed ‘line of credit with its major shareholder’ – to members of the Morse family, who own and control The Villages through various corporate entities.” UnitedHealthcare also charges that The Villages Health “claims not to know” how much money it distributed to shareholders in 2020 and 2021. UnitedHealthcare further contends that the $118.8 million purportedly spent paying down the line of credit was actually “disguised equity distributions” paid to the Morse family. During those years, The Villages Health also was paying roughly $10 million in annual rent to The Villages Operating Co. for the use of the clinics.

So, in other words, the "credible" part is this is what UHC, the party that is also suing TVH CLAIMS. I'm going to "claim" that Santa Claus is real---does that make it "credible"?

[golfing eagles]

Agreed a lot of assumptions along with a lot of suspicious financial transactions. How does the revenue increase that much, and they not catch the billing errors much quicker? The sell of several entities adds to the big gray cloud over the Morse family. The insurance sell was a few years back, but the bank and health entities are quite recent. Does anyone remember the news article on one of the family members purchasing a very expensive home a few months back or does my memory fail me?

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)

As far as "buying an expensive house", that's what billionaires can do----it's a complete non sequitur to the bankruptcy or allegations (only on social media) of fraud.

[Rainger99]

Their revenue was expected by them, not "excess.”

I am confused on this point.

If you are billing properly for the first six or seven years and then you change your billing so that you are making about $90 million more a year for the next four years, wouldn’t you notice that increase in revenue?

One other option is that they always billed improperly but the statute of limitations has run and they can only be sued for four years.

The other option is that if you are that rich, you might not notice an extra $90 million a year.

[Justputt]

I have the same question. I can’t figure out why Medicare was overcharged. It seems that the advantage insurers were the ones that were overcharged. Although no one has explained whether increasing RAF scores increases payments to UHC or to TVH of to both.


Medicare isn't overcharged. Medicare and Medicaid are the worst (aka lowest $$ payors). Private healthcare will pay more, which "helps to keep the lights on." Keeping the lights on is VERY expensive when you have to take into account the payor mix (percentage for no-pay patients, Medicare, Medicaid, private). Everyone has to be billed the same amount, so if Medicare will only pay $100 for "X", Medicaid won't pay anything for "X", and BCBS will pay $300 for "X", you bill $300 knowing Medicare will pay $100, Medicaid won't pay, and you'll get your $300 from BCBS and the self-pays are usually written off. Some of our hospital's insurance company contracts were written to pay a percentage of billed (e.g. 30%), so we'd have to bill much more than Medicare pays just to get paid the same as Medicare. I haven't been involved in setting charges for many years, but we used to take the Medicare payment rate and multiply by 2.5 to set our price.

[Plinker]

Here is pulled from a court record, it’s credible.

In a court document, UnitedHealthcare claims that it had taken seven weeks since the bankruptcy filing for it to be disclosed that The Villages Health paid out in a “three-year period from 2022 to 2024, a very substantial portion of $183 million, consisting of $64.2 million in ‘tax-related distributions’ and $118.8 million to pay down a supposed ‘line of credit with its major shareholder’ – to members of the Morse family, who own and control The Villages through various corporate entities.” UnitedHealthcare also charges that The Villages Health “claims not to know” how much money it distributed to shareholders in 2020 and 2021. UnitedHealthcare further contends that the $118.8 million purportedly spent paying down the line of credit was actually “disguised equity distributions” paid to the Morse family. During those years, The Villages Health also was paying roughly $10 million in annual rent to The Villages Operating Co. for the use of the clinics.

So, without the $90 million dollars per year of excess payments from Medicare, would the developers have been able to make these distributions and pay down their line of credit? Or, would they have had to declare bankruptcy years ago?

[Retiredsteve]

My barber's ex-wife's sister's mechanic knows more than AI.

I'll wait for a good source.

:posting: So instead of the country spending so much on AI we should hire your barber's ex-wife's sister's mechanic? Why are we investing so much in it?

[golfing eagles]

I am confused on this point.

If you are billing properly for the first six or seven years and then you change your billing so that you are making about $90 million more a year for the next four years, wouldn’t you notice that increase in revenue?

One other option is that they always billed improperly but the statute of limitations has run and they can only be sued for four years.

The other option is that if you are that rich, you might not notice an extra $90 million a year.

I would assume that the coding/billing has not changed along the way, but none of us know for sure.

[golfing eagles]

So, without the $90 million dollars per year of excess payments from Medicare, would the developers have been able to make these distributions and pay down their line of credit? Or, would they have had to declare bankruptcy years ago?

ALLEGED distributions. This is only the statement made by UHC, and they are not an unbiased entity. Stay tuned for the accounting to see if their claim is true or false.

[Caymus]

ALLEGED distributions. This is only the statement made by UHC, and they are not an unbiased entity. Stay tuned for the accounting to see if their claim is true or false.

Do you have a guess on the timing? Months? Years? Decades?

[tophcfa]

ALLEGED distributions. This is only the statement made by UHC, and they are not an unbiased entity. Stay tuned for the accounting to see if their claim is true or false.

Agree, the distributions are alleged by another party with an axe to grind. That being said, if the DIP financing is actually being provided by the alleged party, that raises a huge red flag that said party very well might be trying to keep significant accounting out of the public’s eye’s. Stay tuned.

[Rainger99]

I would assume that the coding/billing has not changed along the way, but none of us know for sure.

So they probably owe more money than the $360 million? But there may be a limit as to how far back Medicare can go in getting overpayments?

[Rainger99]

All you want to know about Medicare Overpayments!

https://www.cms.gov/files/document/medicare-overpayments.pdf

[golfing eagles]

All you want to know about Medicare Overpayments!

https://www.cms.gov/files/document/medicare-overpayments.pdf

I think this case goes way beyond that CMS "fact" sheet, but there is the 2 key conditions that result in overpayment: Wrong code and insufficient documentation. And that may be all there is to this, and then again, maybe not. But remember, the reviewers at CMS barely know how to spell medicine, much less have any knowledge of it. They are bean counters, pure and simple---does the progress note have 2 items from 6 different body systems in the exam or doesn't it? Are 2/3 items form past medical history, family history and social history included? That's all they know. Also, many EMRs look at what is included in the note and "suggest" a billing code. Could that be "off", did they coders at TVH just take the EMRs "suggestions".

Bottom line: This could still range anywhere from a computer EMR error and insufficient documentation to a conspiracy to commit criminal fraud. It's probably just aggressive coding like every other practice coupled with the CMS opinion that the documentation didn't meet their criteria, but time will tell. Unfortunately for TVH, this has become a complex high-profile case, and some bureaucrat is likely to act like a dog with a bone because they want to make a name for themselves so they can become a bigger bureaucrat.

[golfing eagles]

So they probably owe more money than the $360 million? But there may be a limit as to how far back Medicare can go in getting overpayments?

Or less. We don't know if the $360 M is correct, for what time period, or if it already includes interest and penalties. CMS will want to recover the actual overpayments, probably the interest, but any penalty would be negotiable.

[BillyGrown]

Or less. We don't know if the $360 M is correct, for what time period, or if it already includes interest and penalties. CMS will want to recover the actual overpayments, probably the interest, but any penalty would be negotiable.

Berkshire Hathaway and United Healthcare should be able to move to have the all assets frozen till all the bills and penalties are paid. This is a big boys game and the developer is the underdog.

[golfing eagles]

Berkshire Hathaway and United Healthcare should be able to move to have the all assets frozen till all the bills and penalties are paid. This is a big boys game and the developer is the underdog.

What assets???? TVH apparently doesn't have any, hence the bankruptcy filing

[BillyGrown]

What assets???? TVH apparently doesn't have any, hence the bankruptcy filing

Court records that were made public show large payouts to the trustees and owners. That is where this needs to go and likely will. The amount isn’t small potatoes that someone can just write off.

[tophcfa]

Berkshire Hathaway and United Healthcare should be able to move to have the all assets frozen till all the bills and penalties are paid. This is a big boys game and the developer is the underdog.

Getting a taste of their own medicine would be a very bitter pill to swallow. Probably should have considered that before getting into bed with the largest health insurance company in the country. Not going to win a war of financial attrition against that.

[ZPaul]

Berkshire Hathaway and United Healthcare should be able to move to have the all assets frozen till all the bills and penalties are paid. This is a big boys game and the developer is the underdog.

A buyer does not have the authority to freeze the assets of the seller. Generally can only cancel purchase if unsatisfactory outcome or excessive delay. Buyer is buying the bundle. Either accept or reject. As long as purchase payment not made the assets are not theirs to control

[golfing eagles]

Court records that were made public show large payouts to the trustees and owners. That is where this needs to go and likely will. The amount isn’t small potatoes that someone can just write off.

No, an allegation made in court by UHC, a biased party that is also suing TVH, CLAIMED large payouts. That is yet to be proven.

[biker1]

IIRC, their assets were listed as $50M-$100M. I am curious as to what this actually includes. They are presumably filing for bankruptcy because their debts exceed their assets.

What assets???? TVH apparently doesn't have any, hence the bankruptcy filing

[golfing eagles]

IIRC, their assets were listed as $50M-$100M. They are presumably filing for bankruptcy because their debts exceed their assets.

Exactly. Not sure of the point. Bankrupt is bankrupt. I doubt UHC has standing, nor would any freeze of assets come to fruition, but if it did, all that would do is freeze out the creditors from getting paid.

[biker1]

The point is they apparently do have assets. I never made any comment about freezing assets.

Exactly. Not sure of the point. Bankrupt is bankrupt. I doubt UHC has standing, nor would any freeze of assets come to fruition, but if it did, all that would do is freeze out the creditors from getting paid.

[golfing eagles]

The point is they apparently do have assets. I never made any comment about freezing assets.

I'm sure they do. "Freezing assets" was somebody else's pipe dream. Unfortunately, they owe more than they have. Again, stay tuned.

[Joecooool]

Thank you for this excellent summary and explanation of events.
Initial reports indicated that the overbilling took place from 2020 to 2024.
As a past business owner if my bottom line started showing extraordinary profits I would have investigated to see what change caused this additional income. So how can a successful company such as they, not have known where the extra profits were being reaped from? A prudent person would deduct they knew.Especially since they had staff trained/certified to look for it.

[drducat]

The assets are the patients..
The people that use the facilities and doctors. They are pushing for a quick sale so uncertainty does not cause a mass exit of patients going elseware.

[Joecooool]

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)
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?

[Joecooool]

So they probably owe more money than the $360 million? But there may be a limit as to how far back Medicare can go in getting overpayments?For Medicare fraud, the False Claims Act (FCA) statute of limitations is:

6 years from when the false claim was submitted or

3 years from when the government knew (or should have known) about the fraud,

but no more than 10 years total after the false claim was submitted.

That means Medicare fraud can be pursued up to 10 years back in some cases.

A couple of related points:

Criminal Medicare fraud (under federal criminal statutes, e.g., 18 U.S.C. § 1347 for health care fraud) generally has a 5-year statute of limitations, but this can be extended to 10 years for health care fraud affecting federal health care programs (like Medicare/Medicaid).

Civil FCA cases (including qui tam whistleblower suits) follow the 6/3/10 rule above.

So in practice:

Civil recovery under FCA → up to 10 years.

Criminal prosecution → usually 5 years, but extended to 10 years in Medicare/Medicaid fraud cases.

[golfing eagles]

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?

Really? Please point out the part of that post which is “conjecture”? You did see the part that stated we’ll need some forensic accounting to determine the truth?

[Joecooool]

Really? Please point out the part of that post which is “conjecture”? You did see the part that stated we’ll need some forensic accounting to determine the truth?
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?"

[golfing eagles]

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?"

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

[Joecooool]

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 yearsAgain, all conjecture. You don't know these things to be facts, you just assume that TVH operated by the book.

Medicare Advantage plans that operate by the book don't over bill hundreds of millions of dollars.

And there are hundreds of cases of medicare fraud where the money went into people's pockets. This operation just went down last month - Office of Public Affairs | National Health Care Fraud Takedown Results in 324 Defendants Charged in Connection with Over $14.6 Billion in Alleged Fraud | United States Department of Justice (https://www.justice.gov/opa/pr/national-health-care-fraud-takedown-results-324-defendants-charged-connection-over-146)

[golfing eagles]

Again, all conjecture. You don't know these things to be facts, you just assume that TVH operated by the book.

Medicare Advantage plans that operate by the book don't over bill hundreds of millions of dollars.

And there are hundreds of cases of medicare fraud where the money went into people's pockets. This operation just went down last month - Office of Public Affairs | National Health Care Fraud Takedown Results in 324 Defendants Charged in Connection with Over $14.6 Billion in Alleged Fraud | United States Department of Justice (https://www.justice.gov/opa/pr/national-health-care-fraud-takedown-results-324-defendants-charged-connection-over-146)

All conjecture???? Give me a break. The "conjecture" is you telling me what I do and do not know. You don't think medical practices pay for equipment, utilities, rent, staff, etc. Conjecture my sweet bippie. I ran a practice for 35 years. I know what EMR they use and I know how it is used, so don't give me "conjecture".

Meanwhile, of course the point of Medicare fraud is to put $$$ into someone's pocket---it's not a charitable exercise. Most of those are fly by night clinics owned by some clown with a Caribbean medical degree that pay homeless people to come in to their clinic and bill more to CMS than they could possibly have done. Here's your problem---the only people that have accused TVH of "fraud" are posters on TOTV.

I can guarantee based on the vague diagnostic codes in ICDM-10 and the stringent documentation requirements in CPT, I could review Harvard Medical or the Mayo clinic system and find way more than $361 million in "fraud" over a 10 year period, just based on the sheer size of those practices. Do you think they are also in a grand conspiracy to defraud Medicare?

[BillyGrown]

All conjecture???? Give me a break. The "conjecture" is you telling me what I do and do not know. You don't think medical practices pay for equipment, utilities, rent, staff, etc. Conjecture my sweet bippie. I ran a practice for 35 years. I know what EMR they use and I know how it is used, so don't give me "conjecture".

Meanwhile, of course the point of Medicare fraud is to put $$$ into someone's pocket---it's not a charitable exercise. Most of those are fly by night clinics owned by some clown with a Caribbean medical degree that pay homeless people to come in to their clinic and bill more to CMS than they could possibly have done. Here's your problem---the only people that have accused TVH of "fraud" are posters on TOTV.

