Originally Posted by OrangeBlossomBaby (Post 2443294)

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.

Originally Posted by Stu from NYC (Post 2443313)

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

Originally Posted by justjim (Post 2443305)

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.

Originally Posted by Rainger99 (Post 2443311)

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?

Originally Posted by OrangeBlossomBaby (Post 2443318)

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.

Originally Posted by OrangeBlossomBaby (Post 2443294)

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.

Originally Posted by Rainger99 (Post 2443311)

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?

Originally Posted by Stu from NYC (Post 2443313)

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

Originally Posted by golfing eagles (Post 2443331)

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

Originally Posted by tophcfa (Post 2443268)

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.

Originally Posted by golfing eagles (Post 2443332)

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

Originally Posted by golfing eagles (Post 2443332)

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

Originally Posted by Rainger99 (Post 2443334)

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.”