Potential Fallout - Beyond Healthcare - of TVHC's Massive Medicare Overbilling Potential Fallout - Beyond Healthcare - of TVHC's Massive Medicare Overbilling - Page 9 - Talk of The Villages Florida

Potential Fallout - Beyond Healthcare - of TVHC's Massive Medicare Overbilling

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  #121  
Old 08-20-2025, 11:07 AM
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Originally Posted by Joecooool View Post
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?
Really? Please point out the part of that post which is “conjecture”? You did see the part that stated we’ll need some forensic accounting to determine the truth?
  #122  
Old 08-20-2025, 02:00 PM
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Really? Please point out the part of that post which is “conjecture”? You did see the part that stated we’ll need some forensic accounting to determine the truth?
OK -

"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."

Conjecture. Unless you work for TVH (which seeing how you are in all the post about them carrying their water wouldn't be a surprise) you have no knowledge what they "thought" when they were billing.

"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)"

More conjecture. Unless you are their accountant. you have no clue what they spend their money on.

And you chose to ignore the most important part of my post -

"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?"
  #123  
Old 08-20-2025, 02:45 PM
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OK -

"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."

Conjecture. Unless you work for TVH (which seeing how you are in all the post about them carrying their water wouldn't be a surprise) you have no knowledge what they "thought" when they were billing.

"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)"

More conjecture. Unless you are their accountant. you have no clue what they spend their money on.

And you chose to ignore the most important part of my post -

"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?"
I'll amplify the first part----their doctors did not know there was overbilling. While I doubt it, somebody higher on the food chain may have been in a position to manipulate the billing.

Second---what do you think medical practices spend their money on? It's not jet skis and ice cream floats. There is no conjecture about what medical practice expenses consist of. The unknown factor is any potential distributions, but I addressed that.

Third--"uneducated/careless in their responsibilities"---almost too inane to deserve a response, but....if they believe they are billing correctly, and if their consultants believe they are billing correctly, how are they careless? And speaking of conjecture, how do YOU know other practices aren't in the same boat????

PS: I have no affiliation with TVH, I've been retired for over 10 years
  #124  
Old 08-20-2025, 03:12 PM
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Originally Posted by golfing eagles View Post
I'll amplify the first part----their doctors did not know there was overbilling. While I doubt it, somebody higher on the food chain may have been in a position to manipulate the billing.

Second---what do you think medical practices spend their money on? It's not jet skis and ice cream floats. There is no conjecture about what medical practice expenses consist of. The unknown factor is any potential distributions, but I addressed that.

Third--"uneducated/careless in their responsibilities"---almost too inane to deserve a response, but....if they believe they are billing correctly, and if their consultants believe they are billing correctly, how are they careless? And speaking of conjecture, how do YOU know other practices aren't in the same boat????

PS: I have no affiliation with TVH, I've been retired for over 10 years
Again, all conjecture. You don't know these things to be facts, you just assume that TVH operated by the book.

Medicare Advantage plans that operate by the book don't over bill hundreds of millions of dollars.

And there are hundreds of cases of medicare fraud where the money went into people's pockets. This operation just went down last month - Office of Public Affairs | National Health Care Fraud Takedown Results in 324 Defendants Charged in Connection with Over $14.6 Billion in Alleged Fraud | United States Department of Justice
  #125  
Old 08-20-2025, 03:24 PM
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Again, all conjecture. You don't know these things to be facts, you just assume that TVH operated by the book.

Medicare Advantage plans that operate by the book don't over bill hundreds of millions of dollars.

And there are hundreds of cases of medicare fraud where the money went into people's pockets. This operation just went down last month - Office of Public Affairs | National Health Care Fraud Takedown Results in 324 Defendants Charged in Connection with Over $14.6 Billion in Alleged Fraud | United States Department of Justice
All conjecture???? Give me a break. The "conjecture" is you telling me what I do and do not know. You don't think medical practices pay for equipment, utilities, rent, staff, etc. Conjecture my sweet bippie. I ran a practice for 35 years. I know what EMR they use and I know how it is used, so don't give me "conjecture".

