Villages Health DOJ investigation
 

Just received a call from from 2 people who identified themselves as investigators for the Department of Justice, looking into Medicare billing practices at the village’s health. I first thought it was a scam, but after hearing the personal information they had on our records, I was inclined to cooperate with their inquires.

They mostly wanted to confirm conditions listed in our files and confirm they were correct. Most conditions were not correct, especially type 2 diabetes.

I’ve thought for years that the Village’s Health was a scam. This active investigation might just be the tip of the iceberg.

???

Pretty sure you just got scammed by people taking advantage of billing errors and pretending to be members of the Dept. of Justice.

And exactly how did they get scammed and what did they get scammed out of? They didn't say they gave them information, they already had their medical records so they would have had to scam someone else that had the records.

I would agree…..from a simple web search below. While they only corrected information it maybe a test and the next call will be more in depth since they know you can be trusted over the phone. Also, you had to correct information they claimed they had so more than likely a phishing exercise setting you up for the next call that could be more a scam.

“If you receive a phone call claiming to be from the Department of Justice, be very cautious as it is likely a scam; legitimate government agencies, including the Department of Justice, will rarely contact you by phone to ask for personal information or money.”

And if they only listened to personal information rather than providing it?


I agree that it sounds shady and I’m not sure how much I would say of if I was called.

Here is an excerpt from what I just received from The Villages Health (“TVH”) "we discovered a problem with some of our Medicare billing practices. Upon discovering a potential problem with our Medicare billing this past Fall, TVH hired outside consultants to conduct an in-depth review of our coding and billing practices. Based on our investigation, we determined that
beginning in 2020, TVH implemented certain billing processes and practices that were not consistent with Medicare payment policies. This resulted in TVH receiving more money from the Medicare program than if billed correctly.
With these consultants, we are now working to identify the financial impact of these billing errors and are in the process of repaying the Medicare program for any overpayments that resulted from the billing issue. In addition to
starting work with relevant government agencies to return the overbilled Medicare funds, we have also already begun to implement a range of new internal safeguards to assure that an error such as this will not recur. The occurrence of these errors has since been self-reported to the proper U.S. government agencies, and we expect a smooth process as we work diligently to make right with the Medicare program itself—all with the goal of continuing to provide you with the best possible care you’ve rightfully come to expect from all of us at TVH."

I received the same text message. Appears they are doing the right thing.

And now let's add the rest of the statement-----This event did not impact any patient care OR ANY PATIENT BILLING This is not uncommon with EMRs, they found a problem, notified CMS and will pay any overpayments back. I doubt the DOJ is even involved, and I'm 99.9999% sure the OP was scammed/phished.

That's why I was pretty sure they were scammed. I got the same notification, and then went to the Villages Health's actual website and logged in to my account and checked my messages and saw that there, confirming that the e-mail notification and text message I received from TVH were legit.

And since they're legit, it means - the DOJ wouldn't be asking ME anything about MY health, to confirm or dispute anything TVH is or is not doing with their Medicare billing. Of course, anyone from the DOJ checking with me about MY Medicare billing info would be obviously lying since I'm not on Medicare in the first place.

But anyway - the DOJ won't call people on the phone to ask them about their health. It's clearly a scam. Just like when you get a call from the IRS saying you'll be going to jail unless you cough up your overdue fines. It's a scam.

Sounds like someone is trying to scam the OP. That being said, I wouldn’t be surprised if The Villages Health is being looked at closely. I’ve never heard of another health care operation that serves a senior population and won’t accept Medigap plans. Something about that smells very rotten.

Definitely a scam! The DOJ would not discuss the issue about anyone's individual case without asking question first to identify the person 100% the person they want to talk with. Just because you answer the phone does not mean you are the person. These initial questions could be enough to get valuable information that they could use. Heck, even in the doctors/dentist/etc office they always ask for some information when you are there in person! I would suggest anyone getting a call ask for a VERIFIABLE DOJ telephone number or website that you can use to gather information on your own about thier investigation before answering any questions!

Why won’t they accept Medigap plans?

Don't all Federal Agencies only correspond by US Mail?

".. Most conditions were not correct .."

They collected this....

Billing issues occurred per TVH. You were scammed as DOJ investigators would not have called you.

From my experience with this situation, I have never heard of the DOJ conducting this type of investigation by calling patients to verify PIH. CMS would more likely look into this and not by calling you. I’m suspicious. If it was me I would have hung up or contacted the AG to discuss.

Letters went from TVH by email stating they were having an issue that's got government agencies involved. They have to pay back Medicare. I'm guessing these are not simple mistakes.

Rotten??? Really???? How so????

Every health care provider has the right to decide which insurances they will and will not accept. We reviewed this every year when the contracts came around. So did every other practice in the country. Sorry you "never heard of this". It is neither "rotten" nor cause for TVH to be "looked at closely", I always wonder where people get these ideas from.

