Thought’s on Villages Health Chapter 11
 

What’s your thoughts on Villages Health filing chapter 11

With owing millions from the Medicare over billing it may be the only option. Really want them to be successful as we need all of the medical options we can get here. It was interesting the Sun article indicated that all insurance will be accepted during the realignment hope that is true. Beautiful facilities were limited for Medicare patients to only Medicare advantage, hope that changes. May increase their success.

I hope that changes, too. Next year is Medicare time for me, and I wasn't sure I wanted to go the Advantage route. But I worried about having to find a new doctor since I am a TVH patient with normal non-Medicare mundane Marketplace insurance.

If they start accepting regular Medicare plans, I'll have more options, and still be able to keep my own doctors.

https://news.bloomberglaw.com/bankru...-to-centerwell

Villages Health Files Chapter 11, to Sell Assets to CenterWell


The Villages Health says it has filed for Chapter 11 bankruptcy in the Middle District of Florida court as part of a strategic restructuring, according to a statement.

Estimated liabilities of $100m-$500m and estimated assets of $50m-$100m, a separate court filing shows Humana Inc’s CenterWell Senior Primary Care entered into a “stalking horse” asset purchase agreement with TVH

Deal provides for CenterWell to acquire TVH’s assets as a going concern, including eight primary care centers and two specialty care centers

TVH will continue to fully operate its business and manage its affairs without interruption during the sale process
TVH ...

In a case like this the court has issued an order to continue the business unchanged. The plan and disclosure statements are due by 10/31/2025 but that is likely to change. So payroll will continue, utilities are prohibited from turning out the lights, everything is likely to remain unchanged for a while.

The Villages Health will have many issues because of the large liabilities outstanding. Who do they stiff and walk away from?
What sort of payments were made before the filing?

Wondering… if this Medicare fraud will lead to some arrest.

I would sure hope so. How can this happen?

Would think there would be at least some oversight but apparently not.

Interesting, but not surprising. The fact that they only accepted certain Advantage plans, and no Medigap plans, for primary care immediately raised the hair on the back of my neck that something fishy was going on. As far as I’m aware, they were the only large health care operation in the country serving a predominantly senior citizen population that wouldn’t accept traditional Medicare. My intuitive suspicions aren’t always correct, but apparently it was this time.

I was shocked when I read it in the Daily Sun today. I received an urgent text message from Villages Health. The link for that did not work. Maybe they need to pay back money to Medicare which they do not have.

Based on the bankruptcy filing it looks like Morse family no longer wants to finance this unprofitable entity. I had always assumed that Morse family would keep on funding entity which allows them to sell more homes to Medicare eligible people.

"The Villages Health says it has filed for Chapter 11 bankruptcy in the Middle District of Florida court as part of a strategic restructuring, according to a statement.
Estimated liabilities of $100m-$500m and estimated assets of $50m-$100m, a separate court filing shows
Humana Inc’s CenterWell Senior Primary Care entered into a “stalking horse” asset purchase agreement with TVH
Deal provides for CenterWell to acquire TVH’s assets as a going concern, including eight primary care centers and two specialty care centers
TVH will continue to fully operate its business and manage its affairs without interruption during the sale process."

Does anyone know who actually owns Villages Health?

The Villages Health System, LLC is owned by The Villages Health Holding Company, LLC, which is part of the Holding Company of The Villages, Inc.

The Holding Company of The Villages, Inc. is a privately-held company, and specific ownership details are not fully disclosed in public records.

It wasn't fraud. It was a really huge, significant flaw that TVH discovered, and reported. They were being overpaid for quite awhile. At some point, someone found what the problem was and said "hey boss - this is totally not right." And the boss said "OMG holy crap" and reported it to Medicare, and told Medicare "hey youz guyz - you've been sending us too much money! How do we give it back to you?" And Medicare said "oh golly gee let's figure this out" and they did.

