[oneclickplus]

Originally Posted by birdawg

What’s your thoughts on Villages Health filing chapter 11

They scammed the system (over billing Medicare HUNDREDS OF MILLIONS). This is the fraud and abuse that the current administration is trying to fix. Know that they have or will also over bill patients (you and me) also without even a pause to consider ethics.

What are my thoughts? "Good riddance"

[Andyb]

Originally Posted by birdawg

What’s your thoughts on Villages Health filing chapter 11

Do the crime, do the time.

[Marmaduke]

Originally Posted by golfing eagles

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

Okay, so this is may be true.
What a shame they didn't have enough business acumen to have an annual audit by certified auditor.
Even small business operations know to check the books. What am I missing Doc?

[john352]

Originally Posted by Rainger99

Does anyone know who actually owns Villages Health?

The Villages Health System, LLC is owned by The Villages Health Holding Company, LLC, which is part of the Holding Company of The Villages, Inc.

The Holding Company of The Villages, Inc. is a privately-held company, and specific ownership details are not fully disclosed in public records.

I checked the property records for The Villages Health building near Sumter Landing; the owner is listed as The Village Operating Company.

[ithos]

I was informed by a well placed source that the inflection point was when they changed the insurance policies and created another layer of management which significantly added to the overhead costs.

[ithos]

Does anyone know how many of the Morse clan works there?

[elevatorman]

This is the site for Centerwell Health that is closest to The Villages. It is about 6 miles from UF Health Spanish Plains (The Villages Hospital). You may get a feel for what to expect if the sale is approved.

The Villages, FL | CenterWell Senior Primary Care

[Manza]

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.

We will all be informed when arrests are made. Otherwise, the coverup will continue.

[BrianL99]

Originally Posted by RoboVil

Regular Medicare does not require pre-authorization for anything.

Regular Medicare with an AARP supplement is the way to go long-term. .

You need to check your facts.

Many things need pre-authorization with Medicare.

AARP is not an insurer. Their Medicare Plans are UnitedHealthcare, who license the AARP name.

[Rainger99]

Originally Posted by egmcaninch

So Medicare was overpaid by TVH millions of dollars? Medicare used those million of dollars for a span of time? Now, Medicare wants to penalize TVH because they got more money than they should have? Don't understand the penalty for getting & using more money...

I think you have it backwards. Medicare was over billed by the Villages. For example, if the payment for the procedure is $100, the Villages was billing more than $100. So Medicare was paying more than the correct amount. Medicare wants the money back.

[NoMo50]

It is somewhat humorous that so many people posting here think they know exactly what happened within TVH, when, in fact, none of them know. In spite of a carefully worded article printed in The Villages Daily Sun on July 4th, this announcement is a big deal, given the amount of money involved, and the possible ramifications.

It has been reported that TVH has a debt to the Federal government in the hundreds of millions of dollars, plus interest and penalties. The interesting thing about that, though, is you typically don't hear about the government assessing penalties unless there is fraud or egregious behavior involved. Think about your taxes. If you make a mistake, and underpay your Federal taxes, you will be assessed the amount owed plus interest. Penalties generally come into play when fraud or some other purposeful behavior is alleged.

Supposedly, TVH reported the overpayments in December 2024. What is not mentioned is how these overpayments came to light. Was it due to an external audit, where reporting to the Federal government was imminent? Were the discrepancies discovered internally by TVH employees? It seems almost inconceivable that a simple "billing discrepancy" would go unnoticed for years, while generating massive payments into the system.

The timing of the bankruptcy filing is also curious. The filing apparently occurred on July 3rd, on the heels of an announcement by the Federal Department of Justice, on June 30th, of indictments in the largest health care fraud case in history. Nothing suggests, at least at this time, that TVH was involved in the federal case...but the timing is still curious.

Again, this is big news in The Villages that will bear watching moving forward. There could be implications for an awful lot of people living here, and not just those currently getting the medical care from TVH.

