Originally Posted by Cardinal64 (Post 2443363)

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.

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 OrangeBlossomBaby (Post 2443300)

Yes if I remember it was some kind of computer error. And Medicare just paid it, over and over again, without once questioning it. It was never flagged. When TVH realized what was happening they immediately reported the error and cooperated with Medicare to repay the overpayments.

Originally Posted by Cardinal64 (Post 2443363)

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.

Originally Posted by tophcfa (Post 2443389)

I am astounded that anyone could possibly believe this was an innocent computer error. I’ve got some swamp land to sell ya that surrounds Alligator Alcatraz if you honestly believe that. Hundreds of millions of dollars were over billed over years, and the $$$ disappeared and isn’t listed as assets in the bankruptcy filling. And then the error was suddenly discovered and self reported, REALLY? Or they knew they were about to get busted and tried to save face and keep from getting thrown in prison by concocting a far fetched story of presumed innocence? If they actual let an innocent computer glitch over bill, and accept 100’s of millions over several years, then they are guilty of gross negligence, incompetence, and lack of any reasonable internal controls. And what happened to all that money, did the computer error miraculously make it disappear? This doesn’t pass even the most lenient of sniff tests.

Originally Posted by tophcfa (Post 2443389)

I am astounded that anyone could possibly believe this was an innocent computer error. I’ve got some swamp land to sell ya that surrounds Alligator Alcatraz if you honestly believe that. .

Originally Posted by rustyp (Post 2443375)

If the miscoding resulted with TVH receiving hundreds of millions of dollars not entitled is it a profitable venture when the dust settles ?

For the record I do not see this as an advantage plan vs Medicare / supplement issue. why couldn't a medicare / supplement establishment miscode ?

Originally Posted by OrangeBlossomBaby (Post 2443377)

The Villages Health doesn't accept regular Medicare/Supplements. It only accepts Medicare Advantage, and it accepts a variety of Marketplace insurance plans for people who aren't old enough for Medicare yet (such as myself).

Originally Posted by Rainger99 (Post 2443403)

I always thought that TVH didn’t take Medicare - only Advantage plans.

I am on Advantage and as far as I know, TVH sends the bills to UHC - not to Medicare. Does anyone know how Medicare could have been over billed?

And if Medicare was over billed, wouldn’t UHC, Blue Cross, etc., also be over billed?

And would the over billing impact patients requiring them to have higher co-pays and deductibles?

Originally Posted by rustyp (Post 2443405)

My question was not aimed at TVH. It was to the posters who refer to an Advantage plan is somehow related to this debacle and it would not happen on Medicare with a supplement. Don't both systems have to code to receive payment ?

Originally Posted by OrangeBlossomBaby (Post 2443315)

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.

Originally Posted by dadspet (Post 2443368)

Just to clarify the TVHCS comment about accepting any insurance. A few years ago, we asked the TVHCS if they accepted my previous employer's UHC plan, which is very good, and they told us NO. Recently, we were surprised when we again asked TVHCS if they accepted our UHC plan, and they said they did. However, once we started to apply and fill in the paperwork, we were then told there were only 2 Primary care doctors in their system that accepted UHC, and it was / and still is months before we could get our first required appointment. They told us that even though it was currently months, after we filled in the paperwork and it was accepted, the appointment could perhaps be changed to a sooner date. Well, after being accepted and calling for a sooner appointment a few times during the last month, nothing opened up, and we just gave up...still waiting. Not sure if this recent announcement has much or anything to do with this. But beware, if you don't have The Villages Health insurance, you will be in for a long 1st appointment wait time for the very limited number of Drs that accept your insurance in their system:cry: