[golfing eagles]

Originally Posted by Rainger99

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]

Originally Posted by golfing eagles

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]

Originally Posted by BillyGrown

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]

Originally Posted by golfing eagles

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]

Originally Posted by BillyGrown

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]

Originally Posted by BillyGrown

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]

Originally Posted by BillyGrown

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.

Originally Posted by golfing eagles

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

[golfing eagles]

Originally Posted by biker1

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.

Originally Posted by golfing eagles

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]

Originally Posted by biker1

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]

Originally Posted by 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.

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]

Originally Posted by golfing eagles

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]

Originally Posted by Rainger99

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.