[BrianL99]

Ran across this, today.

Apparently Emilio Noble got a 2nd chance from TVH.

He was charged with 65 counts of falsifying records and stealing from his previous employer, Affinity Health in NY. Took a Plea Deal.


403 Forbidden

[tophcfa]

Reminds me of the classic scene from Animal House, where John Belushi says to Flounder, “hey, you f up, you trusted us”!

[CoachKandSportsguy]

Originally Posted by BrianL99

Ran across this, today.
Apparently Emilio Noble got a 2nd chance from TVH.
403 Forbidden

OK, but he is not on the list of federal exclusions, who can't be hired by any organization who receives benefits from CMS.

AI Overview
The OIG Exclusion List, also known as the List of Excluded Individuals/Entities (LEIE), is a database maintained by the U.S. Department of Health and Human Services Office of Inspector General (HHS OIG). It identifies individuals and entities excluded from participating in federal healthcare programs, such as Medicare and Medicaid. This means they are prohibited from receiving payments for services rendered to these programs.

web site
https://exclusions.oig.hhs.gov/

under exclusions, click on the first drop down option
online searchable database
put in emilios name and click search

his name comes up with

Not Excluded If no results are found, this individual or entity (if it is an entity search) is not currently excluded. Print this Web page for your documentation

so he is eligible to be hired into a job with CMS reimbursements. .

So yes, he was hired over 10 years after his conviction, and so TVH whom ever is in charge of hiring, would not have found a reason to exclude him from work on a federal level.

Shady, yes, is that the type which "the family" hires, absolutely . .
do I feel bad for TVH or the family, not at all,
do I worry about healthcare in the villages, absolutely due to the doctor patient, service availability ratio, and short sighted voters who turn down pay increases etc for EMTS, etc. .

[Caymus]

When did the "questionable" billing start?

[golfing eagles]

Originally Posted by BrianL99

Ran across this, today.

Apparently Emilio Noble got a 2nd chance from TVH.

He was charged with 65 counts of falsifying records and stealing from his previous employer, Affinity Health in NY. Took a Plea Deal.


403 Forbidden

As disturbing as this is, he was in sales and marketing, he would have nothing to do with coding and billing.

[Caymus]

Originally Posted by golfing eagles

As disturbing as this is, he was in sales and marketing, he would have nothing to do with coding and billing.

Theoretically

[golfing eagles]

Originally Posted by Caymus

Theoretically

Theoretically, how would a director of marketing profit from hypothetical overbilling????

[BrianL99]

Originally Posted by golfing eagles

As disturbing as this is, he was in sales and marketing, he would have nothing to do with coding and billing.

Which is why I segregated the post, from lumping it in with the billing issue.

I agree, other than it's an indication of hiring practices. For all I know, the guy might be the most competent marketing guy in the world, but I think hiring someone with his pedigree, is a corporate culture issue.

[Caymus]

Originally Posted by golfing eagles

Theoretically, how would a director of marketing profit from hypothetical overbilling????

How about if he has a bonus plan tied to increased revenue?

[Pessemist]

Originally Posted by Caymus

When did the "questionable" billing start?

The questionable billing has caught up a lot of providers across the country including myself at one point.

What Medicare did awhile back to save money was to ‘bundle’ a bunch of services, with their own unique CPT codes, that were usually performed together into a single ‘bundled’ code with its own CPT code.

The reimbursement for all those ‘bumbled’ codes was significantly less then if the provider billed each separately.

For example, you go to a PT visit: you get stretching session, Heat treatment, weight session, gait training, kinesiotherapy taping and advice on ADL’s .

The PT clinic submits all these codes to
Medicare and might get reimbursed over $1,000.

So what Medicare did was ‘bundle’ all this and billed under a couple codes, lowering the reimbursement level to maybe $125 no matter what the therapist did.

Same for a surgery. Instead of billing for every sponge, aspirin, suture provided, Medicare ‘bundled it all under the umbrella of a single CPT code. So instead of getting reimbursed the ‘old’ way, Medicare might pay $35k for the entire procedure as a global fee.

Technically what TVH did wasn’t illegal, but it did violate Medicare rules. The trouble is, Medicare is slow but relentless. When it gets around to auditing a doctor, clinic or organization like TVH, it will claw back all the overpayments plus interest PLUS a hefty penalty.

I am sure TVH actually received overpayments that were much less than the hundreds of millions of dollars figure bandied about, but with heavy interest and penalties going back a number of years, it was a crippling blow.

Medicare will set the amount and then withhold any further reimbursements for patients until all the funds are paid back.

That would be a crippling blow to TVH leaving bankruptcy and sale of the organization their only option.

[golfing eagles]

Originally Posted by Caymus

How about if he has a bonus plan tied to increased revenue?

Does he????
And either way, how would we know that???

[blueash]

Did you do any careful diligence to be certain that this person is the same person in the previous case? There can be more than one person with the same name. Not doubting you, but asking if you were careful not to make an easy mistake.

[blueash]

Originally Posted by Pessemist

The questionable billing has caught up a lot of providers across the country including myself at one point.

What Medicare did awhile back to save money was to ‘bundle’ a bunch of services, with their own unique CPT codes, that were usually performed together into a single ‘bundled’ code with its own CPT code.

....n.

It is not Medicare who caught on to the shady way providers billed everything as a separate procedure. Definitions of services have always prohibited unbundling. And the definitions of CPTs are not created by Medicare (CMS) rather they originated with the AMA in the 1960s. So it was physicians themselves who wrote the rules against unbundling. CMS uses the AMA criteria and codes.

By the way there is zero evidence that unbundling is what got TVH in trouble. Rather it seems to be upcoding the intensity of services by creating the appearance of a sicker panel of patients which resulted in a higher payment rate. I don't know this for a fact. I'm just reading between the lines of the reports I've seen to date.

The Villages Health Bankruptcy: What Went Wrong and What We Can Learn - Taino Consultants.

[CoachKandSportsguy]

Originally Posted by Caymus

How about if he has a bonus plan tied to increased revenue?

or increased profitability. .

All he has to do is go to meetings and make suggestions about increasing revenue . . .
There are meetings to which all leaders go to discuss common issues and or goals. .
Strategy suggestions are not just limited to one person, regardless of title. . .

but i really like the answer by Pessemist. . . in how organizations can get caught by ignoring rules/coding changes for profitability. . which means that the auditing/legal function of the company is missing or inept

Also, many facets of the US government is just too slow in many of its response functions.. . allowing illegal activities to go on much too long before the issues blow up certain parts of the economy.

Finally, with the new billing codes and reimbursements being lower or fixed, health care offices will be more careful on patient acceptance / treatments to stay in business. . and the medicare reimbursements in areas with limited private pay patients will result in the loss of small private practices in retirement locations as big as TV, in favor of larger organizations which can maintain profitability with a larger private pay portion to maintain profitability.

However, the state of FL does not by statute require hospital coverage for all locations. . Many other states mandate coverage of all geographies by some provider. . meaning a hospital can't just close down and leave an entire location with out nearby emergency and health options for its citizens without state approval. .

so medicare cost/benefits cutting may have secondary effects which will majorly impact life in the villages. . . and may even threaten future growth without the requisite health care options.. . and this is on the developer,

[idlewild]

Will anyone be held accountable for this “honest” “mistake?”