If you are on a Medicare Advantage Plan, Medicare is still paying for your health care and your Medicare Advantage Plan is managing it for Medicare .... for a %. The actual healthcare provider is essentially a "pass through', but it would seem the insurer must have some liability and/or responsibility for lack of oversight?

It's inconceivable that TV Health could have done almost $100M/year in direct medicare billings, for non-Advantage Emergency Care.

I don't see how BCBS could be involved, as TV Health doesn't accept supplemental insurance.

Someone in the medical business would know better, but I believe the "coding" and billing process is completely different for Advantage insurers, vs Supplemental insurers.

Again, just an educated guess ... with a Supplemental Plan, the consumer/patient is more involved in the process, up and through billing. Depending on the specifics of the supposed "computer error", it's likely that it would have been caught sooner with a Supplemental plan ... the billing is more transparent.

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...

There are other providers in the area besides the TVH. I was turned down from the TVH and went with Orlando which has been fine.

TVH filed because of over billing Medicare by hundreds of millions. Since TVH only accepts their advantage plans and not traditional Medicare their Advantage plans did not do well. I expect TV Advantage plans will be replaced by Humana plans and traditional Medicare. Also when a company files for bankruptcy employees become concerned about their future and may leave. Humana has to assure the employees and keep them informed.

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"

VH
 

Do the crime, do the time.

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?

Who owns the buildings?
 

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

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.

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

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

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

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.

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.

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.

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.

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?

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.

It's not 6 miles from the hospital. It's on the same campus, they share a parking lot. It's behind the Sharon Morse Medical Center.

TVH auditors likely caught it. Their lawyers advised them to file bankruptcy and sell. And that is exactly what they did. People go to prison for a lot less but money to have an army of lawyers can certainly lesson the impact and claim just a honest mistake. It’s the golden rule. Those that have the gold rule. Having “political power” doesn’t hurt either. Occasionally a bone with little meat on it is thrown to us in the middle class. That keeps most of us reasonably happy. Fore.

Where did they acknowledge that? Do you have a statement or press release from Medicare?

The DOJ is involved and looking into HCC up billing due to the amount of overpayment...the amount is too high to be an error..at any rate TVH is going to be on the hook to CMS for the $361 million after Humana owned co takes over...of course the amount is negotiable however the gov is being very aggressive.

So you think it's only coincidence that the "computer glitch" was found, after TV Health started merger talks with CenterWell?

Why do you suppose TVH Auditors missed it every year, for the 1st 4 years it was going on?

Heck if I know, it was in the news at the end of last year, and patients got the e-mail from TVH. I'm a patient, I got the e-mail. I read it, and deleted it, just like I do with any other e-mails that I don't need to save for any reason.

Seriously - this is not news. TVH reported the error, it was acknowledged. The sale of TVH is the "news" part of this whole thing.

It sounds like good news to me. I was going to try Centerwell this year, anyway. Maybe they'll finally take my Humana Advantage PPO and hire some doctors.

It's always been a crime to see those beautiful facilities go to waste, just because The Villages had some corrupt deal with United. We tried it the first couple of years after we moved here and got tired of being sent to some glorified nurse every time. It took 3 months to schedule a visit with your actual doctor. When we left, they even refused to release our medical records.

What concerns me is the possibility of the government going after The Villages for that money, and bankrupting the development company. We might be about to discover how much of that "free golf", "free entertainment", and everything else we supposedly pay for with our CDD fees, is actually subsidized by new houses and phony medicare bills.

Please stay on Topic - Villages Health Chapter 11.

- TVH (The Villages health) problems began in late 2024, when Medicare auditors flagged $250 million in billing overpayments, a sum that could balloon with penalties
- Centerwell (CW) was negotiating to purchase TVH (The Village’s Health) last fall when they discovered the billing and coding issues and backed out, about the same time TVH reportedly self reported the issue
- Filing for chapter 11 allowed TVH to restructure its debt while continuing its operations, but it liabilities remain a ticking time bomb
- The deal TVH reached with CW is designed to allow CW to acquire the assets, but sidestep the TVH’s looming liabilities. CW has entered into a “ stalking horse” purchase agreement to purchase TVH assets at a minimum floor price, but the sale will ultimately go through an auction process. The purchase agreement gives CW an advantage over other bidders as they have the option to match other bidders price and are now privy to information to do their due diligence. The court will oversee the sale process
- It’s not entirely clear whether Chapter 11 protects TVH from its Medicare related government liabilities, chapter 11 does not protect from TAXES owed to the government
- An ultimate sale to CW is by no means a done deal at this point, they have simply entered into a stalking horse asset purchase agreement
- Court fillings indicate Villages Health Holding Company has a 66.3% Equity interest in TVH.
- Stay tuned, this will most definitely get more interesting as facts are leaked out or become public information

So, when it's all over who will be financially impacted? Whoever owns Village Health holding company? Bond Holders (if any)? The money lenders? US Government?

Ripping Off Our Tax Dollars
 

This is the same group who asked me 3 questions and called it a “WellnessCheck”. In turn they billed Medicare 160 bucks. I hope they get fried. Follow the money and bust them all!

Unfortunately, TVH is not alone. Remember Columbia Health care from 2003? Remember, TVH SELF-REPORTED this case unlike Columbia which was the result of whistleblowers exposing corrupt management...and nobody went to jail from Columbia.

Certainly TVH deserves a little credit here.

#386: 06-26-03 LARGEST HEALTH CARE FRAUD CASE IN U.S. HISTORY SETTLED HCA INVESTIGATION NETS RECORD TOTAL OF $1.7 BILLION

Agree. I believe they up-coded to the tune of hundreds of millions of dollars. Up-coding is very common and often deliberate. How much of that money went to management as salary and bonuses instead of patient care? You live in a pollyannish world if you think the bankruptcy, overcharging and sale is all just a coincidence.
Blaming this on a computer error is ridiculous. Without these hundreds of millions of dollars in overcharges, would TVH not gone under long before now?

We went with VH for a brief period when they first started. Never saw the doctor. When we received a letter stating “go with a Medicare Advantage or get thrown out,”. We left, no way were we changing to an Advantage Plan. Medicare Advantage is Not an Advantage.

Investigating and being guilty are 2 different things. And where was it stated that the DOJ was investigating anyway????

Actually, you are more correct than you might think. TVH is paid on a diagnostic complexity per patient per month basis, different from straight Medicare.

It was only for primary care physicians that they only took Medicare Advantage, specialty care physicians accepted standard Medicare Medigap plans.

OK, I'll try to explain what happened (and realize that 99% of previous posts are just speculative BS):

Let's give an example: A patient taking aspirin after previous vascular surgery for say carotid occlusion has easy bruising. It gets coded as "acquired platelet dysfunction", which is exactly what it is. Or is it? Depends on interpretation. So the outside auditors for TVH tell them it is absolutely correct to use that code (Yes, they have continuous outside auditing). Then they get into negotiations with Humana, and Humana says that's wrong, you can't use that code in this instance. So TVH self-reports the discrepancy to CMS and this whole thing begins. There's more to it that I'm not at liberty to discuss, but there was NO INTENT TO DEFRAUD.

My wife, who knows her way around medical insurance after practicing for 40 years, alerted me about an insurance issue. She had gone in for a normal blood draw before an annual wellness visit and they wanted to do a vitals check on her. She declined since she suspected they would code it as an office visit. A month later, I went in for a normal blood draw, and I told them they could skip any vitals check. They said they weren’t doing that any more. Neither one us us has any health issues. Hmmm …

I am still amazed by those who automatically believe the worst in any situation, and nothing will convince them they are wrong.