[Stu from NYC]

Originally Posted by 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.

Thanks think you answered my question as to where the money went. Would hope that the owners of TVH would have to reimburse medicare

[rustyp]

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 ?

[Rainger99]

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

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.

[Pat2015]

Originally Posted by OrangeBlossomBaby

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.

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.

[Pat2015]

Originally Posted by 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.

Medicare will not take a loss as federal debts are not dischargeable under bankruptcy. Also they filed for reorganization not discharge under Chapter 11 in order to sell the business

[tophcfa]

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.

[biker1]

The Villages Health specifically said it was an issue with “certain billing processes and practices”. I didn’t see them use the term “computer error”.

Originally Posted by tophcfa

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.

[BrianL99]

Originally Posted by tophcfa

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. .

The Villages Health over-billed, in excess of $360,000,000, over a 4 year period.

That's $90,000,000 per year.

They currently have assets of between $50,000,000 - $100,000,000.

The yearly over-billing, exceeded their total assets.

This isn't a simple rounding error that went un-noticed.

How do you not notice an extra $90,000,000 per year in revenue? For 4 years?

If it takes a company's management 5 years, to recognize they're receiving $90M a year more than they deserved, would you trust those morons with your health?

As for the "self-reporting" claims?

What seems to have been forgotten, is Central Health and The Villages Health engaged in merger/stock exchange discussions last year. Those discussions were de-railed by the discovery of the over-billing.

It sounds suspiciously like Central Health discovered the over-billing during their Due Diligence and self-reporting became a necessity ... the cat was out of the bag.

[Rainger99]

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?

[rustyp]

Originally Posted by rustyp

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

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).

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 ?

[BrianL99]

Originally Posted by Rainger99

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?

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.

[BrianL99]

Originally Posted by rustyp

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 ?

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.

[egmcaninch]

Originally Posted by OrangeBlossomBaby

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.

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...

[RoseyRed]

Originally Posted by dadspet

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

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.

[joshgun]

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.