Unfortunately, imposed penalties for overpayment don't get absorbed by the people who were doing the overpayment (Medicare) but by the entity that receives it (TVH). So they're on the hook for the millions in the government's overpayments, AND for penalties. Which - they can't afford.

Did I read the Daily Sun article correctly that The Villages Health incorrectly billed Medicare for hundreds of millions of dollars? If so, how does that happen? It seems like no one is that incompetent? Intentional? Over what time period? The article indicated that The Villages Health was proactive in reporting the overbillings.

Yes if I remember it was some kind of computer error. And Medicare just paid it, over and over again, without once questioning it. It was never flagged. When TVH realized what was happening they immediately reported the error and cooperated with Medicare to repay the overpayments.

TVH was apparently “coding”
many procedures wrong. I don’t know who caught the overpayments. Generally auditors are the ones that first spot such a pattern of overpayments. The best money governments can spend is on more monitors and auditors. Sometimes it’s honest mistakes and sometimes not so much the case.

I will say that they have not been very transparent on the overbilling issue. I think they should provide a very detailed explanation. When did it start? Was it one code? A hundred codes? A thousand codes? Were there any audits during the overbilling?

What caused it? And was it a programming error? Did the money go to the doctors or to the owners of the company?

If TVH was getting overpaid for hundreds of millions of dollars where did the money go? Had to go somewhere.

How did people not know how to code for billing purposes?

I smell fraud

Or as I believe Hamlet said "something is rotten in Denmark".

TVH caught the mistakes and reported it to Medicare. The miscoding was not intentional - if it was, then yeah it'd be fraud, and TVH would be under criminal investigation. Medicare acknowledged that this was a mistake. A HUGE mistake, but a mistake nonetheless.

https://thevillageshealth.com/wp-con...FINAL_1230.pdf

Doctors at TVH don't work on commission. They are salaried. The specific codes are irrelevant, to patients, unless the billing error is affecting their bill. This miscoding didn't affect patient billing at all, and so patients really don't need to hear all the nitty gritty details.

They need to know there was a mistake. The mistake was found, and reported. The mistake was corrected so that it can't happen again. There's a debt that has to be repaid as a result. It's in the process of being repaid.

That appears to be a rather vague explanation written by their lawyers. It doesn’t explain what happened.

And for a company that has an “absolute
commitment to transparency amongst our patient community” it clearly lacks transparency.

Is the debt being repaid? I thought they have estimated liabilities of $100m-$500m and estimated assets of $50m-$100m.

100% totally correct. Everything that everybody else posted about this previously was a load of garbage.

And just why do you think you are entitled to that information? This is strictly between CMS and TVH, YOU are not involved.

Take another whiff, it was a computer error that went unnoticed for a long time. Once TVH noticed it they immediately notified CMS. NO FRAUD

One of the parties is CMS which is a federal agency. If it were the plans for the bombing of Iran, I think they should keep that secret - at least while it is in the planning stages.

The case is now in the courts and most court records are public information so we should be entitled to that information. (Perhaps the Daily Sun will do some investigative journalism on the issue.)

Finally, TVH posted a letter saying that they have an “absolute commitment to transparency amongst our patient community.”

Agree. When we moved here 3 years ago I was shocked that they would not accept our insurance which is medicare along with Blue Cross Blue Shield, but only Advantage plans (but somehow their specialists are OK with it).

How many of TVH docs are going to stick around after this debacle plays out ? Most docs were there due to being salaried and limited number o patients. If the system changes many TVH patients will take a hike also. This will tax the regular Medicare docs. And you thought the emergency room wait was long. Watch what's next for the entire community.

You certainly know more about how this works than the rest of us but where did the money go?

just crappy internal / financial auditing, and probably poor data entry training. However, remember, its not fraud if you really believe you are right!

Coding does change over time. . but if TV LLC owned the hospital, most likely the money went to the TV LLC development pot. . .

Words and their placement matters.

The words and their placement:

"Absolute commitment to transparency among our patient community."

