[golfing eagles]

Originally Posted by Rainger99

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

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]

Originally Posted by tophcfa

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]

Originally Posted by Rainger99

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]

Originally Posted by 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

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

[kkingston57]

Originally Posted by dewilson58

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

I'll wait for a good source.

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

[Rainger99]

Originally Posted by golfing eagles

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]

Originally Posted by Rainger99

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]

Originally Posted by golfing eagles

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]

Originally Posted by Rainger99

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

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

[shut the front door]

Originally Posted by 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.

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]

Originally Posted by 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

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]

Originally Posted by 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.

"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/...llages-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.

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+2
LinkedIn
+2
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+2
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+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
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+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
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+12
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+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.

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+9
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+9
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+9
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+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
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+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
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+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
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
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. 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]

Originally Posted by golfing eagles

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]

Originally Posted by ScottFenstermaker

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