[Rainger99]

UnitedHealth says it's under federal investigation for civil fraud - CBS News

[tophcfa]

Originally Posted by Rainger99

UnitedHealth says it's under federal investigation for civil fraud - CBS News

Hmmmm, the preferred Medicare Advantage company of The Villages Health? Do the dots connect?

[golfing eagles]

Originally Posted by tophcfa

Hmmmm, the preferred Medicare Advantage company of The Villages Health? Do the dots connect?

Not yet, time will tell. What if most of the $361M was coded by UHC and not TVH??? There would be a lot of posters on TOTV eating crow morning, noon, and night.

[CoachKandSportsguy]

Originally Posted by golfing eagles

Not yet, time will tell. What if most of the $361M was coded by UHC and not TVH???

ohhh, that is an interesting scenario!
One I hadn't thought about . . . .
and how TVH can fall into the pattern of its the accepted insurance reimbursement practice!
so who then gets the plausible deniability?

financial collusion for a shared financial outcome. .
like the recent posting example of the dentist coding the crown wrong, so that the patient would pay more so that everyone is more profitable. . unless you fight it.

I think that is covered in the Freakonomics book discussing behavioral economics, in the chapter about professional sumo wrestlers throwing matches for the shared financial benefit of all wrestlers. .

[rustyp]

Originally Posted by golfing eagles

Not yet, time will tell. What if most of the $361M was coded by UHC and not TVH??? There would be a lot of posters on TOTV eating crow morning, noon, and night.

Then why would TVH sell ? Selling to me smells the same as taking the 5th.

[golfing eagles]

Originally Posted by rustyp

Then why would TVH sell ? Selling to me smells the same as taking the 5th.

Unless the plan was to eventually sell right from the beginning in 2012. Negotiations for a sale began BEFORE the discovery of the mistake in billing

[CoachKandSportsguy]

Originally Posted by golfing eagles

Unless the plan was to eventually sell right from the beginning in 2012. Negotiations for a sale began BEFORE the discovery of the mistake in billing

which would make sense in that the acquiring company's due diligence is always to validate and forecast the future revenue stream. And if the acquiring company found issues with the current revenue stream, like improper coding, upcoding etc, which was raised somewhere, then the wheels fell off the cart.

Late 90's, I did an acquisition analysis of a company we were bidding on, and the current owner, Dow Jones Co, had purchased this company for $1.5 B two years prior to putting it up for sale at $500M (1/3 of the acquisition cost, or $1.0B of incinerated cash), and I came up with $300 million due to the rapidly declining revenue stream. . . The winning buyer bought the company for $500M and went bankrupt within the year. Sometimes the insiders know when the gig is up. . especially with any reasonable future revenue analysis. .

I have worked for two companies which eventually went bankrupt, and there are tell tales signs if you know where to look. . . and two which were taken over being successful. . the differences are obvious on the inside

[golfing eagles]

Originally Posted by CoachKandSportsguy

which would make sense in that the acquiring company's due diligence is always to validate and forecast the future revenue stream. And if the acquiring company found issues with the current revenue stream, like improper coding, upcoding etc, which was raised somewhere, then the wheels fell off the cart.

Exactly. (Hypothetically), neither TVH's internal audit nor their paid outside consultants found the error/discrepancy/misinterpretation in coding. It was Humana performing their due diligence prior to an acquisition/merger that disagreed with TVH coding, which is why it went on for years and accumulated so many millions in repayment/penalties. If not for the sale negotiations and another perspective from Humana, it would be continuing right now

[CoachKandSportsguy]

Originally Posted by golfing eagles

Exactly. (Hypothetically), neither TVH's internal audit nor their paid outside consultants found the error/discrepancy/misinterpretation in coding. It was Humana performing their due diligence prior to an acquisition/merger that disagreed with TVH coding, which is why it went on for years and accumulated so many millions in repayment/penalties.

if your job depends upon not finding a smoking gun, then you won't find it.
Intermediate behavioral economics 201
consultants are paid to provide cover for the current mgmt.
Advanced behavioral economics 301

Watch "The Big Short" again

[golfing eagles]

Originally Posted by CoachKandSportsguy

if your job depends upon not finding a smoking gun, then you won't find it.
Intermediate behavioral economics 201
consultants are paid to provide cover for the current mgmt.
Advanced behavioral economics 301

Watch "The Big Short" again

Agree. A perfect example is golf in TV. If an ambassadors job depends on not getting into confrontations, they will say nothing to groups that are 35 minutes and 3 holes behind the group ahead of them.

[Topspinmo]

Originally Posted by tophcfa

Hmmmm, the preferred Medicare Advantage company of The Villages Health? Do the dots connect?

Does frogs fart in water?

[Aces4]

The provider, specifically the physician or their designated coding staff, is responsible for coding the procedures submitted to Medicare. While supplemental insurance companies may review claims, they don't determine the procedure codes.

How would UHC have coded the claims for submission?

[dewilson58]

Originally Posted by Topspinmo

Does frogs fart in water?

Never thought about that...........Hmmmmm.

[golfing eagles]

Originally Posted by Aces4

The provider, specifically the physician or their designated coding staff, is responsible for coding the procedures submitted to Medicare. While supplemental insurance companies may review claims, they don't determine the procedure codes.

How would UHC have coded the claims for submission?

By altering them or amending them----the usual way

[tophcfa]

Originally Posted by Topspinmo

Does frogs fart in water?

Is that what that noise is coming out of the swampy wildlife preserve behind our house?