I can guarantee based on the vague diagnostic codes in ICDM-10 and the stringent documentation requirements in CPT, I could review Harvard Medical or the Mayo clinic system and find way more than $361 million in "fraud" over a 10 year period, just based on the sheer size of those practices. Do you think they are also in a grand conspiracy to defraud Medicare?

It doesn’t matter either way. Reimbursement is required. If there is fraud, then prosecution must also take place.

[margaretmattson]

What assets???? TVH apparently doesn't have any, hence the bankruptcy filing To prove you are bankrupt, you must have more debt than assets. Assets include building, equipment, furniture, shares, revenue earned, cash, and more depending on the business. The court documents filed are requesting the Morse Family provide ACCURATE accounting of all assets asociated with this business. This is standard for bankruptcy filings. Once all the needed information is obtained, the court will decide on the issue. The financial disaster caused by incorrect coding happened. Nothing anyone can do to change it.I have not seen any court documents that claim individual doctors are accountable.

[Rainger99]

Evercore is TVH’s investment banker. There appears to be plenty of money to pay them.

The court approved paying Evercore a

1. $600,000 upfront retainer

2. A $200,000 monthly fee, and a

3. A $5.0 million restructuring fee upon plan confirmation/restructuring completion

[BrianL99]

Assets include building, equipment, furniture, shares, revenue earned, cash, and more depending on the business.
.

TVH doesn't own buildings, nor any significant equipment.



The court documents filed are requesting the Morse Family provide ACCURATE accounting of all assets asociated with this business.
.

Please provide your source for this. I can't find the words "Morse Family" in the Bankruptcy documents nor any place where the family has been requested to do anything.

[golfing eagles]

To prove you are bankrupt, you must have more debt than assets. Assets include building, equipment, furniture, shares, revenue earned, cash, and more depending on the business. The court documents filed are requesting the Morse Family provide ACCURATE accounting of all assets asociated with this business. This is standard for bankruptcy filings. Once all the needed information is obtained, the court will decide on the issue. The financial disaster caused by incorrect coding happened. Nothing anyone can do to change it.I have not seen any court documents that claim individual doctors are accountable.

They are requiring THE VILLAGES HEALTH to provide accurate accounting. It seems a lot of people are conflating the Morse family with TVH.

[Greatlawn]

A rotten fish stinks at the head

[tophcfa]

They are requiring THE VILLAGES HEALTH to provide accurate accounting. It seems a lot of people are conflating the Morse family with TVH.

Based in the 29 page bankruptcy court filing by UnitedHealth Care, TVH is trying very hard to avoid providing full and accurate accounting. UHC’s attorneys are trying to stop the court from approving TVH’s latest DIP financing motion. Their attorneys claim that the DIP financing is being provided by the same parties that control TVH, is not an arms length transaction that was competitively bid, is not at fair market value, and is in fact being provided by insiders. They further claim this transaction breaches TVH’s fiduciary responsibility of acting fairly toward all constituents involved in the bankruptcy, including creditors. Providers of DIP financing are privy to accounting statements others are not when a private entity is involved. UHC claims TVH is trying to force a hurried sale, with insider provided DIP financing, in order to avoid accounting discovery and potential creditor clawback of monies diverted away from TVH prior to filing bankruptcy.

If the arguments UHC’s attorneys made to the court are valid, and the court denies TVH’s DIP financing motion, or opts to not decide on the motion without full evidentiary discovery, it will force much fuller disclosure of TVH’s accounting and might provide true answers to things being speculated about.

Although it’s not easy reading, I would encourage anyone following this with interest to take the time to read and understand it. It is very well researched and prepared by UHC’s big league legal counsel and sites numerous case references backing their arguments to the court. Every time there is another court filing involving this case it gets more complex and interesting. It’s very clear that things went very bad between TVH and UHC, and UHC is prepared to fight TVH tooth and nail through this process.

Unfortunately, I can’t see any way this is going to turn out good for the general population of Villages residents : (

[margaretmattson]

They are requiring THE VILLAGES HEALTH to provide accurate accounting. It seems a lot of people are conflating the Morse family with TVH.The name Parr was mentioned in a court document. She is a member of the Morse Family.I have not seen any individual doctors named in the court documents. I believe it IS YOU who is conflating. Bankruptcy filing has nothing to do with incorrect medical coding. They are different issues. Again, to legally prove bankruptcy, you must have more debt than assets. Nothing more! Simply provide the court DEBTS AND ASSETS. And YES! The court will absolutely require ALL ASSETS be accounted. Including any owned, large or small, by the Morse Family.

[margaretmattson]

TVH doesn't own buildings, nor any significant equipment.



Please provide your source for this. I can't find the words "Morse Family" in the Bankruptcy documents nor any place where the family has been requested to do anything.It is common knowledge. In order to prove bankruptcy, you must have more debts than assets. I do not keep a file of what the Morse family owns. However, the name Parr was mentioned along with it took several weeks to get information from her regarding money given to her and family members from this business. This information was in the first paragraph of a court document another poster showed on this thread. Money is an asset! Whatever assets, large or small, the Morse family owns regarding this business,the court document is requiring Parr to provide accurate accounting.

[BrianL99]

I do not keep a file of what the Morse family owns. .


Here you go. Now you know just about everything the Morse Family owns, as of 12/31/2023.

https://www.atlantafed.org/-/media/documents/FRY6Docs/2023/VILLAGES_BC_2012315_2023.pdf

[margaretmattson]

Here you go. Now you know everything the Morse Family owns, as of 12/31/2023.

https://www.atlantafed.org/-/media/documents/FRY6Docs/2023/VILLAGES_BC_2012315_2023.pdfThis information will not change the fact that a court document required Parr to give proper accounting of money received from this business. This due diligence eases my mind. After the verdict, there will be no unanswered questions. Personally, I am hoping all is legit and health care will not be interrupted. I do not believe many Villagers want the opposite.

[golfing eagles]

The name Parr was mentioned in a court document. She is a member of the Morse Family.I have not seen any individual doctors named in the court documents. I believe it IS YOU who is conflating. Bankruptcy filing has nothing to do with incorrect medical coding. They are different issues. Again, to legally prove bankruptcy, you must have more debt than assets. Nothing more! Simply provide the court DEBTS AND ASSETS. And YES! The court will absolutely require ALL ASSETS be accounted. Including any owned, large or small, by the Morse Family.

No, I'M the person who has stated all along that the alleged overbilling is a completely different issue form the bankruptcy filing. Get your facts straight before posting nonsense. I also stated that while The Villages Holding Co. owns 60% of TVH, that it is unlikely they are making day to day decisions. I also read the document. They order is to disclose all assets of TVH. And The Villages Holding Co. makes that information public. I very much doubt they could get a listing of all the Morse family's personal assets---it would be massive judicial overreach especially in a bankruptcy case, and met by a ton of legal objections by their lawyers. However, you never know what a judge will do. But thanks for letting me know that a person or business is bankrupt when their debt exceeds their assets---I had no idea that was the case before you "educated" me :1rotfl:L:1rotfl::1rotfl:

[margaretmattson]

No, I'M the person who has stated all along that the alleged overbilling is a completely different issue form the bankruptcy filing. Get your facts straight before posting nonsense. I also stated that while The Villages Holding Co.
owns 60% of TVH, that it is
unlikely they are making day to
day decisions. I also read the
document. They order is to
disclose all assets of TVH.
And The Villages Holding Co.
makes that information public.
I very much doubt they could
get a listing of all the Morse
family's personal assets---it
would be massive judicial
overreach especially in a
bankruptcy case, and met by a
ton of legal objections by their
lawyers. However, you never
know what a judge will do. But
thanks for letting me know
that a person or business is
bankrupt when their debt
exceeds their assets---I had no
idea that was the case before
you "educated" me :1rotfl:L:1rotfl::1rotfl:You stated I was conflating the issue. By typing those words, it appeared that you believe I am uneducated. I merely stated the facts about bankruptcy. Great! My words matched yours. What's your problem with that? I also stated there was indeed a mention of the Morse family in the court documents. Fact!

By the way, I never would think a court would look into personal assets when overseeing a BUSINESS bankruptcy. Two different issues. I stated Parr was required to provide accurate accounting of money received FROM THIS BUSINESS. But, I do not see a reason to argue. I think we both want healthcare to remain uninterrupted. This is what matters most.

[dewilson58]

By the way, I never would think a court would look into personal assets when overseeing a BUSINESS bankruptcy. Two different issues. I stated Parr was required to provide accurate accounting of money received FROM THIS BUSINESS. But, I do not see a reason to argue. I think we both want healthcare to remain uninterrupted. This is what matters most.

"And YES! The court will absolutely require ALL ASSETS be accounted. Including any owned, large or small, by the Morse Family."

Sounds like personal assets. :mornincoffee:

[BrianL99]

No, I'M
But thanks for letting me know that a person or business is bankrupt when their debt exceeds their assets---I had no idea that was the case before you "educated" me :1rotfl:L:1rotfl::1rotfl:

The education one receives on TOTV is amazing. Who would have known?

[margaretmattson]

"And YES! The court will absolutely require ALL ASSETS be accounted. Including any owned, large or small, by the Morse Family."

Sounds like personal assets. :mornincoffee:Exactly! Large or small assets FROM THIS BUSINESS. Geez!

[BrianL99]

By the way, I never would think a court would look into personal assets when overseeing a BUSINESS bankruptcy. Two different issues. I stated Parr was required to provide accurate accounting of money received FROM THIS BUSINESS. But, I do not see a reason to argue. I think we both want healthcare to remain uninterrupted. This is what matters most.

"And YES! The court will absolutely require ALL ASSETS be accounted. Including any owned, large or small, by the Morse Family."

Sounds like personal assets. :mornincoffee:

The post that contained the noted text, was edited to remove the references to "all the Morse Family assets".

It's unfortunate that the Forum software, doesn't allow readers to see specific edits, it only notes that a post was edited.

[dewilson58]

Exactly! Large or small assets FROM THIS BUSINESS. Geez!

Nice try.

Your statement, "And YES! The court will absolutely require ALL ASSETS be accounted. Including any owned, large or small, by the Morse Family,"

By definition............you have included assets "outside this business".

"owned by the family"...............this includes various companies, houses, boats, cars, etc..

Geez.

[margaretmattson]

The education one receives on TOTV is amazing. Who would have known?At least I did not write paragraph after paragraph on incorrect medical coding. Which has absolutely NOTHING to do with a bankruptcy filing. Why didn't you attack GE? Afraid he will deflate you with his words? Yes, indeed, we do get an education on TOTV.

[margaretmattson]

Nice try.

Your statement, "And YES! The court will absolutely require ALL ASSETS be accounted. Including any owned, large or small, by the Morse Family,"

By definition............you have
included assets "outside this
business".

"owned by the family"...............this includes various companies, houses, boats, cars, etc..

Geez.If you read my other posts, you would see I typed the words FROM THIS BUSINESS. But, I don't want argue. See it as you like.

[golfing eagles]

You stated I was conflating the issue. By typing those words, it appeared that you believe I am uneducated. I merely stated the facts about bankruptcy. Great! My words matched yours. What's your problem with that? I also stated there was indeed a mention of the Morse family in the court documents. Fact!

By the way, I never would think a court would look into personal assets when overseeing a BUSINESS bankruptcy. Two different issues. I stated Parr was required to provide accurate accounting of money received FROM THIS BUSINESS. But, I do not see a reason to argue. I think we both want healthcare to remain uninterrupted. This is what matters most.

I think we both can agree on that. Common ground---it's not that hard:)

[BrianL99]

To prove you are bankrupt, you must have more debt than assets.



. Again, to legally prove bankruptcy, you must have more debt than assets. Nothing more! Simply provide the court DEBTS AND ASSETS..

It is common knowledge. In order to prove bankruptcy, you must have more debts than assets. .

You stated I was conflating the issue. By typing those words, it appeared that you believe I am uneducated. I merely stated the facts about bankruptcy.

At least I did not write paragraph after paragraph on incorrect medical coding. Which has absolutely NOTHING to do with a bankruptcy filing. .


That is incorrect and your "facts" about Bankruptcy are incorrect.

IF Medicare has a $360M claim against TVH, it absolutely is an issue in the Bankruptcy.

Your understanding of Bankruptcy, may not be complete. Bankruptcy is not always a case of actual, current Liabilities exceeding Assets, despite the assertions you and others have made in this thread.

One does not necessarily have to prove current Liabilities exceed current Assets.

[margaretmattson]

That is incorrect and your "facts" about Bankruptcy are incorrect.

IF Medicare has a $360M claim against TVH, it absolutely is an issue in the Bankruptcy.

Your understanding of Bankruptcy, may not be complete. Bankruptcy is not
always a case of actual,
current Liabilities exceeding
Assets, despite the assertions
you and others have made in
this thread.
One does not necessarily have to prove current Liabilities exceed current Assets. I stand by my beliefs. Bankruptcy is ONE
issue the court will decide.
Medicare may be listed as a
creditor. Anything involving
incorrect coding, fraud, or whatever is a different court issue..

The judge will decide if the business is bankrupt. Maybe the court will allow assets to remain. Maybe they will not. It is not for us to speculate. In general terms, bankrupt means you do not have enough assets to pay off your debt at this time. Therefore, debt is larger than assets.

[Normal]

Pecuniary intent wouldn’t need to be proven for board members on the Villages Health, but the audits will be indicative of increases of income and concurrent distributions to its members. The audits will lineate or pinpoint decisions and time frames made by its board and the flow of money. It should be interesting to see the testimony and the review of minutes from the board after the proceedings.

If decisions were made, and the aftermath saw increases in disbursements to board members, there will be big problems. People won’t only be losing their capital, but could also be going to jail.

[Aces4]

Pecuniary intent wouldn’t need to be proven for board members on the Villages Health, but the audits will be indicative of increases of income and concurrent distributions to its members. The audits will lineate or pinpoint decisions and time frames made by its board and the flow of money. It should be interesting to see the testimony and the review of minutes from the board after the proceedings.

If decisions were made, and the aftermath saw increases in disbursements to board members, there will be big problems. People won’t only be losing their capital, but could also be going to jail.

Now, now, don't worry. According to some here it was just a boo-boo where hundreds of millions of dollars were siphoned away from taxpayers and paid for the benefit of TVH system. Accidents happen, no one is to blame, look the other way and keep truckin.

