[Stu from NYC]

Originally Posted by OrangeBlossomBaby

It wasn't fraud. It was a really huge, significant flaw that TVH discovered, and reported. They were being overpaid for quite awhile. At some point, someone found what the problem was and said "hey boss - this is totally not right." And the boss said "OMG holy crap" and reported it to Medicare, and told Medicare "hey youz guyz - you've been sending us too much money! How do we give it back to you?" And Medicare said "oh golly gee let's figure this out" and they did.

Unfortunately, imposed penalties for overpayment don't get absorbed by the people who were doing the overpayment (Medicare) but by the entity that receives it (TVH). So they're on the hook for the millions in the government's overpayments, AND for penalties. Which - they can't afford.

If TVH was getting overpaid for hundreds of millions of dollars where did the money go? Had to go somewhere.

How did people not know how to code for billing purposes?

I smell fraud

[Stu from NYC]

Originally Posted by Stu from NYC

If TVH was getting overpaid for hundreds of millions of dollars where did the money go? Had to go somewhere.

How did people not know how to code for billing purposes?

I smell fraud

Or as I believe Hamlet said "something is rotten in Denmark".

[OrangeBlossomBaby]

Originally Posted by justjim

TVH was apparently “coding”
many procedures wrong. I don’t know who caught the overpayments. Generally auditors are the ones that first spot such a pattern of overpayments. The best money governments can spend is on more monitors and auditors. Sometimes it’s honest mistakes and sometimes not so much the case.

TVH caught the mistakes and reported it to Medicare. The miscoding was not intentional - if it was, then yeah it'd be fraud, and TVH would be under criminal investigation. Medicare acknowledged that this was a mistake. A HUGE mistake, but a mistake nonetheless.

[OrangeBlossomBaby]

Originally Posted by Rainger99

I will say that they have not been very transparent on the overbilling issue. I think they should provide a very detailed explanation. When did it start? Was it one code? A hundred codes? A thousand codes? Were there any audits during the overbilling?

What caused it? And was it a programming error? Did the money go to the doctors or to the owners of the company?

https://thevillageshealth.com/wp-con...FINAL_1230.pdf

Doctors at TVH don't work on commission. They are salaried. The specific codes are irrelevant, to patients, unless the billing error is affecting their bill. This miscoding didn't affect patient billing at all, and so patients really don't need to hear all the nitty gritty details.

They need to know there was a mistake. The mistake was found, and reported. The mistake was corrected so that it can't happen again. There's a debt that has to be repaid as a result. It's in the process of being repaid.

[Rainger99]

Originally Posted by OrangeBlossomBaby

https://thevillageshealth.com/wp-con...FINAL_1230.pdf

Doctors at TVH don't work on commission. They are salaried. The specific codes are irrelevant, to patients, unless the billing error is affecting their bill. This miscoding didn't affect patient billing at all, and so patients really don't need to hear all the nitty gritty details.

They need to know there was a mistake. The mistake was found, and reported. The mistake was corrected so that it can't happen again. There's a debt that has to be repaid as a result. It's in the process of being repaid.

That appears to be a rather vague explanation written by their lawyers. It doesn’t explain what happened.

And for a company that has an “absolute
commitment to transparency amongst our patient community” it clearly lacks transparency.

Is the debt being repaid? I thought they have estimated liabilities of $100m-$500m and estimated assets of $50m-$100m.

[golfing eagles]

Originally Posted by OrangeBlossomBaby

It wasn't fraud. It was a really huge, significant flaw that TVH discovered, and reported. They were being overpaid for quite awhile. At some point, someone found what the problem was and said "hey boss - this is totally not right." And the boss said "OMG holy crap" and reported it to Medicare, and told Medicare "hey youz guyz - you've been sending us too much money! How do we give it back to you?" And Medicare said "oh golly gee let's figure this out" and they did.

Unfortunately, imposed penalties for overpayment don't get absorbed by the people who were doing the overpayment (Medicare) but by the entity that receives it (TVH). So they're on the hook for the millions in the government's overpayments, AND for penalties. Which - they can't afford.

100% totally correct. Everything that everybody else posted about this previously was a load of garbage.