Having done medical billing before! You definitely have to watch it very close here.
Same procedure, twice in a year, same facility, same Dr , same anesthesiologist, same etc
billed two completely different ways.

And I'm guessing they are simple mistakes, typically generated by EMR coding, and HIGHLY UNLIKELY to be intentional.

Read the letter----TVH conducted their own internal review, which is something most practices do----we would review each others coding and documentation to spot any problems. Having found "something". they then hired outside consultants to look into it further. "Government agencies", probably CMS (Center for Medicare Services), are required to be notified of any irregularity along these lines. THERE IS NO CONSPIRACY TO DEFRAUD PATIENTS, THIS IS NOT UNUSUAL AT ALL.

If jumping to conclusions without any knowledge of the processes involved were an Olympic sport, this thread would have multiple gold medal winners. And I would like to upgrade my assessment of the OPs chance of being scammed from 99.9999% to 100%.

Got a letter from Villages Health saying there were billing discrepancies and they were working them through to come up with how much they were going to have pay back so not a scam.

You have to watch all kinds of billing, everywhere. Mistakes happen----it does not constitute a conspiracy to defraud.

If you read the letter, no patient billing was affected by this event---meaning no one was "ripped off" or overpaid. This is most likely a glitch in the electronic submission of billing and coding between TVH and CMS with ABSOLUTELY NO EFFECT on patients or their pocketbooks

I think the gist of this thread is that the OP, having claimed to received phone calls from the DOJ asking to "verify" his health information is clearly a scam. No federal authority contacts anyone other than by snail mail. This goes especially for the IRS, where scams are a dime a dozen and yet people fall for them.

I hope you didn’t give them any additional information. Confirm what they had only and request an in person meeting so you can make sure who you are talking to

:agree:

i got an email telling me of a breach that was found in the code & billing sections. email also states it does & did not affect the treatments of medical care & standards

When you get the call, hang up.

The Villages Health ( primary care docs) only use Medicare Advantage. Only the specialists within the Villages Health use traditional Medicare. Why would the Department of Justice be calling about a Medicare issue? Wouldn't it be another agency, if at all? Don't ever believe your caller ID. Have them send you something in the mail.

I suggest you read that e-mail again, and then retract your post.

The letter states ABSOLUTELY NOTHING about a "breach"

It specifically stated that patient care and billing WAS NOT AFFECTED

I would recommend that you set your phone to not accept calls from numbers that are not in your Contacts. Then at best, some random caller can only leave a voice mail. Scammers generally don't have time for that and move on.

Legitimate callers will leave a message and you can return a call, if you want to. Scammers will rarely have a number for a return call. That leaves them open to more law enforcement risk.

Of course, this assumes that you are not using an old fashioned land-line.

Regardless of what type of phone(s) you use, enter the number into the do not call registry. It is a federal offense - extremely rarely enforced - for a caller to violate.

FYI, you can look up your contact info. It was illegally published, likely many times, months ago. Research how to do it. Then put a stop on all credit searches with all credit agencies. At the same time, have them remove all previous addresses.

Hang up!

I received the same email...

Yep. I worked for them... they don't call. DUH! They will, however, do in-person interviews.... I mean, seriously, how would they know who is on the other end of the phone?
PHISHING..... hang in there... call #2 is coming:

Call the Villages health, explain what happened and ask how you can protect yourself from Medical Identity Theft. Check your bills for any unusual charges. Freeze your credit reports.

The moral of the story is never give information over the phone unless you initiated the call. Don’t use any number they give you. Hang up and call the source directly.

Oftentimes it’s not the provider that discovered they were billing incorrectly as it’s CMS that flags them based on billings. TV says they are working with federal agencies which I’m certain they are based on overpayments. There is a possibility that an investigation has been opened up and the charges for services that shouldn’t have been billed are being considered as a civil fraud matter by DOJ. Sounds like they may have billed for services not rendered, or unnecessary tests and put in an incorrect diagnosis (in the OP’s case diabetes) to justify that. It will be interesting to see how this ends up playing out.

The DOJ would not be involved. You've been scammed. I've been involved in many cases where there were disputes with Medicare, including a full-blown RAC audit for every patient we treated with a specific kind of radiation therapy was called into question involving just under $1M. We won all but 1 case where the technique was used. Medicare interpretations are also inconsistent, and we've had to argue many times why a women's breast cancer couldn't be hypo-fractionated and depending on who does the peer-to-peer, sometimes we prevail and sometimes not, and when "not" the Medicare peer we find to be some pediatrician with zero radiotherapy training is just following a script! Medicare is the government, and they do screw up!

Because they are not required to. Seems they make their money taking only advantage plan holders.

I agree as I think it may be looked at as a potential fraud issue and not simple mistakes. I am also not convinced that this is something TV caught and reported vs an audit that flagged them by CMS at which time an investigation got opened up.

Actually DOJ and CMS both investigate Medicare fraud and in this case TV has already admitted that they overbilled so I don’t see where the government is at fault here.