[Babubhat]

There is no purpose for the judge in bankruptcy to say it is solvent. no vendor will ever do business with them again. Judge function is to clean this up as quickly as possible. Lawyers clean up. The rest get the crumbs

[GoldenBoy]

If the Family is found liable for this fraud should Villagers start preparing for increase in amenities fees to go up to cover the Familiy's payback?

[dewilson58]

If the Family is found liable for this fraud should Villagers start preparing for increase in amenities fees to go up to cover the Familiy's payback?

Been here 5 years???......................amenities fees do not go to the family (except new areas for a short period of time)

:sigh:

[biker1]

FYI, the amenities' fee goes up by the CPI on the anniversary of when your house first sold. Regarding who gets the funds, see the previous post.

If the Family is found liable for this fraud should Villagers start preparing for increase in amenities fees to go up to cover the Familiy's payback?

[golfing eagles]

If the Family is found liable for this fraud should Villagers start preparing for increase in amenities fees to go up to cover the Familiy's payback?

What "fraud"? Again, neither CMS nor DOJ is using that term, only posters on TOTV.

[Babubhat]

If the Family is found liable for this fraud should Villagers start preparing for increase in amenities fees to go up to cover the Familiy's payback?

Fraud is a very high standard to prove. These matters are usually settled. Appeals process can go on for a decade

[ThirdOfFive]

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
You seem like you have more familiarity with this topic than most. So...

This is a big deal (and rightfully so) to people living in TV. And $360 million more or less is a LOT of money. But looking at things objectively it is (relatively speaking) peanuts. Most estimates place the amount of Medicare fraud occurring in America at the rate of $60 BILLION dollars per year. We don't know how much if any of this $360 million was intentionally fraudulent, and I am sure that it spanned years. But even if it was fraudulent and occurred all within one year it would still amount to barely 1/2 of 1% of the total Medicare fraud for that year.

OK. Given the above, what are the safeguards against fraud, if any, on the other end of the money pipeline? Aren't there watchdogs on the Medicare end of things? $360 million relatively speaking might be peanuts but $60 billion is huge. Is that particular segment of our government so clueless that $60 billion can just be explained by ignorance? Politely speaking, that possibility beggars the imagination. Or is there even the faintest possibility that fraud may be being committed on both ends?

Your thoughts appreciated.

[BrianL99]

You seem like you have more familiarity with this topic than most. So...

This is a big deal (and rightfully so) to people living in TV. And $360 million more or less is a LOT of money. But looking at things objectively it is (relatively speaking) peanuts. .


$360 Million seems like a huge number.

Over 4 years, it comes to $90M/year.

On a per patient basis, it's $1600/year.

Given the cost of medical care these days, that's probably about 6 minutes in an Operating Room, per patient.

6 minutes here, 6 minutes there ... pretty soon we're talking about real money.

[golfing eagles]

You seem like you have more familiarity with this topic than most. So...

This is a big deal (and rightfully so) to people living in TV. And $360 million more or less is a LOT of money. But looking at things objectively it is (relatively speaking) peanuts. Most estimates place the amount of Medicare fraud occurring in America at the rate of $60 BILLION dollars per year. We don't know how much if any of this $360 million was intentionally fraudulent, and I am sure that it spanned years. But even if it was fraudulent and occurred all within one year it would still amount to barely 1/2 of 1% of the total Medicare fraud for that year.

OK. Given the above, what are the safeguards against fraud, if any, on the other end of the money pipeline? Aren't there watchdogs on the Medicare end of things? $360 million relatively speaking might be peanuts but $60 billion is huge. Is that particular segment of our government so clueless that $60 billion can just be explained by ignorance? Politely speaking, that possibility beggars the imagination. Or is there even the faintest possibility that fraud may be being committed on both ends?

Your thoughts appreciated.

And some other estimates are as high as $105 billion. But I think we need to clarify what is being loosely thrown around as "fraud". I believe the definition of fraud is intentional misrepresentation (legal dictionaries agree). If I believe my SUV is in good working order and sell it to you, and it turns out it's a lemon, it is NOT fraud. If I knew and concealed it, THEN it is fraud. If I believe I correctly documented a patient visit as a 99214, but CMS disagrees, IT IS NOT FRAUD. It's only if I knew it didn't meet the criteria and billed that code anyway that I committed fraud.

Now that the definition is clear (sorry to the hundreds of posters that are accusing TVH of "fraud"), there is the question of what is included in that $60-105B estimate:
First there is outright fraud, medical practices that were set up for no other purpose than to bill Medicare millions for unnecessary work or services that were never performed. These are usually fly by night clinics owned by somebody with a bogus medical degree from the Caribbean that pays winos and homeless people cash and a bottle of thunderbird to come to their clinic and have "tests", or just say they did. They are usually gone by the time CMS catches on, and doing the same thing under a different name. California, Arizona and Florida are notorious for these.

Then there is gray zone "fraud". Coding aggressively but not necessarily having the documentation to support the submitted codes. If this is intentional it might be fraud, but like I said, it's a gray zone. And believe me, I can turn even a 3-minute visit for a sore throat into a 99215 (highest level of office visit) if I was so inclined. How is that possible? Because it is no longer important what you doctor does, only what he writes. Thank the bean counters at CMS and insurance co. as well as lawyers for that one. The result, for some less scrupulous physicians, is that they would rather spend 2 minutes with the patient and 10 minutes documenting that visit--far more lucrative.

And then there is "overbilling" or "miscoding" or "computer error" or "misinterpretation of ICDM-10 and CPT" or whatever you want to call it. This is devoid of intent, and also subject to interpretation of the vague guidelines.

So, what are the safeguards?
For the fraudulent practices, it involves CMS and DOJ identifying them, usually because their billing is way more than similar sized legitimate practices. But again, they have a tendency to disappear off the grid until they re-emerge elsewhere.

For the aggressive coders, CMS knows the bell curve of CPT E&M charges and can identify anomalies. They would then ask the practice to submit 25 or 50 progress notes for review to see if the documentation supports the coding, and pay the practice a "visit" if they are out of compliance. For one group of cardiovascular surgeons in Syracuse, that visit was by the FBI with M-16s in full body armor while their waiting room was packed with their patients.

For the other 95% of practices that wants to play by the rules, it starts with internal chart review. In our group of 6, we just reviewed each other's notes and coding. In large practices like TVH, they have outside consultants that perform that task. And this is where the TVH case get murky. (Hypothetically), those outside consultants told TVH that they were in compliance with the rules. Also, hypothetically, later reviewers disagreed. And like all practices they also had to send CMS charts to review periodically, so I don't understand how any "overbilling" didn't come to light years ago. Now, and to appease certain others on TOTV, I will term the following "conjecture". The chart review at CMS was conducted by low level staff who either didn't catch it or more likely also thought it was legitimate. But with all the hoopla with Humana and UHC as well as a very large number being thrown around, it caught the attention of a higher level bureaucrat, and probably one with even higher ambitions.

From my experience, if CMS finds what is overbilling in their opinion, you can appeal or just give them some money back. But I don't think anyone wants to try to give $361M back. Of course, we don't know exactly what period of time might be involved, if that number is accurate, and whether or not it includes interest and penalties, which would be negotiable.

I just want to reiterate that no one on TOTV, including myself, knows what happened. And it will take time for this to all settle out.

In the meantime, I agree we are in a mess. TVH has 50,000 patients. Already at least 2 doctors are trying to leave. We don't have enough physicians for our population as it is, and any mass exodus will spell trouble. And not only for patients of TVH---those patients will start flooding other practices, and those that can't find a new PCP will end up in urgent care and ER's. In turn, anyone with a real emergency may be walking into a logjam. So let's hope they get acquired or bailed out before it's too late and table the recriminations until we know the population will be cared for.

[Babubhat]

So will these criminals repay the $350 million stolen in their Medicare fraud scheme? Will they be appropriately prosecuted considering the magnitude of this fraud? Let's see how it all plays out.

Making an unfounded claim can get you sued for slander. Hiding behind a screen name will not protect you.

[Kerry Azz]

From AI deep research:

Potential Liability of Jennifer Parr & the Morse Family in The Villages Health Overbilling Case

Ownership Structure and Control of The Villages Health System: Bankruptcy filings confirm that The Villages Health System, LLC (TVHS) is closely held and controlled by the Morse family (developers of The Villages). In the Chapter 11 petition, Jennifer L. Parr (a member of the Morse family) is identified as a Manager of The Villages Health Holding Company, LLC – the majority owner of TVHS. Similarly, Mark G. Morse (Jennifer’s brother and a principal in the family business) signed the corporate resolutions both as a Board Member of TVHS and as a Manager of the holding company. These documents make clear that the same individuals behind The Villages development also own and control TVHS, which a court filing emphasizes is a “closely-held family-owned company." In short, the Morse family – through The Villages Health Holding Co. – has majority ownership and operational control over the health system.

Financial Relationship with The Villages Development: The bankruptcy case documents and related disclosures shed light on the intertwined financial relationship between TVHS and the Morse family’s development enterprise. UnitedHealthCare (UHC), the Medicare Advantage insurer for most TVHS patients, revealed in a court objection that it had a special arrangement with The Villages’ owners: UHC prepaid for exclusive rights to use The Villages’ branding and marketing via an affiliate of The Villages (the developer). This indicates that the Morse family’s companies benefited financially from TVHS’s operations by licensing the community’s name and logo. Additionally, public reports suggest that many of the clinics and facilities were built by The Villages’ developer and then leased to TVHS, meaning the health system was effectively paying rent to its owners’ affiliated real estate business. Such self-dealing arrangements underscore how deeply enmeshed the health system’s finances are with the Morse family’s broader business interests.

Disclosures of Overbilling and Alleged Responsibility: In late 2024, The Villages Health System self-reported a massive Medicare billing problem: an internal investigation found that TVHS had logged patient diagnoses that “were not clinically supported or otherwise did not meet Medicare coding and payment guidance,” leading to hundreds of millions in improper payments. By the time of the Chapter 11 filing (July 3, 2025), a preliminary analysis indicated overpayments of at least $350–361 million to TVHS. Court filings show the company openly acknowledged these errors and even notified patients about the issue. Notably, UnitedHealthCare’s filing goes further in characterizing blame: it states that TVHS “admitted to the submission of incorrect information” to insurers and has a “record of corporate misbehavior." UHC points out that the same individuals who own The Villages (the Morse family) also own and control TVHS, insinuating that the development owners were in a position to direct or permit the practices that led to the overbilling. In a striking assertion, UHC’s court submission warns that the Debtor’s officers, directors, and owners (i.e. the Morse family and Jennifer Parr) now “face hundreds of millions of dollars of liability” due to the false Medicare information submitted. This implies that beyond the company’s liability, those in control could be held personally or corporately responsible for the $361 million overbilling, at least in UHC’s view.

Potential Legal Exposures for Jennifer Parr and the Morse Family
Civil Liability and DOJ Inquiry: The bankruptcy documents make clear that federal authorities are involved. TVHS’s filings note it has been in communication with the U.S. Department of Justice (Civil Division) and the HHS Office of Inspector General regarding the overpayments. The company is working “toward a resolution with the U.S. government” to repay the approximately $361 million, which will likely include significant financial penalties. This suggests a potential False Claims Act civil action or similar, which can impose treble damages. While no lawsuit naming individual executives has been filed as of the filings, UHC’s allegation that the owners themselves face liability indicates that Jennifer Parr, Mark Morse, and other insiders could be targets of civil claims – either by the government under the False Claims Act (if they knew about or directed the false billing) or by private parties (such as UHC seeking indemnification). In sum, the civil exposure is substantial, and the DOJ’s involvement confirms that a federal investigation is ongoing (even if currently civil in nature). Any eventual settlement or judgment could potentially seek guarantees or contributions from those in control if misconduct is proven.

Criminal Liability: No direct evidence of a criminal investigation appears in the bankruptcy filings to date – references to DOJ have been explicitly to its civil division. The overbilling has been officially described as “erroneous” or based on misunderstandings of coding guidance, rather than an intentional fraud, and the company self-disclosed the issue. These factors suggest the matter is being handled as a civil regulatory breach. However, the magnitude ($361 million) of the improper claims raises the stakes. If future evidence were to show knowing or willful fraud (for example, if executives pressured clinicians to upcode diagnoses), the Morse family principals could conceivably face criminal health care fraud or false claims charges. So far, there is no indication in the court papers of a criminal referral, but the risk remains if new facts emerge. For now, the legal peril for Parr and the Morse family lies more in civil enforcement (with massive financial and reputational consequences) than in criminal prosecution.

Breach of Fiduciary Duty: As managers and controlling owners of the LLC, Jennifer Parr and the Morse family owed fiduciary duties to the company (and now, in bankruptcy, to its creditors). The court documents do not explicitly accuse them of breaching those duties, but certain facts invite scrutiny. The need to bring in “independent managers” and a new Chief Restructuring Officer to improve compliance after the overbilling was uncovered suggests that previous oversight by insiders was inadequate. If it is shown that the family-controlled board failed to implement proper auditing or compliance controls (allowing the false billing to continue for years), that could be viewed as a breach of their duty of care. Moreover, any self-dealing transactions are a red flag: for instance, if TVHS paid above-market rents or fees to Morse-controlled entities (benefiting the owners while the company racked up liabilities), a creditors’ committee or trustee could argue the insiders breached their duty of loyalty. In the ongoing bankruptcy, stakeholders may investigate whether the owners prioritized their own interests over the company’s solvency. Any such findings could lead to litigation against the Morse family for mismanagement or fiduciary lapses, though no lawsuit of that kind has been filed yet.

Fraudulent Conveyance Concerns: Thus far, the filings have not revealed any specific transfers of assets from TVHS to the owners pre-bankruptcy. However, given the enormous government claim and the family’s control, creditors will likely examine any pre-petition distributions or asset transfers to Morse-family entities. If, for example, significant profits from the overcoding years were upstreamed to The Villages Holding Company or related family trusts, those could be subject to clawback as fraudulent conveyances in bankruptcy (if made when TVHS was insolvent or intended to hinder creditors). Public observers have noted suspicious timing in the Morse family’s financial maneuvers – for instance, a large family-owned asset (a Villages-affiliated bank) was sold not long before the overbilling became public, prompting questions about whether this was done to isolate assets from potential forfeiture or liability. While this is speculative and not documented in the court record, it underscores the concern that any transfer benefiting the owners at the expense of TVHS’s creditors will face scrutiny. The bankruptcy court has strong powers to unwind fraudulent transfers, so if evidence emerges of such transactions, Jennifer Parr and her family could be forced to return funds to the estate.