Meanwhile, of course the point of Medicare fraud is to put $$$ into someone's pocket---it's not a charitable exercise. Most of those are fly by night clinics owned by some clown with a Caribbean medical degree that pay homeless people to come in to their clinic and bill more to CMS than they could possibly have done. Here's your problem---the only people that have accused TVH of "fraud" are posters on TOTV.

I can guarantee based on the vague diagnostic codes in ICDM-10 and the stringent documentation requirements in CPT, I could review Harvard Medical or the Mayo clinic system and find way more than $361 million in "fraud" over a 10 year period, just based on the sheer size of those practices. Do you think they are also in a grand conspiracy to defraud Medicare?
  #126  
Old 08-20-2025, 06:01 PM
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Originally Posted by golfing eagles View Post
All conjecture???? Give me a break. The "conjecture" is you telling me what I do and do not know. You don't think medical practices pay for equipment, utilities, rent, staff, etc. Conjecture my sweet bippie. I ran a practice for 35 years. I know what EMR they use and I know how it is used, so don't give me "conjecture".

Meanwhile, of course the point of Medicare fraud is to put $$$ into someone's pocket---it's not a charitable exercise. Most of those are fly by night clinics owned by some clown with a Caribbean medical degree that pay homeless people to come in to their clinic and bill more to CMS than they could possibly have done. Here's your problem---the only people that have accused TVH of "fraud" are posters on TOTV.

I can guarantee based on the vague diagnostic codes in ICDM-10 and the stringent documentation requirements in CPT, I could review Harvard Medical or the Mayo clinic system and find way more than $361 million in "fraud" over a 10 year period, just based on the sheer size of those practices. Do you think they are also in a grand conspiracy to defraud Medicare?
It doesn’t matter either way. Reimbursement is required. If there is fraud, then prosecution must also take place.
  #127  
Old 08-20-2025, 06:32 PM
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Originally Posted by golfing eagles View Post
What assets???? TVH apparently doesn't have any, hence the bankruptcy filing
To prove you are bankrupt, you must have more debt than assets. Assets include building, equipment, furniture, shares, revenue earned, cash, and more depending on the business. The court documents filed are requesting the Morse Family provide ACCURATE accounting of all assets asociated with this business. This is standard for bankruptcy filings. Once all the needed information is obtained, the court will decide on the issue. The financial disaster caused by incorrect coding happened. Nothing anyone can do to change it.I have not seen any court documents that claim individual doctors are accountable.

Last edited by margaretmattson; 08-20-2025 at 06:42 PM.
  #128  
Old 08-20-2025, 06:34 PM
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Evercore is TVH’s investment banker. There appears to be plenty of money to pay them.

The court approved paying Evercore a

1. $600,000 upfront retainer

2. A $200,000 monthly fee, and a

3. A $5.0 million restructuring fee upon plan confirmation/restructuring completion
  #129  
Old 08-20-2025, 06:57 PM
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Originally Posted by margaretmattson View Post
Assets include building, equipment, furniture, shares, revenue earned, cash, and more depending on the business.
.
TVH doesn't own buildings, nor any significant equipment.

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Originally Posted by margaretmattson View Post