[golfing eagles]

Originally Posted by Rainger99

I will say that they have not been very transparent on the overbilling issue. I think they should provide a very detailed explanation. When did it start? Was it one code? A hundred codes? A thousand codes? Were there any audits during the overbilling?

What caused it? And was it a programming error? Did the money go to the doctors or to the owners of the company?

And just why do you think you are entitled to that information? This is strictly between CMS and TVH, YOU are not involved.

[golfing eagles]

Originally Posted by Stu from NYC

If TVH was getting overpaid for hundreds of millions of dollars where did the money go? Had to go somewhere.

How did people not know how to code for billing purposes?

I smell fraud

Take another whiff, it was a computer error that went unnoticed for a long time. Once TVH noticed it they immediately notified CMS. NO FRAUD

[Rainger99]

Originally Posted by golfing eagles

And just why do you think you are entitled to that information? This is strictly between CMS and TVH, YOU are not involved.

One of the parties is CMS which is a federal agency. If it were the plans for the bombing of Iran, I think they should keep that secret - at least while it is in the planning stages.

The case is now in the courts and most court records are public information so we should be entitled to that information. (Perhaps the Daily Sun will do some investigative journalism on the issue.)

Finally, TVH posted a letter saying that they have an “absolute commitment to transparency amongst our patient community.”

[Risuli]

Originally Posted by tophcfa

Interesting, but not surprising. The fact that they only accepted certain Advantage plans, and no Medigap plans, for primary care immediately raised the hair on the back of my neck that something fishy was going on. As far as I’m aware, they were the only large health care operation in the country serving a predominantly senior citizen population that wouldn’t accept traditional Medicare. My intuitive suspicions aren’t always correct, but apparently it was this time.

Agree. When we moved here 3 years ago I was shocked that they would not accept our insurance which is medicare along with Blue Cross Blue Shield, but only Advantage plans (but somehow their specialists are OK with it).

[rustyp]

How many of TVH docs are going to stick around after this debacle plays out ? Most docs were there due to being salaried and limited number o patients. If the system changes many TVH patients will take a hike also. This will tax the regular Medicare docs. And you thought the emergency room wait was long. Watch what's next for the entire community.

[Stu from NYC]

Originally Posted by golfing eagles

Take another whiff, it was a computer error that went unnoticed for a long time. Once TVH noticed it they immediately notified CMS. NO FRAUD

You certainly know more about how this works than the rest of us but where did the money go?

[CoachKandSportsguy]

Originally Posted by golfing eagles

Take another whiff, it was a computer error that went unnoticed for a long time. Once TVH noticed it they immediately notified CMS. NO FRAUD

just crappy internal / financial auditing, and probably poor data entry training. However, remember, its not fraud if you really believe you are right!

Coding does change over time. . but if TV LLC owned the hospital, most likely the money went to the TV LLC development pot. . .

[OrangeBlossomBaby]

Originally Posted by Rainger99

One of the parties is CMS which is a federal agency. If it were the plans for the bombing of Iran, I think they should keep that secret - at least while it is in the planning stages.

The case is now in the courts and most court records are public information so we should be entitled to that information. (Perhaps the Daily Sun will do some investigative journalism on the issue.)

Finally, TVH posted a letter saying that they have an “absolute commitment to transparency amongst our patient community.”

Words and their placement matters.

The words and their placement:

"Absolute commitment to transparency among our patient community."

What that does NOT mean:

Commitment to absolute transparency.

What that also does NOT mean:

Commitment to transparency among anyone beyond their patient community.

They were transparent. They weren't "absolutely" transparent, because the details are none of your business.

Any public information is public. If you want to know the public information, you can put in a FOIA request with the government.

[Cardinal64]

I wonder who wrote that self-serving article in the newspaper owned by the Developer who also owns TVH. The computer didn't cause the error. It submits claims that someone instructs it to. The lack of oversight by TVH and by Medicare in this case is just another example of why Medicare is in trouble nationally. TVH has spent the over-payments as it expanded, and would have been in deep trouble without those funds. You declare bankruptcy to avoid payment of debts, so it looks like Medicare will take the brunt of the loss. Hopefully Sumter County and Florida tax payments are up to date. Let us pray that Centerwell has the internal controls and management skills that will allow the existing facilities and services to survive.