Department of Justice and Regulatory Actions: In addition to the bankruptcy process, the Morse family must be mindful of parallel government actions. The DOJ civil inquiry (and involvement of HHS OIG) means there is a risk of a False Claims Act case, which could theoretically name individuals (owners or executives) if they were complicit in the false billings. So far, TVHS’s cooperation and self-disclosure may be mitigating factors. Nevertheless, the overbilling is at a scale that has drawn federal attention, and the outcome could include a corporate integrity agreement or other oversight that affects the family’s control over any reorganized health business. If negotiations with DOJ do not resolve the liability, a civil suit could be filed. The Morse family also faces intense scrutiny from private creditors like UHC. UHC’s filings indicate it feels misled and left out, and it may pursue its own legal remedies to recover losses – potentially even alleging fraud or conspiracy involving TVHS leadership. All of these avenues mean Jennifer Parr and her relatives are not shielded simply by putting the company in bankruptcy; their decisions and any knowledge of the overbilling are under the microscope of federal investigators and creditors.

Conclusion
In summary, the bankruptcy documents portray The Villages Health System’s overbilling debacle as a liability largely resting with the company, but they also tie that company inextricably to the Morse family. Jennifer Parr, Mark Morse, and related insiders are documented as the ultimate decision-makers for TVHS, and even the firm’s long-time business partner (UHC) has alleged in court that these owners could personally face “hundreds of millions” in exposure for the false Medicare billings. While no filing to date outright accuses Parr or the Morse family of criminal wrongdoing, the evidence of massive billing irregularities and the close involvement of ownership raise the prospect of significant legal repercussions. They range from civil False Claims Act penalties and DOJ-driven settlements to potential breach of duty or fraudulent transfer claims in the bankruptcy. Any criminal liability would depend on proof of intent and is not asserted so far, but it remains a looming possibility given the scale of the fraud. Going forward, Jennifer Parr and the Morse family will likely be under significant legal pressure: they may need to contribute to any government settlement, justify past transactions, and demonstrate that they did not personally profit from or direct the improper billing. The court filings and exhibits thus far highlight their control over the health system and foreshadow a careful examination of whether that control was misused, making personal or corporate liability a very real concern as this case progresses. Sources: The Villages Health System LLC Chapter 11 Petition & Board Resolutions.


Sources:

The Villages Health Bankruptcy | PDF | Chapter 11 | Unsecured Debt
The Villages Health Bankruptcy | PDF | Chapter 11 | Unsecured Debt (https://www.scribd.com/document/884871596/The-Villages-Health-Bankruptcy)

United HealthCare highly suspicious of proposed sale of The Villages Health - **************.com
https://www.**************.com/2025/07/23/united-healthcare-highly-suspicious-of-proposed-sale-of-the-villages-health/

Bankruptcy of The Villages Health raises many questions - **************.com
https://www.**************.com/2025/08/07/bankruptcy-of-the-villages-health-raises-many-questions/

Villages Health System Sees $350 Million in Medicare Overcharges
Villages Health System Sees $350 Million in Medicare Overcharges (https://www.insurancejournal.com/news/southeast/2025/07/09/830964.htm)

Villages Health company, under fire for Medicare overpayments, files for Chapter 11 bankruptcy
Villages Health company, under fire for Medicare overpayments, files for Chapter 11 bankruptcy (https://www.clickorlando.com/news/local/2025/07/06/villages-health-company-under-fire-for-medicare-overpayments-files-for-chapter-11-bankruptcy/)
They wanna play the morse family must pay, the family acted together to conspire to commit what we all know was a crime, they should be charged with the RICO ACT! They strong arm the stores and restaurants in the villages and healthcare prosecute them to the max.

[Aces4]

And some other estimates are as high as $105 billion. But I think we need to clarify what is being loosely thrown around as "fraud". I believe the definition of fraud is intentional misrepresentation (legal dictionaries agree). If I believe my SUV is in good working order and sell it to you, and it turns out it's a lemon, it is NOT fraud. If I knew and concealed it, THEN it is fraud. If I believe I correctly documented a patient visit as a 99214, but CMS disagrees, IT IS NOT FRAUD. It's only if I knew it didn't meet the criteria and billed that code anyway that I committed fraud.

Now that the definition is clear (sorry to the hundreds of posters that are accusing TVH of "fraud"), there is the question of what is included in that $60-105B estimate:
First there is outright fraud, medical practices that were set up for no other purpose than to bill Medicare millions for unnecessary work or services that were never performed. These are usually fly by night clinics owned by somebody with a bogus medical degree from the Caribbean that pays winos and homeless people cash and a bottle of thunderbird to come to their clinic and have "tests", or just say they did. They are usually gone by the time CMS catches on, and doing the same thing under a different name. California, Arizona and Florida are notorious for these.

Then there is gray zone "fraud". Coding aggressively but not necessarily having the documentation to support the submitted codes. If this is intentional it might be fraud, but like I said, it's a gray zone. And believe me, I can turn even a 3-minute visit for a sore throat into a 99215 (highest level of office visit) if I was so inclined. How is that possible? Because it is no longer important what you doctor does, only what he writes. Thank the bean counters at CMS and insurance co. as well as lawyers for that one. The result, for some less scrupulous physicians, is that they would rather spend 2 minutes with the patient and 10 minutes documenting that visit--far more lucrative.

And then there is "overbilling" or "miscoding" or "computer error" or "misinterpretation of ICDM-10 and CPT" or whatever you want to call it. This is devoid of intent, and also subject to interpretation of the vague guidelines.

So, what are the safeguards?
For the fraudulent practices, it involves CMS and DOJ identifying them, usually because their billing is way more than similar sized legitimate practices. But again, they have a tendency to disappear off the grid until they re-emerge elsewhere.

For the aggressive coders, CMS knows the bell curve of CPT E&M charges and can identify anomalies. They would then ask the practice to submit 25 or 50 progress notes for review to see if the documentation supports the coding, and pay the practice a "visit" if they are out of compliance. For one group of cardiovascular surgeons in Syracuse, that visit was by the FBI with M-16s in full body armor while their waiting room was packed with their patients.

For the other 95% of practices that wants to play by the rules, it starts with internal chart review. In our group of 6, we just reviewed each other's notes and coding. In large practices like TVH, they have outside consultants that perform that task. And this is where the TVH case get murky. (Hypothetically), those outside consultants told TVH that they were in compliance with the rules. Also, hypothetically, later reviewers disagreed. And like all practices they also had to send CMS charts to review periodically, so I don't understand how any "overbilling" didn't come to light years ago. Now, and to appease certain others on TOTV, I will term the following "conjecture". The chart review at CMS was conducted by low level staff who either didn't catch it or more likely also thought it was legitimate. But with all the hoopla with Humana and UHC as well as a very large number being thrown around, it caught the attention of a higher level bureaucrat, and probably one with even higher ambitions.

From my experience, if CMS finds what is overbilling in their opinion, you can appeal or just give them some money back. But I don't think anyone wants to try to give $361M back. Of course, we don't know exactly what period of time might be involved, if that number is accurate, and whether or not it includes interest and penalties, which would be negotiable.

I just want to reiterate that no one on TOTV, including myself, knows what happened. And it will take time for this to all settle out.

In the meantime, I agree we are in a mess. TVH has 50,000 patients. Already at least 2 doctors are trying to leave. We don't have enough physicians for our population as it is, and any mass exodus will spell trouble. And not only for patients of TVH---those patients will start flooding other practices, and those that can't find a new PCP will end up in urgent care and ER's. In turn, anyone with a real emergency may be walking into a logjam. So let's hope they get acquired or bailed out before it's too late and table the recriminations until we know the population will be cared for.

Possibly a billion dollars in false payments..yeah, couldn't be any fraud anywhere. I'd like to see a computerized tracking device for the care of Medicare patients. Hand the tracker to the patient for when they enter the office, time the MA or nurse spends in the room and actual time Dr. is in the room.

I had a pretty good Dr. but this Dr.'s. caseload is in overload. The last two yearly visits had me waiting in the room for 40 minutes after the scheduled appt., I get that. But then this Dr. spent 7-8 minutes with me for the yearly followup. I get that, the Dr. is behind. But when I see it come through Medicare charged as a long visit, it torques my jaw. The Dr. should be paying me for wasting my time and then overbilling.

[golfing eagles]

Possibly a billion dollars in false payments..yeah, couldn't be any fraud anywhere. I'd like to see a computerized tracking device for the care of Medicare patients. Hand the tracker to the patient for when they enter the office, time the MA or nurse spends in the room and actual time Dr. is in the room.

I had a pretty good Dr. but this Dr.'s. caseload is in overload. The last two yearly visits had me waiting in the room for 40 minutes after the scheduled appt., I get that. But then this Dr. spent 7-8 minutes with me for the yearly followup. I get that, the Dr. is behind. But when I see it come through Medicare charged as a long visit, it torques my jaw. The Dr. should be paying me for wasting my time and then overbilling.

The usual billing codes have nothing to do with time. Physicians do not punch a time clock. There is no such thing as a "long" visit. The level of coding is determined by the extent of the medical history and physical exam along with the complexity of medical management. So basically, unless you have the progress note, know the E&M codes, and know how to apply them, you have absolutely no basis upon which to accuse him of "overbilling"

PS: and now we're up to $1 billion in "false" charges? Inflation?????

[Aces4]

The usual billing codes have nothing to do with time. Physicians do not punch a time clock. There is no such thing as a "long" visit. The level of coding is determined by the extent of the medical history and physical exam along with the complexity of medical management. So basically, unless you have the progress note, know the E&M codes, and know how to apply them, you have absolutely no basis upon which to accuse him of "overbilling"

PS: and now we're up to $1 billion in "false" charges? Inflation?????

Yeah, may be slightly over a billion... follow all the threads regarding this.

Then why does Medicare declare it to be a "long visit"? The extent of the visit was minimal, ten seconds of thyroid neck check, (didn't even have to swallow water this time), and was advised to reschedule in a year. That is my basis. At this age I am well aware of time allotted and the extent of service. The Dr. is very familiar with my history and, honestly, was more determined to get back on schedule than my office visit. You can schmooz it over and pad the services but they were so basic it was ridiculous. Maybe things have changed since you hung up your smock. AI: Yes, Medicare does distinguish between different levels of office visits, including "long" office visits, for payment purposes. Here's how Medicare addresses this: Office Visit Codes: Medicare uses Evaluation and Management (E/M) codes to classify office visits based on the level of complexity, medical decision-making, or the total time spent during the encounter. Prolonged Services: For visits that extend beyond the maximum time allocated for a standard Level 5 office visit (99205 for new patients and 99215 for established patients), Medicare utilizes a specific add-on code, G2212. G2212 - The Medicare Prolonged Services Code: This code is used when the total time spent by the physician or qualified healthcare professional on the date of service exceeds the maximum time for the highest level E/M visit (99205 or 99215) by at least 15 minutes. It is billed in 15-minute increments. Total time includes all the time spent by the reporting practitioner on the date of service, including face-to-face time and time spent on activities like chart review, documentation, communication with other professionals, etc., according to the American Academy of Family Physicians | AAFP Medicare's guidelines for prolonged services differ from the AMA's CPT code 99417, which some other payers might utilize. In essence, Medicare distinguishes longer office visits by requiring the use of a prolonged services code (G2212) in addition to the standard E/M code when the visit duration surpasses a specific threshold, ensuring appropriate reimbursement for extended care.

[golfing eagles]

Yeah, may be slightly over a billion... follow all the threads regarding this.

Then why does Medicare declare it to be a "long visit"? The extent of the visit was minimal, ten seconds of thyroid neck check, (didn't even have to swallow water this time), and was advised to reschedule in a year. That is my basis. At this age I am well aware of time allotted and the extent of service. The Dr. is very familiar with my history and, honestly, was more determined to get back on schedule than my office visit. You can schmooz it over and pad the services but they were so basic it was ridiculous. Maybe things have changed since you hung up your smock. AI: Yes, Medicare does distinguish between different levels of office visits, including "long" office visits, for payment purposes. Here's how Medicare addresses this: Office Visit Codes: Medicare uses Evaluation and Management (E/M) codes to classify office visits based on the level of complexity, medical decision-making, or the total time spent during the encounter. Prolonged Services: For visits that extend beyond the maximum time allocated for a standard Level 5 office visit (99205 for new patients and 99215 for established patients), Medicare utilizes a specific add-on code, G2212. G2212 - The Medicare Prolonged Services Code: This code is used when the total time spent by the physician or qualified healthcare professional on the date of service exceeds the maximum time for the highest level E/M visit (99205 or 99215) by at least 15 minutes. It is billed in 15-minute increments. Total time includes all the time spent by the reporting practitioner on the date of service, including face-to-face time and time spent on activities like chart review, documentation, communication with other professionals, etc., according to the American Academy of Family Physicians | AAFP Medicare's guidelines for prolonged services differ from the AMA's CPT code 99417, which some other payers might utilize. In essence, Medicare distinguishes longer office visits by requiring the use of a prolonged services code (G2212) in addition to the standard E/M code when the visit duration surpasses a specific threshold, ensuring appropriate reimbursement for extended care.

Short answer to first question: THEY DON'T. There is no "long visit" There is extent and complexity of visits. Here is the CPT description and documentation requirements for 99215:

What Does CPT Code 99215 Mean?

CPT code 99215 is specifically used to document a comprehensive evaluation and management service for established patients. To qualify for this code, the visit must meet the following criteria:

Comprehensive History: The patient’s history must be well-documented, including a detailed assessment of their medical condition, family history, and social history.
Comprehensive Examination: The physical examination should be thorough, covering all systems related to the patient’s presenting problems.
High Complexity Medical Decision-Making (MDM): The physician must demonstrate a high level of decision-making. This involves analyzing multiple diagnoses, reviewing test results, and determining complex treatment options.

Using this code appropriately ensures that healthcare providers are compensated for the time, effort, and resources required to manage complex patient conditions.

