[Normal]

Originally Posted by dewilson58

I'll wait for a good source.

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.

[RoseyRed]

Originally Posted by Bill14564

AI hallucinates enough when you ask it for straight facts. Asking it for speculation?!

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?

[golfing eagles]

Originally Posted by Normal

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.

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"?

[golfing eagles]

Originally Posted by RoseyRed

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?

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.

[Rainger99]

Originally Posted by golfing eagles

Their revenue was expected by them, not "excess.”

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.

[Justputt]

Originally Posted by Rainger99

I have the same question. I can’t figure out why Medicare was overcharged. It seems that the advantage insurers were the ones that were overcharged. Although no one has explained whether increasing RAF scores increases payments to UHC or to TVH of to both.

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.

[Plinker]

Originally Posted by Normal

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.

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?

[Retiredsteve]

Originally Posted by dewilson58

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

I'll wait for a good source.

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?

[golfing eagles]

Originally Posted by Rainger99

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.

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

[golfing eagles]

Originally Posted by Plinker

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?

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.

[Caymus]

Originally Posted by golfing eagles

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?

[tophcfa]

Originally Posted by golfing eagles

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.

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.

[Rainger99]

Originally Posted by golfing eagles

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

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?

[Rainger99]

All you want to know about Medicare Overpayments!

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

[golfing eagles]

Originally Posted by Rainger99

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.