The court documents filed are requesting the Morse Family provide ACCURATE accounting of all assets asociated with this business.
.
Please provide your source for this. I can't find the words "Morse Family" in the Bankruptcy documents nor any place where the family has been requested to do anything.
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  #130  
Old 08-20-2025, 07:14 PM
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Originally Posted by margaretmattson View Post
To prove you are bankrupt, you must have more debt than assets. Assets include building, equipment, furniture, shares, revenue earned, cash, and more depending on the business. The court documents filed are requesting the Morse Family provide ACCURATE accounting of all assets asociated with this business. This is standard for bankruptcy filings. Once all the needed information is obtained, the court will decide on the issue. The financial disaster caused by incorrect coding happened. Nothing anyone can do to change it.I have not seen any court documents that claim individual doctors are accountable.
They are requiring THE VILLAGES HEALTH to provide accurate accounting. It seems a lot of people are conflating the Morse family with TVH.
  #131  
Old 08-20-2025, 07:28 PM
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A rotten fish stinks at the head
  #132  
Old 08-20-2025, 09:07 PM
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Originally Posted by golfing eagles View Post
They are requiring THE VILLAGES HEALTH to provide accurate accounting. It seems a lot of people are conflating the Morse family with TVH.
Based in the 29 page bankruptcy court filing by UnitedHealth Care, TVH is trying very hard to avoid providing full and accurate accounting. UHC’s attorneys are trying to stop the court from approving TVH’s latest DIP financing motion. Their attorneys claim that the DIP financing is being provided by the same parties that control TVH, is not an arms length transaction that was competitively bid, is not at fair market value, and is in fact being provided by insiders. They further claim this transaction breaches TVH’s fiduciary responsibility of acting fairly toward all constituents involved in the bankruptcy, including creditors. Providers of DIP financing are privy to accounting statements others are not when a private entity is involved. UHC claims TVH is trying to force a hurried sale, with insider provided DIP financing, in order to avoid accounting discovery and potential creditor clawback of monies diverted away from TVH prior to filing bankruptcy.

If the arguments UHC’s attorneys made to the court are valid, and the court denies TVH’s DIP financing motion, or opts to not decide on the motion without full evidentiary discovery, it will force much fuller disclosure of TVH’s accounting and might provide true answers to things being speculated about.

Although it’s not easy reading, I would encourage anyone following this with interest to take the time to read and understand it. It is very well researched and prepared by UHC’s big league legal counsel and sites numerous case references backing their arguments to the court. Every time there is another court filing involving this case it gets more complex and interesting. It’s very clear that things went very bad between TVH and UHC, and UHC is prepared to fight TVH tooth and nail through this process.

Unfortunately, I can’t see any way this is going to turn out good for the general population of Villages residents : (
  #133  
Old Yesterday, 12:00 AM
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Originally Posted by golfing eagles View Post
They are requiring THE VILLAGES HEALTH to provide accurate accounting. It seems a lot of people are conflating the Morse family with TVH.
The name Parr was mentioned in a court document. She is a member of the Morse Family.I have not seen any individual doctors named in the court documents. I believe it IS YOU who is conflating. Bankruptcy filing has nothing to do with incorrect medical coding. They are different issues. Again, to legally prove bankruptcy, you must have more debt than assets. Nothing more! Simply provide the court DEBTS AND ASSETS. And YES! The court will absolutely require ALL ASSETS be accounted. Including any owned, large or small, by the Morse Family.

Last edited by margaretmattson; Yesterday at 01:10 AM.
  #134  
Old Yesterday, 12:13 AM
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Originally Posted by BrianL99 View Post
TVH doesn't own buildings, nor any significant equipment.



Please provide your source for this. I can't find the words "Morse Family" in the Bankruptcy documents nor any place where the family has been requested to do anything.
It is common knowledge. In order to prove bankruptcy, you must have more debts than assets. I do not keep a file of what the Morse family owns. However, the name Parr was mentioned along with it took several weeks to get information from her regarding money given to her and family members from this business. This information was in the first paragraph of a court document another poster showed on this thread. Money is an asset! Whatever assets, large or small, the Morse family owns regarding this business,the court document is requiring Parr to provide accurate accounting.

Last edited by margaretmattson; Yesterday at 03:55 AM.
  #135  
Old Yesterday, 04:08 AM
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Originally Posted by margaretmattson View Post
I do not keep a file of what the Morse family owns. .

Here you go. Now you know just about everything the Morse Family owns, as of 12/31/2023.

https://www.atlantafed.org/-/media/d...12315_2023.pdf
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Last edited by BrianL99; Yesterday at 04:13 AM.
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