Documentation Requirements for CPT Code 99215
Proper documentation is key to successfully using CPT code 99215. It is essential that the documentation captures all three critical components: history, examination, and decision-making. Here’s a breakdown of what’s required:



Comprehensive History: This must include an extended history of present illness, an extended review of systems (ROS), and a complete past, family, and social history (PFSH). The history should be documented thoroughly to reflect the patient’s complex health status.
Comprehensive Examination: The physician must document a detailed examination of at least eight organ systems or body areas. All pertinent findings, whether normal or abnormal, should be included in the documentation.
High Complexity MDM: The documentation must show a high level of decision-making, including multiple management options, a thorough review of test results, and an assessment of patient risks and benefits for each treatment option considered.

Please point out, right from this excerpt from CPT, the word "long"

Now, as an aside, CPT does make statements that ARE NOT PART OF THE CRITERIA such as "this visit will typically take a physician xxx minutes to complete", which is a suggestion/guideline, but not part of the requirements. Also, when the strict documentation guidelines do not fit the service, there is a way to document time spent---the most obvious example is psychiatry where 50 minutes is spent "just talking", but bedside management in an ICU setting can also be billed by time.

Two other points that I will try to make politely:

1) "Yeah, may be slightly over a billion... follow all the threads regarding this."

Yep, social media, the place to get all the facts:1rotfl::1rotfl::1rotfl:. If it's on the internet, it must be true???:1rotfl::1rotfl::1rotfl:

2) "ten seconds of thyroid neck check, (didn't even have to swallow water this time), and was advised to reschedule in a year. That is my basis."

OK, that's your basis. My basis is using, documenting and reviewing these codes for 35 years. Please don't even think about equating the two.

[BrianL99]

S
OK, that's your basis. My basis is using, documenting and reviewing these codes for 35 years. Please don't even think about equating the two.

It's clear that one of the crippling aspects of healthcare in the USA (& perhaps elsewhere), is way to much time is spent on documentation, management, paperwork and tailoring care to meet obscure insurance criteria.

It's unfortunate, that our healthcare system has been highjacked by regulators, insurance companies and lawyers (who bill the same, whether they're in court or sitting on their butts, "thinking").

[biker1]

I have seen the term "long visit" on EOBs from visits to The Villages Health before (pre Medicare age).

I also had a Medicare insurance question about two years. I had several conversations with my PCPs billing folks, my Supplemental Plan, and Medicare itself. The question was "why did an annual visit (to essentially go over blood work) count towards my Part B deductible and carry a $20 copay? I was under the impression that these "wellness visits" were covered 100%." The only person who was able to answer the question was my PCP. What she told me I found interesting. She stated "if you come in for an annual visit and don't have any issues to discuss then it would be coded as a "wellness" visit and would be covered 100% without impacting my Part B deductible and being charged a copay. If I discuss any issues bothering me (i.e. my knee is getting worse) then it gets coded differently and would count towards my Part B deductible and might have a copay (I have Plan N)". Who knew ...

Short answer to first question: THEY DON'T. There is no "long visit" There is extent and complexity of visits. Here is the CPT description and documentation requirements for 99215:

[golfing eagles]

It's clear that one of the crippling aspects of healthcare in the USA (& perhaps elsewhere), is way to much time is spent on documentation, management, paperwork and tailoring care to meet obscure insurance criteria.

It's unfortunate, that our healthcare system has been highjacked by regulators, insurance companies and lawyers (who bill the same, whether they're in court or sitting on their butts, "thinking").

And that is EXACTLY the problem. Kudos! The coding system encourages documentation over patient care. It siphons off time from patient encounters to entering data.

Why? Because the bureaucrats, regulators and lawyers don't know enough about medicine to be qualified to apply a band-aid, so they have to reduce everything to bean counting.

This is my main reason for retiring 10 years ago---I always stated that when I was spending more than 50% of my time on paperwork, I was done---and the regulators managed to achieve that goal.

[golfing eagles]

I have seen the term "long visit" on EOBs from visits to The Villages Health before (pre Medicare age).

I also had a Medicare insurance question about two years. I had several conversations with my PCPs billing folks, my Supplemental Plan, and Medicare itself. The question was "why did an annual visit (to essentially go over blood work) count towards my Part B deductible and carry a $20 copay? I was under the impression that these "wellness visits" were covered 100%." The only person who was able to answer the question was my PCP. What she told me I found interesting. She stated "if you come in for an annual visit and don't have any issues to discuss then it would be coded as a "wellness" visit and would be covered 100% without impacting my Part B deductible and being charged a copay. If I discuss any issues bothering me (i.e. my knee is getting worse) then it gets coded differently and would count towards my Part B deductible and might have a copay (I have Plan N)". Who knew ...

"I have seen the term "long visit" on EOBs from visits to The Villages Health before (pre Medicare age)."

If it was there, it was not an official CPT term or criteria----I've already posted those criteria and there is not term "long"

As for the rest of it, it is even more complicated than the answer that was given.

If your appointment was scheduled as the annual wellness visit:

If you then bring up another problem, the proper procedure is for the physician to complete the wellness visit, close the note and start a new note on the problem. The she is supposed to bill for both with the appropriate CPT codes and the "problem" visit may be subject to a copay.

If it was booked as a visit for a specific problem:

And the physician states "while you're here let's also do your annual wellness visit", that is a violation of the rules and would subject her to paying the wellness visit back

Kind of dumb, predicating two different billings on the original reason for scheduling the visit, but those are the dumb rules

[ThirdOfFive]

And some other estimates are as high as $105 billion. But I think we need to clarify what is being loosely thrown around as "fraud". I believe the definition of fraud is intentional misrepresentation (legal dictionaries agree). If I believe my SUV is in good working order and sell it to you, and it turns out it's a lemon, it is NOT fraud. If I knew and concealed it, THEN it is fraud. If I believe I correctly documented a patient visit as a 99214, but CMS disagrees, IT IS NOT FRAUD. It's only if I knew it didn't meet the criteria and billed that code anyway that I committed fraud.

Now that the definition is clear (sorry to the hundreds of posters that are accusing TVH of "fraud"), there is the question of what is included in that $60-105B estimate:
First there is outright fraud, medical practices that were set up for no other purpose than to bill Medicare millions for unnecessary work or services that were never performed. These are usually fly by night clinics owned by somebody with a bogus medical degree from the Caribbean that pays winos and homeless people cash and a bottle of thunderbird to come to their clinic and have "tests", or just say they did. They are usually gone by the time CMS catches on, and doing the same thing under a different name. California, Arizona and Florida are notorious for these.

Then there is gray zone "fraud". Coding aggressively but not necessarily having the documentation to support the submitted codes. If this is intentional it might be fraud, but like I said, it's a gray zone. And believe me, I can turn even a 3-minute visit for a sore throat into a 99215 (highest level of office visit) if I was so inclined. How is that possible? Because it is no longer important what you doctor does, only what he writes. Thank the bean counters at CMS and insurance co. as well as lawyers for that one. The result, for some less scrupulous physicians, is that they would rather spend 2 minutes with the patient and 10 minutes documenting that visit--far more lucrative.

And then there is "overbilling" or "miscoding" or "computer error" or "misinterpretation of ICDM-10 and CPT" or whatever you want to call it. This is devoid of intent, and also subject to interpretation of the vague guidelines.

So, what are the safeguards?
For the fraudulent practices, it involves CMS and DOJ identifying them, usually because their billing is way more than similar sized legitimate practices. But again, they have a tendency to disappear off the grid until they re-emerge elsewhere.

For the aggressive coders, CMS knows the bell curve of CPT E&M charges and can identify anomalies. They would then ask the practice to submit 25 or 50 progress notes for review to see if the documentation supports the coding, and pay the practice a "visit" if they are out of compliance. For one group of cardiovascular surgeons in Syracuse, that visit was by the FBI with M-16s in full body armor while their waiting room was packed with their patients.

For the other 95% of practices that wants to play by the rules, it starts with internal chart review. In our group of 6, we just reviewed each other's notes and coding. In large practices like TVH, they have outside consultants that perform that task. And this is where the TVH case get murky. (Hypothetically), those outside consultants told TVH that they were in compliance with the rules. Also, hypothetically, later reviewers disagreed. And like all practices they also had to send CMS charts to review periodically, so I don't understand how any "overbilling" didn't come to light years ago. Now, and to appease certain others on TOTV, I will term the following "conjecture". The chart review at CMS was conducted by low level staff who either didn't catch it or more likely also thought it was legitimate. But with all the hoopla with Humana and UHC as well as a very large number being thrown around, it caught the attention of a higher level bureaucrat, and probably one with even higher ambitions.

From my experience, if CMS finds what is overbilling in their opinion, you can appeal or just give them some money back. But I don't think anyone wants to try to give $361M back. Of course, we don't know exactly what period of time might be involved, if that number is accurate, and whether or not it includes interest and penalties, which would be negotiable.

I just want to reiterate that no one on TOTV, including myself, knows what happened. And it will take time for this to all settle out.

In the meantime, I agree we are in a mess. TVH has 50,000 patients. Already at least 2 doctors are trying to leave. We don't have enough physicians for our population as it is, and any mass exodus will spell trouble. And not only for patients of TVH---those patients will start flooding other practices, and those that can't find a new PCP will end up in urgent care and ER's. In turn, anyone with a real emergency may be walking into a logjam. So let's hope they get acquired or bailed out before it's too late and table the recriminations until we know the population will be cared for.
Many thanks for your informative, factual post. It should help folks better understand just what a complicated maze Medicare is. It certainly did me.

[ThirdOfFive]

They wanna play the morse family must pay, the family acted together to conspire to commit what we all know was a crime, they should be charged with the RICO ACT! They strong arm the stores and restaurants in the villages and healthcare prosecute them to the max.
So saith The Court Of Public Opinion.

Thankfully this issue will be settled by courts of law.

[golfing eagles]

Many thanks for your informative, factual post. It should help folks better understand just what a complicated maze Medicare is. It certainly did me.

And for the really sad part----that's just the tip of the iceberg. Think of the maze from "Harry Potter and the Goblet of Fire" and expand it to 4 spatial dimensions :1rotfl::1rotfl::1rotfl:

[biker1]

The term "long visit" was used on the EOB from either the Supplemental Plan or Medicare, don't recall which as I gets EOBs from both. Apparently, the term "long visit" is an interpretation for the patient ???? At least one was, by the way, a long visit because I was discussing some treatment options that were complicated (the pre-Medicare visit)

The appointment was for a "wellness" visit. The conversation eventually moved to "this is bothering me, any thoughts?". I find it more of a curiosity than anything as I would hit my Part B deductible anyway and the co-pay is only $20. Thanks for the explanation.


"I have seen the term "long visit" on EOBs from visits to The Villages Health before (pre Medicare age)."

If it was there, it was not an official CPT term or criteria----I've already posted those criteria and there is not term "long"

As for the rest of it, it is even more complicated than the answer that was given.

If your appointment was scheduled as the annual wellness visit:

If you then bring up another problem, the proper procedure is for the physician to complete the wellness visit, close the note and start a new note on the problem. The she is supposed to bill for both with the appropriate CPT codes and the "problem" visit may be subject to a copay.

If it was booked as a visit for a specific problem:

And the physician states "while you're here let's also do your annual wellness visit", that is a violation of the rules and would subject her to paying the wellness visit back

Kind of dumb, predicating two different billings on the original reason for scheduling the visit, but those are the dumb rules

[Aces4]

Short answer to first question: THEY DON'T. There is no "long visit" There is extent and complexity of visits. Here is the CPT description and documentation requirements for 99215:

What Does CPT Code 99215 Mean?

CPT code 99215 is specifically used to document a comprehensive evaluation and management service for established patients. To qualify for this code, the visit must meet the following criteria:

Comprehensive History: The patient’s history must be well-documented, including a detailed assessment of their medical condition, family history, and social history.
Comprehensive Examination: The physical examination should be thorough, covering all systems related to the patient’s presenting problems.
High Complexity Medical Decision-Making (MDM): The physician must demonstrate a high level of decision-making. This involves analyzing multiple diagnoses, reviewing test results, and determining complex treatment options.

Using this code appropriately ensures that healthcare providers are compensated for the time, effort, and resources required to manage complex patient conditions.

Documentation Requirements for CPT Code 99215
Proper documentation is key to successfully using CPT code 99215. It is essential that the documentation captures all three critical components: history, examination, and decision-making. Here’s a breakdown of what’s required:



Comprehensive History: This must include an extended history of present illness, an extended review of systems (ROS), and a complete past, family, and social history (PFSH). The history should be documented thoroughly to reflect the patient’s complex health status.
Comprehensive Examination: The physician must document a detailed examination of at least eight organ systems or body areas. All pertinent findings, whether normal or abnormal, should be included in the documentation.
High Complexity MDM: The documentation must show a high level of decision-making, including multiple management options, a thorough review of test results, and an assessment of patient risks and benefits for each treatment option considered.

Please point out, right from this excerpt from CPT, the word "long"

Now, as an aside, CPT does make statements that ARE NOT PART OF THE CRITERIA such as "this visit will typically take a physician xxx minutes to complete", which is a suggestion/guideline, but not part of the requirements. Also, when the strict documentation guidelines do not fit the service, there is a way to document time spent---the most obvious example is psychiatry where 50 minutes is spent "just talking", but bedside management in an ICU setting can also be billed by time.

Two other points that I will try to make politely:

1) "Yeah, may be slightly over a billion... follow all the threads regarding this."

Yep, social media, the place to get all the facts:1rotfl::1rotfl::1rotfl:. If it's on the internet, it must be true???:1rotfl::1rotfl::1rotfl:

2) "ten seconds of thyroid neck check, (didn't even have to swallow water this time), and was advised to reschedule in a year. That is my basis."

OK, that's your basis. My basis is using, documenting and reviewing these codes for 35 years. Please don't even think about equating the two.

I think some minds are so closed to reality that they can only see their limited perspective perhaps due to bias from their occupation. I've had enough exposure to medical claims and physicians charges to know nothing is perfect, physicians are human and temptations are real. I could throw 3 or 4 laughing idiot icons on to finish this but I think I'll pass.

[golfing eagles]

I think some minds are so closed to reality that they can only see their limited perspective perhaps due to bias from their occupation. I've had enough exposure to medical claims and physicians charges to know nothing is perfect, physicians are human and temptations are real. I could throw 3 or 4 laughing idiot icons on to finish this but I think I'll pass.

Whatever.

[Aces4]

Whatever. But that does justify the “laughing idiot” icons

In one mind anyway... whatever.

[golfing eagles]

In one mind anyway... whatever.

Ok, I'm sorry I wasn't clear. This is not a debate. This is me educating people how the system works and hopefully some of them listen. Their choice. But if they want to know what happens in reality, at least I've shown them. To those with "closed minds", res ipsa loquitur.

[Aces4]

Ok, I'm sorry I wasn't clear. This is not a debate. This is me educating people how the system works and hopefully some of them listen. Their choice. But if they want to know what happens in reality, at least I've shown them. To those with "closed minds", res ipsa loquitur.

The "system", Medicare, indicates payment for a "long visit" which I indicated in the earlier post per Medicare guidelines exists. Then educating would include this vital information and the fact that some Drs. or their offices do bill this for charge when it has not occurred in any form. And yeah, " the thing does speak for itself".. if critical thinking is applied.

[golfing eagles]

The "system", Medicare, indicates payment for a "long visit" which I indicated in the earlier post per Medicare guidelines exists. Then educating would include this vital information and the fact that some Drs. or their offices do bill this for charge when it has not occurred in any form.

I don't get it. I posted the criteria for just one E&M code, the highest level 99215. I can post others if anyone wants. I threw down the challenge to show me the word "long" anywhere in the requirements. Guess what? IT ISN'T THERE. If someone has seen the word long on their EOB, they are either hallucinating, or it is some sort of attempt to explain the code to an amateur, but it IS NOT AN OFFICIAL TERM. This is the third time I've had to reiterate this, it's really not that hard.

Now we have a new accusation----"some Drs. or their offices do bill this for charge when it has not occurred in any form." If true, and I very much doubt that it is, that would be an example of outright fraud. So naturally the person who posted that has irrefutable proof of their accusation? Of course they do, :1rotfl::1rotfl::1rotfl:

[Aces4]

I don't get it. I posted the criteria for just one E&M code, the highest level 99215. I can post others if anyone wants. I threw down the challenge to show me the word "long" anywhere in the requirements. Guess what? IT ISN'T THERE. If someone has seen the word long on their EOB, they are either hallucinating, or it is some sort of attempt to explain the code to an amateur, but it IS NOT AN OFFICIAL TERM. This is the third time I've had to reiterate this, it's really not that hard.

Now we have a new accusation----"some Drs. or their offices do bill this for charge when it has not occurred in any form." If true, and I very much doubt that it is, that would be an example of outright fraud. So naturally the person who posted that has irrefutable proof of their accusation? Of course they do, :1rotfl::1rotfl::1rotfl:

I've got my EOB right in front of me, "Doctor's office visit, long", but you are unable to accept any truth so maybe those reading this thread followers will realize the truth isn't always told by doctors. AI: the codes are based on the total time spent on the day of the encounter and the patient's status as new or established. For established patients, codes range from 99212 (shorter visits) to 99215 (longer, more complex visits).

[biker1]

That is the exact wording I see. It comes on the EOB from my Supplemental Plan under Part B services. I don't really give it much thought, more of a curiosity to me. The most recent time I saw it, the appointment wasn't really that long. Perhaps "long" is not relative to time??

I've got my EOB right in front of me, "Doctor's office visit, long", but you are unable to accept any truth so maybe those reading this thread followers will realize the truth isn't always told by doctors. AI: the codes are based on the total time spent on the day of the encounter and the patient's status as new or established. For established patients, codes range from 99212 (shorter visits) to 99215 (longer, more complex visits).

[Aces4]

That is the exact wording I see. It comes on the EOB from my Supplemental Plan under Part B services. I don't really give it much thought, more of a curiosity to me. The most recent time I saw it, the appointment wasn't really that long. Perhaps "long" is not relative to time??

Yes, it is. Established Patient Codes (Example) 99212: Typically 10-19 minutes 99213: Typically 20-29 minutes 99214: Typically 30-39 minute 99215: Typically 40-54 minutes. I allow for extra time for note taking, updating information and record research and there is no way my visit was a long one. I don't say all Drs. do this but I do think there is bill padding happening in some areas whether directly from the Drs. office or agency coding.

[golfing eagles]

I've got my EOB right in front of me, "Doctor's office visit, long", but you are unable to accept any truth so maybe those reading this thread followers will realize the truth isn't always told by doctors. AI: the codes are based on the total time spent on the day of the encounter and the patient's status as new or established. For established patients, codes range from 99212 (shorter visits) to 99215 (longer, more complex visits).

Now this has gone from amusing to ridiculous. Here is the TRUTH, again, right from CPT for 99215. It's ridiculous that I have to re-post it when the wording couldn't be clearer, and the absence of the word "long" is obvious. You may have some cute little amateur explanation on the EOB that's "right in front of you", but there is no such code "Office visit, long".

What Does CPT Code 99215 Mean?

CPT code 99215 is specifically used to document a comprehensive evaluation and management service for established patients. To qualify for this code, the visit must meet the following criteria:

Comprehensive History: The patient’s history must be well-documented, including a detailed assessment of their medical condition, family history, and social history.
Comprehensive Examination: The physical examination should be thorough, covering all systems related to the patient’s presenting problems.
High Complexity Medical Decision-Making (MDM): The physician must demonstrate a high level of decision-making. This involves analyzing multiple diagnoses, reviewing test results, and determining complex treatment options.

Using this code appropriately ensures that healthcare providers are compensated for the time, effort, and resources required to manage complex patient conditions.

Documentation Requirements for CPT Code 99215
Proper documentation is key to successfully using CPT code 99215. It is essential that the documentation captures all three critical components: history, examination, and decision-making. Here’s a breakdown of what’s required:



Comprehensive History: This must include an extended history of present illness, an extended review of systems (ROS), and a complete past, family, and social history (PFSH). The history should be documented thoroughly to reflect the patient’s complex health status.
Comprehensive Examination: The physician must document a detailed examination of at least eight organ systems or body areas. All pertinent findings, whether normal or abnormal, should be included in the documentation.
High Complexity MDM: The documentation must show a high level of decision-making, including multiple management options, a thorough review of test results, and an assessment of patient risks and benefits for each treatment option considered.

Also, ONCE AGAIN, the components required for 99215 are in CLEAR ENGLISH---and nowhere does it include "time spent on the encounter. GET IT----NOWHERE IS TIME SPENT ON THE ENCOUNTER PART OF THE CODING REQUIREMENT. AND AGAIN, REPEAT AFTER ME, THERE IS NO "DOCTORS VISIT, LONG CODE AND TIME IS NOT A FACTOR IN THE E&M CODES. And furthermore, this just goes to show the problem with AI----it's still garbage in, garbage out.

So, now I'm done responding to gibberish. If anyone has a legitimate question and wants to know more, just post it (except for one person)

PS: REPEAT AFTER ME, THERE IS NO "DOCTORS VISIT, LONG CODE AND TIME IS NOT A FACTOR IN THE E&M CODES.

[golfing eagles]

Yes, it is. Established Patient Codes (Example) 99212: Typically 10-19 minutes 99213: Typically 20-29 minutes 99214: Typically 30-39 minute 99215: Typically 40-54 minutes. I allow for extra time for note taking, updating information and record research and there is no way my visit was a long one. I don't say all Drs. do this but I do think there is bill padding happening in some areas whether directly from the Drs. office or agency coding.

Those times ARE NOT part of the criteria for an E&M code. REPEAT: THEY ARE NOT PART OF THE CRITERIA FOR E&M CODES.

Now, for an elementary physics question that applies here: What is mass/volume?

[Aces4]

Now this has gone from amusing to ridiculous. Here is the TRUTH, again, right from CPT for 99215. It's ridiculous that I have to re-post it when the wording couldn't be clearer, and the absence of the word "long" is obvious. You may have some cute little amateur explanation on the EOB that's "right in front of you", but there is no such code "Office visit, long".

What Does CPT Code 99215 Mean?

CPT code 99215 is specifically used to document a comprehensive evaluation and management service for established patients. To qualify for this code, the visit must meet the following criteria:

Comprehensive History: The patient’s history must be well-documented, including a detailed assessment of their medical condition, family history, and social history.
Comprehensive Examination: The physical examination should be thorough, covering all systems related to the patient’s presenting problems.
High Complexity Medical Decision-Making (MDM): The physician must demonstrate a high level of decision-making. This involves analyzing multiple diagnoses, reviewing test results, and determining complex treatment options.

Using this code appropriately ensures that healthcare providers are compensated for the time, effort, and resources required to manage complex patient conditions.

Documentation Requirements for CPT Code 99215
Proper documentation is key to successfully using CPT code 99215. It is essential that the documentation captures all three critical components: history, examination, and decision-making. Here’s a breakdown of what’s required:



Comprehensive History: This must include an extended history of present illness, an extended review of systems (ROS), and a complete past, family, and social history (PFSH). The history should be documented thoroughly to reflect the patient’s complex health status.
Comprehensive Examination: The physician must document a detailed examination of at least eight organ systems or body areas. All pertinent findings, whether normal or abnormal, should be included in the documentation.
High Complexity MDM: The documentation must show a high level of decision-making, including multiple management options, a thorough review of test results, and an assessment of patient risks and benefits for each treatment option considered.

Also, ONCE AGAIN, the components required for 99215 are in CLEAR ENGLISH---and nowhere does it include "time spent on the encounter. GET IT----NOWHERE IS TIME SPENT ON THE ENCOUNTER PART OF THE CODING REQUIREMENT. AND AGAIN, REPEAT AFTER ME, THERE IS NO "DOCTORS VISIT, LONG CODE AND TIME IS NOT A FACTOR IN THE E&M CODES. And furthermore, this just goes to show the problem with AI----it's still garbage in, garbage out.

So, now I'm done responding to gibberish. If anyone has a legitimate question and wants to know more, just post it (except for one person)

PS: REPEAT AFTER ME, THERE IS NO "DOCTORS VISIT, LONG CODE AND TIME IS NOT A FACTOR IN THE E&M CODES.

If there is no Doctor's office visit, long code.. why the devil is Medicare using this verbage on their statements. Talk about gibberish, I guess the Medicare billing and Drs. offices need a new update on a 10 yr retired opinion of coding. This is laughable and I'm done too. People, the information is out there and if you're too old to figure out when Medicare may be overcharged by Drs. or their offices, you're out of luck. Speaking of luck, we're all going to need it after what I've read here.

[biker1]

A code of 99214 was associated with the term "Doctor's office visit, long" on my Supplemental Plan EOB. Some additional clarity such as the time range (that you listed) would be useful if the Supplemental Plan feels the need to provide a description (layman's translation of the code??) of the service. It is what it is.


Yes, it is. Established Patient Codes (Example) 99212: Typically 10-19 minutes 99213: Typically 20-29 minutes 99214: Typically 30-39 minute 99215: Typically 40-54 minutes. I allow for extra time for note taking, updating information and record research and there is no way my visit was a long one. I don't say all Drs. do this but I do think there is bill padding happening in some areas whether directly from the Drs. office or agency coding.

[golfing eagles]

A code of 99214 was associated with the term "Doctor's office visit, long" on my Supplemental Plan EOB. Some additional clarity such as the time range (that you listed) would be useful if the Supplemental Plan feels the need to provide a description (translation of the code) of the service. It is what it is.

I believe I gave way more than additional clarity. Not you, but some people want to muddy the waters.

[Aces4]

A code of 99214 was associated with the term "Doctor's office visit, long" on my Supplemental Plan EOB. Some additional clarity such as the time range (that you listed) would be useful if the Supplemental Plan feels the need to provide a description of the service. It is what it is.

Your visit was based on the time the physician had to spend for your case and, apparently, your visit took up 30-39 minutes of his time in one way or another. The fact that some people provide clarity of the billing for Medicare makes some prefer muddy water. I am not one.

[biker1]

When people ask me for clarity/explanation, I preface my response with "remember, you asked". Rarely am I asked twice for an explanation by the same person ;-)

I believe I gave way more than additional clarity. Not you, but some people want to muddy the waters.

[golfing eagles]

Your visit was based on the time the physician had to spend for your case and, apparently, your visit took up 30-39 minutes of his time in one way or another. The fact that some people provide clarity of the billing for Medicare makes some prefer muddy water. I am not one.

Batting 100% I see. Once again WRONG.

The code 99214 was submitted because it met the following criteria:

Care Components
When it comes to accurate medical billing and coding for a 99214 visit, healthcare providers need to understand the care components involved. This particular visit requires a detailed history, a detailed examination, and medical decision making of moderate complexity. Let’s take a closer look at each component:

Detailed History
The detailed history component of a 99214 visit involves gathering relevant information from the patient. This includes their chief complaint, present illness, past medical history, family history, social history, and a review of systems. It is crucial for healthcare providers to document this information accurately to support the billing and coding process.

Detailed Examination
The detailed examination component involves conducting a thorough physical examination of the patient. This includes evaluating all relevant body systems and documenting any pertinent findings. Healthcare providers should carefully document their findings to ensure accurate billing and coding for the 99214 visit.

Medical Decision Making of Moderate Complexity
The medical decision making component evaluates the complexity of the healthcare provider’s decision-making process for the patient’s care. This includes assessing the patient’s diagnosis, treatment options, and the associated risks and benefits. Healthcare providers should document their medical decision making thought process to support accurate billing and coding for the 99214 visit.

Proper medical billing and coding is essential to optimize reimbursement for healthcare services. By accurately documenting each care component of the 99214 visit, healthcare providers can ensure accurate coding and billing that reflects the level of care provided.

The 2021 revisions to CPT allowed an ALTERNATIVE to meeting those documentation criteria for visits that don't lend themselves to such documentation---notably psychiatry, but something like a family conference about a patient would qualify as well. In that case there are time guidelines, but these are not used often except in psychiatry (which I'm beginning to think might be in play here) and occasionally when an oncologist has a family meeting. The 99214 WAS NOT BILLED for time. IT DOESN"T MEAN LONG!!!!

If unable to answer what mass/volume is, perhaps this would be a better question: Why do some people insist on arguing with an expert in a field they know nothing about????

[Aces4]

Batting 100% I see. Once again WRONG.