[kingofbeer]

Originally Posted by Laurawilcox

With owing millions from the Medicare over billing it may be the only option. Really want them to be successful as we need all of the medical options we can get here. It was interesting the Sun article indicated that all insurance will be accepted during the realignment hope that is true. Beautiful facilities were limited for Medicare patients to only Medicare advantage, hope that changes. May increase their success.

I do not know how the Villages Health could have overbilled. All patients are enrolled in select Medicare Advantage plans. Here is an example of a doctor visit:
$249.00 Billed
$123.95 Allowed
$121.48 Plan Paid
So, the Villages Health should be allowed to collect $2.47 from Medicare. If they collected more than $2.47, then there would be an o overpayment. I think any overpayments would be a fraud or just stupidity from the Villages Health.

[OrangeBlossomBaby]

Originally Posted by Rainger99

At this point, I don’t think we can reach any conclusion as to whether it was a coding error or whether it is fraud.

All we have is a conclusory statement from TVH. I know that corporations “always” tell the truth but I would like to hear more details before I make any final decision as to what happened.

Intrawebz armchair lawyering is pretty silly.

1. It's not up to you to "decide." The decision was already made.
2. Medicare has already acknowledged that it was an error, not fraud.
3. You aren't owed any further details, but if you REALLY care, you'll fill out the appropriate FOIA forms and submit them to the state and federal government, and wait the expect 6-months-to-never for a response.

[kingofbeer]

Originally Posted by OrangeBlossomBaby

Intrawebz armchair lawyering is pretty silly.

1. It's not up to you to "decide." The decision was already made.
2. Medicare has already acknowledged that it was an error, not fraud.
3. You aren't owed any further details, but if you REALLY care, you'll fill out the appropriate FOIA forms and submit them to the state and federal government, and wait the expect 6-months-to-never for a response.

Where is the document that says it was not Medicare fraud?

[OrangeBlossomBaby]

Originally Posted by Pat2015

Computer error, and never flagged? What’s the basis for your comment? I went round and round with you relative to this back in January when I said that there was probably a DOJ investigation which you said wasn’t the case.

It wasn't just a "computer error." Yes I used that term, yes you're quoting me. I was simplifying it so as to not have to type paragraph upon paragraph of hypotheticals to explain a complicated process that could result in a simple error, that would further result in disastrous outcomes. It was a mis-coding. The computer didn't make a mistake. The input was incorrect. If you've ever worked on a medical billing floor you'd understand how this mistake might be made.

An example: a "yearly checkup" might have several diagnostic codes attached to it. It might be C400, C407, C802, C803, R931 (I'm making those up, they might actually be code for something but I'm pulling them out of my head, not from a coding list). The coder inputs the wrong one. Maybe the routine annual physical is supposed to be C803. But the billing department has been entering it as C802, which might be "specialty yearly checkup for patients with early onset dementia, requiring extra stuff that costs more". Because a yearly checkup - no matter what the code is - doesn't cost the patient anything, the patient will never see a bill for it. But Medicare might see a specialty diagnosis that incurs a surcharge of $270 in addition to the $130 they might be paying for a routine annual physical, which has a different code. They'll pay it, because it's a yearly thing. It won't flag, unless it's noticed that it isn't happening yearly. It also isn't likely to flag when it's a "early onset dementia that costs more" yearly exam, when it's a medical group catering to seniors, since early onset dementia isn't all that uncommon for a group that caters to seniors.

Whoever has been inputting the yearly checkups, has been putting in the wrong ones, over and over again. Medicare's been paying on it, because it really IS a yearly checkup - even though it's the wrong code out of the list of codes for yearly checkups.

It's a mistake. The person entering the code didn't mistype, they miscoded. The Medicare system's accounts payable department never flagged it, because they had no reason to flag it. So it just kept paying out too much.

Until someone in the billing department at TVH brought the incorrect code to their boss's attention.

That's all that happened (though I don't know which code(s) were mis-coded, I was using a hypothetical above). It caused a HUGE financial disaster, but the error itself was simple, and not nefarious.