What that does NOT mean:

Commitment to absolute transparency.

What that also does NOT mean:

Commitment to transparency among anyone beyond their patient community.

They were transparent. They weren't "absolutely" transparent, because the details are none of your business.

Any public information is public. If you want to know the public information, you can put in a FOIA request with the government.

I wonder who wrote that self-serving article in the newspaper owned by the Developer who also owns TVH. The computer didn't cause the error. It submits claims that someone instructs it to. The lack of oversight by TVH and by Medicare in this case is just another example of why Medicare is in trouble nationally. TVH has spent the over-payments as it expanded, and would have been in deep trouble without those funds. You declare bankruptcy to avoid payment of debts, so it looks like Medicare will take the brunt of the loss. Hopefully Sumter County and Florida tax payments are up to date. Let us pray that Centerwell has the internal controls and management skills that will allow the existing facilities and services to survive.

Thanks think you answered my question as to where the money went. Would hope that the owners of TVH would have to reimburse medicare

If the miscoding resulted with TVH receiving hundreds of millions of dollars not entitled is it a profitable venture when the dust settles ?

For the record I do not see this as an advantage plan vs Medicare / supplement issue. why couldn't a medicare / supplement establishment miscode ?

At this point, I don’t think we can reach any conclusion as to whether it was a coding error or whether it is fraud.

All we have is a conclusory statement from TVH. I know that corporations “always” tell the truth but I would like to hear more details before I make any final decision as to what happened.

Computer error, and never flagged? What’s the basis for your comment? I went round and round with you relative to this back in January when I said that there was probably a DOJ investigation which you said wasn’t the case.

Medicare will not take a loss as federal debts are not dischargeable under bankruptcy. Also they filed for reorganization not discharge under Chapter 11 in order to sell the business

I am astounded that anyone could possibly believe this was an innocent computer error. I’ve got some swamp land to sell ya that surrounds Alligator Alcatraz if you honestly believe that. Hundreds of millions of dollars were over billed over years, and the $$$ disappeared and isn’t listed as assets in the bankruptcy filling. And then the error was suddenly discovered and self reported, REALLY? Or they knew they were about to get busted and tried to save face and keep from getting thrown in prison by concocting a far fetched story of presumed innocence? If they actual let an innocent computer glitch over bill, and accept 100’s of millions over several years, then they are guilty of gross negligence, incompetence, and lack of any reasonable internal controls. And what happened to all that money, did the computer error miraculously make it disappear? This doesn’t pass even the most lenient of sniff tests.

The Villages Health specifically said it was an issue with “certain billing processes and practices”. I didn’t see them use the term “computer error”.

The Villages Health over-billed, in excess of $360,000,000, over a 4 year period.

That's $90,000,000 per year.

They currently have assets of between $50,000,000 - $100,000,000.

The yearly over-billing, exceeded their total assets.

This isn't a simple rounding error that went un-noticed.

How do you not notice an extra $90,000,000 per year in revenue? For 4 years?

If it takes a company's management 5 years, to recognize they're receiving $90M a year more than they deserved, would you trust those morons with your health?

As for the "self-reporting" claims?

What seems to have been forgotten, is Central Health and The Villages Health engaged in merger/stock exchange discussions last year. Those discussions were de-railed by the discovery of the over-billing.

It sounds suspiciously like Central Health discovered the over-billing during their Due Diligence and self-reporting became a necessity ... the cat was out of the bag.

I always thought that TVH didn’t take Medicare - only Advantage plans.

I am on Advantage and as far as I know, TVH sends the bills to UHC - not to Medicare. Does anyone know how Medicare could have been over billed?

And if Medicare was over billed, wouldn’t UHC, Blue Cross, etc., also be over billed?

And would the over billing impact patients requiring them to have higher co-pays and deductibles?

My question was not aimed at TVH. It was to the posters who refer to an Advantage plan is somehow related to this debacle and it would not happen on Medicare with a supplement. Don't both systems have to code to receive payment ?