The code 99214 was submitted because it met the following criteria:

Care Components
When it comes to accurate medical billing and coding for a 99214 visit, healthcare providers need to understand the care components involved. This particular visit requires a detailed history, a detailed examination, and medical decision making of moderate complexity. Let’s take a closer look at each component:

Detailed History
The detailed history component of a 99214 visit involves gathering relevant information from the patient. This includes their chief complaint, present illness, past medical history, family history, social history, and a review of systems. It is crucial for healthcare providers to document this information accurately to support the billing and coding process.

Detailed Examination
The detailed examination component involves conducting a thorough physical examination of the patient. This includes evaluating all relevant body systems and documenting any pertinent findings. Healthcare providers should carefully document their findings to ensure accurate billing and coding for the 99214 visit.

Medical Decision Making of Moderate Complexity
The medical decision making component evaluates the complexity of the healthcare provider’s decision-making process for the patient’s care. This includes assessing the patient’s diagnosis, treatment options, and the associated risks and benefits. Healthcare providers should document their medical decision making thought process to support accurate billing and coding for the 99214 visit.

Proper medical billing and coding is essential to optimize reimbursement for healthcare services. By accurately documenting each care component of the 99214 visit, healthcare providers can ensure accurate coding and billing that reflects the level of care provided.

The 2021 revisions to CPT allowed an ALTERNATIVE to meeting those documentation criteria for visits that don't lend themselves to such documentation---notably psychiatry, but something like a family conference about a patient would qualify as well. In that case there are time guidelines, but these are not used often except in psychiatry (which I'm beginning to think might be in play here) and occasionally when an oncologist has a family meeting. The 99214 WAS NOT BILLED for time. IT DOESN"T MEAN LONG!!!!

If unable to answer what mass/volume is, perhaps this would be a better question: Why do some people insist on arguing with an expert in a field they know nothing about????

I think it takes a lot of audacity to insist another Dr. knows how a visit which I made to my Dr. should be billed. If that Dr. was not in the office with me, didn't see the EOB from that visit and has absolutely no belief in Medicare statements or AIs explanation, then no input is needed as to what I was billed and how the appointment was coded for a long visit. Perhaps a call to Medicare should be next for a former practicing physician for clarity and why they would insist on putting "Office visit, Long" on THEIR form. Take it up with Medicare, I've only provided facts.

[Rainger99]

I don't get it. I posted the criteria for just one E&M code, the highest level 99215. I can post others if anyone wants. I threw down the challenge to show me the word "long" anywhere in the requirements. Guess what? IT ISN'T THERE. If someone has seen the word long on their EOB, they are either hallucinating, or it is some sort of attempt to explain the code to an amateur, but it IS NOT AN OFFICIAL TERM. This is the third time I've had to reiterate this, it's really not that hard.

Now we have a new accusation----"some Drs. or their offices do bill this for charge when it has not occurred in any form." If true, and I very much doubt that it is, that would be an example of outright fraud. So naturally the person who posted that has irrefutable proof of their accusation? Of course they do, :1rotfl::1rotfl::1rotfl:

It is true that the word long is not there. But 99215 does say 40-54 minutes while other codes are 15-29 minutes or 30-44 minutes or 45-59 minutes or 60-74 minutes. So there appears to be a time element involved.

https://www.ohfama.org/aws/OHFAMA/asset_manager/get_file/904100?ver=1

[collie1228]

If nothing else, this forum has reaffirmed my opinion that the government should not be in charge of health care for anyone. The complexity is amazing. I really like my Medicare Advantage program, but from almost everything I’ve read, the Advantage programs are ripping off the taxpayers. Is that true? Who knows.

[golfing eagles]

I think it takes a lot of audacity to insist another Dr. knows how a visit which I made to my Dr. should be billed. If that Dr. was not in the office with me, didn't see the EOB from that visit and has absolutely no belief in Medicare statements or AIs explanation, then no input is needed as to what I was billed and how the appointment was coded for a long visit. Perhaps a call to Medicare should be next for a former practicing physician for clarity and why they would insist on putting "Office visit, Long" on THEIR form. Take it up with Medicare, I've only provided facts.

Wrong again. Every doctor should know how to bill a visit. And for the last time, TIME HAS NOTHING TO DO WITH IT. If you are so sure you were somehow cheated, maybe you should call the Medicare fraud number at the bottom of your EOB

[golfing eagles]

It is true that the word long is not there. But 99215 does say 40-54 minutes while other codes are 15-29 minutes or 30-44 minutes or 45-59 minutes or 60-74 minutes. So there appears to be a time element involved.

https://www.ohfama.org/aws/OHFAMA/asset_manager/get_file/904100?ver=1

Only for visits that don’t lend themselves to the usual documentation is impractical. You spend 50 minutes with a psychiatrist, how would you feel if he tried to do a 12 point physical examination? That’s where the ALTERNATIVE time related billing is permitted.

[Rainger99]

Only for visits that don’t lend themselves to the usual documentation is impractical. You spend 50 minutes with a psychiatrist, how would you feel if he tried to do a 12 point physical examination? That’s where the ALTERNATIVE time related billing is permitted.

But if the doctor spent 1 minute with you, can they bill 99215?

[golfing eagles]

But if the doctor spent 1 minute with you, can they bill 99215?

They shouldn’t, because you can’t possibly actually do what is required to be documented in that time. There is no way to interview the patient to ascertain the extent of history much less perform the extent physical examination required. I think Medicare may have done the public a disservice by relating their time guidelines for alternative documentation, it could cause confusion for the non-professional and on this thread it’s obvious it has completely befuddled one individual.

[Aces4]

They shouldn’t, because you can’t possibly actually do what is required to be documented in that time. There is no way to interview the patient to ascertain the extent of history much less perform the extent physical examination required. I think Medicare may have done the public a disservice by relating their time guidelines for alternative documentation, it could cause confusion for the non-professional and on this thread it’s obvious it has completely befuddled one individual.

Yes, it has but we can only hope that befuddled individual will contact Medicare and see that the info I provided is what is current and that 10 year old philosophies, rules and regulations have changed.

[Aces4]

Wrong again. Every doctor should know how to bill a visit. And for the last time, TIME HAS NOTHING TO DO WITH IT. If you are so sure you were somehow cheated, maybe you should call the Medicare fraud number at the bottom of your EOB

Maybe you should contact Medicare and straighten them out with all your rules and regulations, I think they would be surprised.. to put it mildly.

[Aces4]

Wrong again. Every doctor should know how to bill a visit. And for the last time, TIME HAS NOTHING TO DO WITH IT. If you are so sure you were somehow cheated, maybe you should call the Medicare fraud number at the bottom of your EOB

Maybe you should contact Medicare and straighten them out with all your rules and regulations, I think they would be surprised.. to put it mildly. Like any physician takes an extensive history everytime one is seen is a stretch. BTW, most of us don't need or are seeing psychiatrist so we aren't worried about their billing procedures. I didn't think I was cheated, lol, most drs realize the public is being fleeced when they cheat, not the Medicare patient.

[golfing eagles]

Yes, it has but we can only hope that befuddled individual will contact Medicare and see that the info I provided is what is current and that 10 year old philosophies, rules and regulations have changed.

Oh, I see. You think I’ve been sitting on my hands since retiring and I’m not current. Have you ever heard of consulting. So you’re still batting 1000

[Rainger99]

They shouldn’t, because you can’t possibly actually do what is required to be documented in that time. There is no way to interview the patient to ascertain the extent of history much less perform the extent physical examination required. I think Medicare may have done the public a disservice by relating their time guidelines for alternative documentation, it could cause confusion for the non-professional and on this thread it’s obvious it has completely befuddled one individual.

When I go to a doctor, they usually put me in a room where I wait for 15-20 minutes before the doctor comes in for a quick exam.

Does the clock start when they put me in the room or when the doctor shows up?

As a patient, I really don’t care how long I see the doctor. I care more about results. I went to a specialist a few years ago. I met with him for less than five minutes and he diagnosed me and sent me to physical therapy for a month. After three weeks, I was totally cured.

[Aces4]

Oh, I see. You think I’ve been sitting on my hands since retiring and I’m not current. Have you ever heard of consulting. So you’re still batting 1000

I would have never guessed that, huh!

[golfing eagles]

I would have never guessed that, huh!

In that case, your 100% batting record remains intact :1rotfl::1rotfl::1rotfl:

[golfing eagles]

When I go to a doctor, they usually put me in a room where I wait for 15-20 minutes before the doctor comes in for a quick exam.

Does the clock start when they put me in the room or when the doctor shows up?

As a patient, I really don’t care how long I see the doctor. I care more about results. I went to a specialist a few years ago. I met with him for less than five minutes and he diagnosed me and sent me to physical therapy for a month. After three weeks, I was totally cured.

Looks like the confusion has continued---there is no "clock", only meeting strict documentation criteria

[Aces4]

In that case, your 100% batting record remains intact :1rotfl::1rotfl::1rotfl:

In your rolling on the floor *ss... I think others can see exactly what happening with coding and if the Drs. are doing the coding, there's probably a fire where they're seeing all that smoke in The Villages. After all the coders aren't sitting in the office with every patient to see how the patient should actually be coded for a claim. You can educate a Dr. but you can't infuse the integrity and honestly that is missing in some. Money talks.

[golfing eagles]

In your rolling on the floor *ss... I think others can see exactly what happening with coding and if the Drs. are doing the coding, there's probably a fire where they're seeing all that smoke in The Villages. After all the coders aren't sitting in the office with every patient to see how the patient should actually be coded for a claim. You can educate a Dr. but you can't infuse the integrity and honestly that is missing in some. Money talks.

And you perfect record continues. Kudos!

This time because the physicians at TVH do not utilize point of service coding

[Aces4]

And you perfect record continues. Kudos!

This time because the physicians at TVH do not utilize point of service coding

And your perfect record of mumbo jumbo goes on. I rest my case.

[golfing eagles]

And your perfect record of mumbo jumbo goes on. I rest my case.

Just because a there is a lack of understanding on somebody's part doesn't make it "mumbo jumbo". On the other hand, 20 posts lacking a factual knowledge basis could be, and is, considered ridiculous nonsense. I'm still at a loss here----if somebody has an electrical problem in their home and hires a master electrician, do they try to debate with the expert?? And what would we call somebody who actually does--in fact there are a number of names that apply

[Aces4]

[QUOTE=golfing eagles;2455783]Just because a there is a lack of understanding on somebody's part doesn't make it "mumbo jumbo". On the other hand, 20 posts lacking a factual knowledge basis could be, and is, considered ridiculous nonsense. I'm still at a loss here----if somebody has an electrical problem in their home and hire a master electrician, do they try to debate with the expert?? And what would call somebody who actually does--in fact there are a number of names that apply.

Factual information does seem to be missing with the claim that being charged for an office visit, long on Medicare billing doesn't exist and well as the CPT code for longer visits is printed, on record but someone can't grasp the truth. If coders at TVH are making all the billing decisions and the Drs have no imput as to what is being charged, that's a huge problem right there. And then there is the premise that Medicare shouldn't let the insureds know about CPT coding because it cause terrible confusion, like if you don't have MD behind your name you can't tell when your billing has been overcharged when a simple, no clothes removed 7-8 minute visit with no tests should be billed at the highest code for a long, complicated visit. Baloney.

[golfing eagles]

[QUOTE=golfing eagles;2455783]Just because a there is a lack of understanding on somebody's part doesn't make it "mumbo jumbo". On the other hand, 20 posts lacking a factual knowledge basis could be, and is, considered ridiculous nonsense. I'm still at a loss here----if somebody has an electrical problem in their home and hire a master electrician, do they try to debate with the expert?? And what would call somebody who actually does--in fact there are a number of names that apply.

Factual information does seem to be missing with the claim that being charged for a long office on Medicare billing doesn't exist and well as the CPT code for longer visits is printed, on record but someone can't grasp the truth. If coders at TVH are making all the billing decisions and the Drs have no imput as to what is being charged, that's a huge problem right there. And then there is the premise that Medicare shouldn't let the insureds know about CPT coding because it cause terrible confusion, like if you don't have MD behind your name you can't tell when your billing has been overcharged when a simple, no clothes removed 7-8 minute visit with no tests should be billed at the highest code for a long, complicated visit. Baloney.

And yet it continues. Do I have to post the criteria for 99215 for a third time? Ask it to be pointed out where the term "long visit" is located in the definition. Ask where "40-59 minutes" is located. Now, if somewhere on an EOB CMS tries to idiot proof the understanding of the charges are, fine, I've never looked at mine, because I DON"T HAVE TO, I already know everything there is to know about it. But yet some people are stuck on "7-8 minute" visit. AGAIN, TIME HAS NOTHING TO DO WITH IT.

Now , if you ask me the CORRECT question: Is it ethical to spend 7-8 minutes and bill 99215, even if it meets documentation criteria? Then I would agree with you, I don't thin k it is and I've never done that. But that's not the question at hand. The question has been "what are the requirements to bill 99214 or 99215" and the answer remains that it has everything to do with extent of history and physical and complexity of medical management, and nothing to do with time unless it is something like a psychiatric visit or a family conference.

[golfing eagles]

I think I now know how a theoretical physicist feels when trying to teach quantum field theory to a goldfish.

[Caymus]

I think I now know how a theoretical physicist feels when trying to teach quantum field theory to a goldfish.

There are studies that claim a goldfish has an attention span of 9 seconds vs 8 seconds for a human.

[Aces4]

[QUOTE=Aces4;2455786]

And yet it continues. Do I have to post the criteria for 99215 for a third time? Ask it to be pointed out where the term "long visit" is located in the definition. Ask where "40-59 minutes" is located. Now, if somewhere on an EOB CMS tries to idiot proof the understanding of the charges are, fine, I've never looked at mine, because I DON"T HAVE TO, I already know everything there is to know about it. But yet some people are stuck on "7-8 minute" visit. AGAIN, TIME HAS NOTHING TO DO WITH IT.

Now , if you ask me the CORRECT question: Is it ethical to spend 7-8 minutes and bill 99215, even if it meets documentation criteria? Then I would agree with you, I don't thin k it is and I've never done that. But that's not the question at hand. The question has been "what are the requirements to bill 99214 or 99215" and the answer remains that it has everything to do with extent of history and physical and complexity of medical management, and nothing to do with time unless it is something like a psychiatric visit or a family conference.

