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

Their exposure would be if they participated in illegal up coding.

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

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.

Never a good sign when the vultures start circling looking for road kill.

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.

"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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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.

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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.

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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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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.

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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.

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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
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. 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”
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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)
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. 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
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. 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.

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.

Somehow, I doubt 50 or 60 doctors collaborated in a Medicare fraud, especially when they had little to gain

Court Record
 

Here is pulled from a court record, it’s credible.

In a court document, UnitedHealthcare claims that it had taken seven weeks since the bankruptcy filing for it to be disclosed that The Villages Health paid out in a “three-year period from 2022 to 2024, a very substantial portion of $183 million, consisting of $64.2 million in ‘tax-related distributions’ and $118.8 million to pay down a supposed ‘line of credit with its major shareholder’ – to members of the Morse family, who own and control The Villages through various corporate entities.” UnitedHealthcare also charges that The Villages Health “claims not to know” how much money it distributed to shareholders in 2020 and 2021. UnitedHealthcare further contends that the $118.8 million purportedly spent paying down the line of credit was actually “disguised equity distributions” paid to the Morse family. During those years, The Villages Health also was paying roughly $10 million in annual rent to The Villages Operating Co. for the use of the clinics.

Agreed a lot of assumptions along with a lot of suspicious financial transactions. How does the revenue increase that much, and they not catch the billing errors much quicker? The sell of several entities adds to the big gray cloud over the Morse family. The insurance sell was a few years back, but the bank and health entities are quite recent. Does anyone remember the news article on one of the family members purchasing a very expensive home a few months back or does my memory fail me?

So, in other words, the "credible" part is this is what UHC, the party that is also suing TVH CLAIMS. I'm going to "claim" that Santa Claus is real---does that make it "credible"?

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)

As far as "buying an expensive house", that's what billionaires can do----it's a complete non sequitur to the bankruptcy or allegations (only on social media) of fraud.

I am confused on this point.

If you are billing properly for the first six or seven years and then you change your billing so that you are making about $90 million more a year for the next four years, wouldn’t you notice that increase in revenue?

One other option is that they always billed improperly but the statute of limitations has run and they can only be sued for four years.

The other option is that if you are that rich, you might not notice an extra $90 million a year.

Medicare isn't overcharged. Medicare and Medicaid are the worst (aka lowest $$ payors). Private healthcare will pay more, which "helps to keep the lights on." Keeping the lights on is VERY expensive when you have to take into account the payor mix (percentage for no-pay patients, Medicare, Medicaid, private). Everyone has to be billed the same amount, so if Medicare will only pay $100 for "X", Medicaid won't pay anything for "X", and BCBS will pay $300 for "X", you bill $300 knowing Medicare will pay $100, Medicaid won't pay, and you'll get your $300 from BCBS and the self-pays are usually written off. Some of our hospital's insurance company contracts were written to pay a percentage of billed (e.g. 30%), so we'd have to bill much more than Medicare pays just to get paid the same as Medicare. I haven't been involved in setting charges for many years, but we used to take the Medicare payment rate and multiply by 2.5 to set our price.

So, without the $90 million dollars per year of excess payments from Medicare, would the developers have been able to make these distributions and pay down their line of credit? Or, would they have had to declare bankruptcy years ago?

So instead of the country spending so much on AI we should hire your barber's ex-wife's sister's mechanic? Why are we investing so much in it?

I would assume that the coding/billing has not changed along the way, but none of us know for sure.

ALLEGED distributions. This is only the statement made by UHC, and they are not an unbiased entity. Stay tuned for the accounting to see if their claim is true or false.

Do you have a guess on the timing? Months? Years? Decades?

Agree, the distributions are alleged by another party with an axe to grind. That being said, if the DIP financing is actually being provided by the alleged party, that raises a huge red flag that said party very well might be trying to keep significant accounting out of the public’s eye’s. Stay tuned.

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?

All you want to know about Medicare Overpayments!

https://www.cms.gov/files/document/m...erpayments.pdf

I think this case goes way beyond that CMS "fact" sheet, but there is the 2 key conditions that result in overpayment: Wrong code and insufficient documentation. And that may be all there is to this, and then again, maybe not. But remember, the reviewers at CMS barely know how to spell medicine, much less have any knowledge of it. They are bean counters, pure and simple---does the progress note have 2 items from 6 different body systems in the exam or doesn't it? Are 2/3 items form past medical history, family history and social history included? That's all they know. Also, many EMRs look at what is included in the note and "suggest" a billing code. Could that be "off", did they coders at TVH just take the EMRs "suggestions".

Bottom line: This could still range anywhere from a computer EMR error and insufficient documentation to a conspiracy to commit criminal fraud. It's probably just aggressive coding like every other practice coupled with the CMS opinion that the documentation didn't meet their criteria, but time will tell. Unfortunately for TVH, this has become a complex high-profile case, and some bureaucrat is likely to act like a dog with a bone because they want to make a name for themselves so they can become a bigger bureaucrat.

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.

Freeze Assets
 

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

Court records
 

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.

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.

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

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.

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.

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.

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.

Especially since they had staff trained/certified to look for it.

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.

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?

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.