No one ever accused you of that coding deceit. This isn't about you, this is about some physicians practicing who do fudge the coding. And I'll say it again, if Drs. have no imput on the coding at TVH, that's a big problem right there, IMHO. I'm sure you know that when a patient of a Dr. for many years, comes in for a simple medical followup for medication under 10 minutes, something is awry when the 99215 CPT is used.

[golfing eagles]

There are studies that claim a goldfish has an attention span of 9 seconds vs 8 seconds for a human.

I think you're giving some humans too much credit

[golfing eagles]

[QUOTE=golfing eagles;2455792]

No one ever accused you of that coding deceit. This isn't about you, this is about some physicians practicing who do fudge the coding. And I'll say it again, if Drs. have no imput on the coding at TVH, that's a big problem right there, IMHO. I'm sure you know that when a patient of a Dr. for many years, comes in for a simple medical followup for medication under 10 minutes, something is awry.

Again, that's a different question. Upcoding is rampant, more the rule than the exception. But without any statistics to back it up, I think more practices have persons other than the physician doing the coding---it isn't necessarily a problem in and of itself, but it should be closely monitored. And I never took anything that was posted as a personal accusation (I would have head many more rolling, laughing little men:1rotfl::1rotfl::1rotfl:)

[Aces4]

[QUOTE=Aces4;2455797]

Again, that's a different question. Upcoding is rampant, more the rule than the exception. But without any statistics to back it up, I think more practices have persons other than the physician doing the coding---it isn't necessarily a problem in and of itself, but it should be closely monitored. And I never took anything that was posted as a personal accusation (I would have head many more rolling, laughing little men:1rotfl::1rotfl::1rotfl:)

Sorry you missed it, upcoding has been the point all along.

[IPrescribeWine]

I’m a bit late to this thread because it literally took weeks for the administrator to approve my account. I’m not new to the Villages, but new to TOTV. I’ve been following along. I’m a semi-retired doc who, in my current role did a LOT of work to help prevent Medicare fraud in my organization, mostly about ensuring that we were compliant with legitimately reporting conditions for MA patients.

Since I am new on TOTV, the moderators won’t let me post links to some interesting articles But I will tell you what to google.

I’ve read the bankruptcy filings like everyone else and haven’t noticed many people focusing on the Risk Scores as the area of concern. While I don’t have inside knowledge of TVH inside workings, I understand how “overbilling” can happen with the risk scores and want to provide my perspective.

As a reminder, traditional medicare doesn’t use risk scores. But for MA, if a patient is more complex, then TVH gets more money to care for them in the outpatient setting.

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.

I also did not notice anyone mentioning that Florida Blue also filed a claim yesterday in TVH bankruptcy filing accusing TVH of adding unsupported diagnoses (also know as inflating risk scores). Google: Florida blue accuses villages health of adding false codes.

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

Last, I’m calling out the apparent absence of oversight in TVH billing practices. Computer error or not, there should have been a corporate compliance officer who oversaw billing. Even if it was an innocent error, the compliance officer is accountable for this.

[Rainger99]

I also did not notice anyone mentioning that Florida Blue also filed a claim yesterday in TVH bankruptcy filing accusing TVH of adding unsupported diagnoses (also know as inflating risk scores). Google: Florida blue accuses villages health of adding false codes.



There are two separate threads. This one and Villages Health Bankruptcy.

Check out post 98 on that thread. It mentions Florida Blue.

[OrangeBlossomBaby]

The name Parr was mentioned in a court document. She is a member of the Morse Family.I have not seen any individual doctors named in the court documents. I believe it IS YOU who is conflating. Bankruptcy filing has nothing to do with incorrect medical coding. They are different issues. Again, to legally prove bankruptcy, you must have more debt than assets. Nothing more! Simply provide the court DEBTS AND ASSETS. And YES! The court will absolutely require ALL ASSETS be accounted. Including any owned, large or small, by the Morse Family.

"The Morse Family" doesn't own TVH. Jennifer Parr, a singular, individual Morse family member, is listed as a principal of TVH. Jennifer Parr does not make up the entirety of The Morse Family.

Imagine your third cousin filing for bankruptcy. Would the court look at YOUR assets, just because you're a blood relative? No, it wouldn't.

[OrangeBlossomBaby]

"And YES! The court will absolutely require ALL ASSETS be accounted. Including any owned, large or small, by the Morse Family."

Sounds like personal assets. :mornincoffee:

Exactly! Large or small assets FROM THIS BUSINESS. Geez!

The Morse family isn't a business. "...any owned, large or small, by the Morse Family" is not applicable in this thread, because the Morse family isn't a business. It's a family. And the Villages Health is not owned by the family. It has a 60% ownership by the holding company, which is owned by Jennifer Parr and her two siblings. The other 40% ownership is - something other than the holding company led by someone other than a member of the Morse family.

[OrangeBlossomBaby]

...
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.

...

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.

[Aces4]

The Morse family isn't a business. "...any owned, large or small, by the Morse Family" is not applicable in this thread, because the Morse family isn't a business. It's a family. And the Villages Health is not owned by the family. It has a 60% ownership by the holding company, which is owned by Jennifer Parr and her two siblings. The other 40% ownership is - something other than the holding company led by someone other than a member of the Morse family.

The 60% ownership is the family, the three Morse siblings and their family business. I'd like to see the details of the other 40% ownership.

[OrangeBlossomBaby]

The 60% ownership is the family, the three Morse siblings and their family business. I'd like to see the details of the other 40% ownership.

You can look it up, it's public record.

[Aces4]

You can look it up, it's public record.

Look up what? You stated that Jennifer Parr and her two siblings, the "holding company" own 60%, was that incorrect info? Otherwise, those are Morse siblings that own 60%.

[Rainger99]

You can look it up, it's public record.

This is from the bankruptcy filing. Go to page 14 for a list of all of the shareholders of TVH. There are quite a few but the major shareholder is Villages Health Holding Company with more than 100,000 shares.

https://cases.stretto.com/public/x458/13910/PLEADINGS/1391007032580000000195.pdf

[BrianL99]

The 60% ownership is the family, the three Morse siblings and their family business. I'd like to see the details of the other 40% ownership.

This is from the bankruptcy filing. Go to page 14 for a list of all of the shareholders of TVH. There are quite a few but the major shareholder is Villages Health Holding Company with more than 100,000 shares.

https://cases.stretto.com/public/x458/13910/PLEADINGS/1391007032580000000195.pdf


The Morse family (Jennifer Parr, Mark Morse & Tracy Morse Dadeo) as of 12/31/23 owned 100% of Villages Health Holding Co., LLC.

Here's documentation: https://www.atlantafed.org/-/media/documents/FRY6Docs/2023/VILLAGES_BC_2012315_2023.pdf

(BTW, the Corporate Officers filing of TVH was amended 2 months ago, with the Florida Secy of State, per: Detail by Entity Name (https://search.sunbiz.org/Inquiry/CorporationSearch/SearchResults?InquiryType=EntityName&InquiryDirectionType=ForwardRecord&SearchNameOrder=VILLAGESHEALTHHOLDING%20L120000585 330&ListNameOrder=VILLAGESGRIDIRONCLASSICDESIGNW%20T03 0000013660&Detail=FL.DOS.Corporations.Shared.Contracts.Filing Record))

Minority ownership of TVH may be a little harder to discern. On paper, I believe EJ Sussman owns the largest chunk of stock not held by Villages Health Holding, LLC. Who provided the funding for EJ Sussman, is probably an interesting question.

[golfing eagles]

The Morse family (Jennifer Parr, Mark Morse & Tracy Morse Dadeo) as of 12/31/23 owned 100% of Villages Health Holding Co., LLC.

Here's documentation: https://www.atlantafed.org/-/media/documents/FRY6Docs/2023/VILLAGES_BC_2012315_2023.pdf

(BTW, the Corporate Officers filing of TVH was amended 2 months ago, with the Florida Secy of State, per: Detail by Entity Name (https://search.sunbiz.org/Inquiry/CorporationSearch/SearchResults?InquiryType=EntityName&InquiryDirectionType=ForwardRecord&SearchNameOrder=VILLAGESHEALTHHOLDING%20L120000585 330&ListNameOrder=VILLAGESGRIDIRONCLASSICDESIGNW%20T03 0000013660&Detail=FL.DOS.Corporations.Shared.Contracts.Filing Record))

Minority ownership of TVH may be a little harder to discern. On paper, I believe EJ Sussman owns the largest chunk of stock not held by Villages Health Holding, LLC. Who provided the funding for EJ Sussman, is probably an interesting question.

All the minority shareholders are listed right in the bankruptcy filing, I believe a link was posted above.

[BrianL99]

All the minority shareholders are listed right in the bankruptcy filing, I believe a link was posted above.

For whatever difference it makes, it seems like Sussman was the front man when TVH was set up and I suspect the financing for his investment in TVH, came from the Morse family.

The Morse family usually holds things pretty close to the vest and don't seem to do a lot of business with partners, unless there's a good reason ... like they didn't know much about the health business, when they started TVH.

[margaretmattson]

"The Morse Family" doesn't own TVH. Jennifer Parr, a singular, individual Morse family member, is listed as a principal of TVH. Jennifer Parr does not make up the entirety of The Morse Family.

Imagine your third cousin filing
for bankruptcy. Would the
court look at YOUR assets, just
because you're a blood
relative? No, it wouldn't.
In a court document,
Jennifer Parr was required to
give accounting of monies
dispersed to her and family
members. Money is an asset.
It is the only asset the court
ordered Parr to account for. It is presently in the hands of family members.This
particular paragraph did not
mention the name of their
joint owned business. Therefore, I posted
my remark as Morse Family.
Stating the business name
when it was not mentioned in
this part of the court
document would be drawing conclusions. As other posters stated, it will be interesting to see the date this money was dispersed.

[golfing eagles]

In a court document,
Jennifer Parr was required to
give accounting of monies
dispersed to her and family
members. Money is an asset.
It is the only asset the court
ordered Parr to account for. It is presently in the hands of family members.This
particular paragraph did not
mention the name of their
joint owned business. Therefore, I posted
my remark as Morse Family.
Stating the business name
when it was not mentioned in
this part of the court
document would be drawing conclusions. As other posters stated, it will be interesting to see the date this money was dispersed.

Could you please post a link to that court document?

[margaretmattson]

Could you please post a link to that court document?It was uploaded by another poster on this thread pages back.

[golfing eagles]

It was uploaded by another poster on this thread pages back.

And it states the court ordered Jennifer Parr to give an accounting of funds dispersed to "her family"?

[Aces4]

And it states the court ordered Jennifer Parr to give an accounting of funds dispersed to "her family"?

Her family would include her brother and sisters.. it does for everyone else out there.

[golfing eagles]

Her family would include her brother and sisters.. it does for everyone else out there.

Not the question.

[Aces4]

Not the question.

I disagree but then we've been in this boat before, haven't we?:1rotfl::1rotfl::1rotfl::1rotfl::1rotfl::1rotfl ::1rotfl::1rotfl:

[golfing eagles]

I disagree but then we've been in this boat before, haven't we?:1rotfl::1rotfl::1rotfl::1rotfl::1rotfl::1rotfl ::1rotfl::1rotfl:

I thought the question was whether or not a court ordered Jennifer Parr to disclose any distributions from TVH through The Villages Holding Co. to her family, not whether brothers and sisters constitute family.

PS: using little rolling laughing men is a skill :1rotfl::1rotfl::1rotfl:

[Aces4]

I thought the question was whether or not a court ordered Jennifer Parr to disclose any distributions from TVH through The Villages Holding Co. to her family, not whether brothers and sisters constitute family.

PS: using little rolling laughing men is a skill :1rotfl::1rotfl::1rotfl:

PPSS: using little rolling laughing men with an alphabet pause to hold the number to lucky seven takes even more skill. Anyway.. I think you are parsing the request a little too much. We all know the court wants to know how much has been distributed to her family.. the richest ones. What if she were unmarried and childless? I consider my spouse, children and siblings my family. Are we to consider after marriage that our brothers and sisters aren't our family? Nah!

[OrangeBlossomBaby]

The 60% ownership is the family, the three Morse siblings and their family business. I'd like to see the details of the other 40% ownership.

You can look it up, it's public record.

Not sure what part of that you didn't understand.

If you want to see the details of the other 40% ownership, you can look it up. It's public record.

[OrangeBlossomBaby]

In a court document, Jennifer Parr was required to give accounting of monies dispersed to her and family members. Money is an asset. It is the only asset the court ordered Parr to account for. It is presently in the hands of family members.This
particular paragraph did not mention the name of their joint owned business. Therefore, I posted my remark as Morse Family. Stating the business name when it was not mentioned in this part of the court document would be drawing conclusions. As other posters stated, it will be interesting to see the date this money was dispersed.

You are assuming that the ONLY people with ANY ownership of the holding company are the entirety of the Morse family. And that is not true. First of all, many members of the family have no ownership in it at all. Second, some non-Morse people have shares of ownership in it.

The holding company is owned PRIMARILY by Morse family members. Not exclusively, and not collectively. A third cousin (Yes I like using that hypothetical) who doesn't talk to his family members, doesn't live in Florida, has his own life that has nothing to do with the Morse family or The Villages, should not have his assets checked, just because he's a blood relative of the Morse family.

[drducat]

llᴉʞs lɐᴉɔǝds ɐ sǝʞɐʇ sᴉɥʇ oN

[Aces4]

Not sure what part of that you didn't understand.

If you want to see the details of the other 40% ownership, you can look it up. It's public record.

Did I say I didn't understand something? As far as the other hands in the pot, I'm not interested. For better or worse it will be worked out and life goes on.

[Aces4]

The Morse family isn't a business. "...any owned, large or small, by the Morse Family" is not applicable in this thread, because the Morse family isn't a business. It's a family. And the Villages Health is not owned by the family. It has a 60% ownership by the holding company, which is owned by Jennifer Parr and her two siblings. The other 40% ownership is - something other than the holding company led by someone other than a member of the Morse family.

The holding company which is owned by Jennifer Parr, her brother and sister, own the majority of Villages Health. They are family. What is so complicated about that? I understand those facts very clearly, no confusion here.

[Rainger99]

llᴉʞs lɐᴉɔǝds ɐ sǝʞɐʇ sᴉɥʇ oN

Impressive!!