[Bill14564]

Originally Posted by tophcfa

Cash flow problem? According to the UHC bankruptcy court filing, TVH admitted on the seventh week of this case, that it distributed $183 million between 2022 and 2024. UHC further claims the DIP financing is being provided by key insiders of TVH (the same parties that benefited from the distributions), which is highly unusual and suspicious. None of that proves anything, but it certainly takes the teeth out of the cash flow problem argument.

To the contrary, if all that cash was distributed and then they came across the billing issue and now UHC is withholding payments it reinforces the cash flow argument.

[Rainger99]

Originally Posted by golfing eagles

Unfortunately, at this point, the only winners that I see emerging from this are the lawyers.

I think everyone can agree with that statement!

[golfing eagles]

Originally Posted by Bill14564

To the contrary, if all that cash was distributed and then they came across the billing issue and now UHC is withholding payments it reinforces the cash flow argument.

If there were significant cash distributions along the way, and if there was significant "overbilling", that is a huge issue apart from cash flow. Forensic accounting will tell.

[dewilson58]

Originally Posted by Rainger99

And neither has TVH proved that there was no scheme.

Welcome to USA..................innocent until proven guilty.

[dewilson58]

Originally Posted by Rainger99

They state that "a Florida Blue investigation revealed that in payment year 2024, the Debtor had falsely added the following diagnoses into patient files:


That does not look like clickbait.

"falsely" does not mean a scheme.

Also, if someone makes a statement (like "falsely") it doesn't make it true.

Here, let me show you.................The sky is falling.
Go outside, the sky is not falling.

[golfing eagles]

Originally Posted by dewilson58

"falsely" does not mean a scheme.

Also, if someone makes a statement (like "falsely") it doesn't make it true.

Here, let me show you.................The sky is falling.
Go outside, the sky is not falling.

Welcome to the shark tank.

TVH, UHC, Florida Blue, Humana, CMS and possibly DOJ---each with an army of lawyers.

What could possibly go wrong?

[dewilson58]

Originally Posted by golfing eagles

Welcome to the shark tank.

TVH, UHC, Florida Blue, Humana, CMS and possibly DOJ---each with an army of lawyers.

What could possibly go wrong?

Meta is reading ToTV.............she jus did an article with the word scheme.....clickbait.

[Bill14564]

Originally Posted by golfing eagles

If there were significant cash distributions along the way, and if there was significant "overbilling", that is a huge issue apart from cash flow. Forensic accounting will tell.

Distributions in the form of paying off debt according to the reporting. UHC and perhaps FB characterize it differently.

But my point was simply that if:
- TVH distributed cash reserves that it had with the understanding that future cash flows would be high;
- TVH discovered an error which not only reduced cash flows but raised the potential for a significant additional debt; and,
- UHC is now withholding reimbursements to TVH

then that supports a TVH claim of a cash flow issue today.

[Pat2015]

Originally Posted by Snowbirdtobe

I’ll bet there are 100 lawyers listed as being involved in the case and none of them could explain it.
How could someone hide $300,000,000 in losses from Medicare and United Health? Why would someone come along fat dumb and happy and try to buy into the mess?

Because it’s going to be a fire sale. Also, it’s $360 million owed to the government, and Florida Blue is filing against them for another $25 million. Lot’s more insurance companies will be adding on as the Specialists take all kinds of insurance and the fraudulent billing scheme would not just be the government and BCBS.

[golfing eagles]

Originally Posted by Pat2015

Because it’s going to be a fire sale. Also, it’s $360 million owed to the government, and Florida Blue is filing against them for another $25 million. Lot’s more insurance companies will be adding on as the Specialists take all kinds of insurance and the fraudulent billing scheme would not just be the government and BCBS.

Again, and I think this is about 50 times: WHAT FRAUDULENT BILLING "SCHEME"???? The only accusations of fraud are coming from uninformed, unsubstantiated posts on TOTV. Neither CMS or DOJ has made any accusation of fraud. Will there be a charge of fraud in the future? Who knows, but certainly NOT posters on TOTV. So those uninformed people should put down their torches and pitchforks for the time being until more is known.

[tophcfa]

Originally Posted by Pat2015

Because it’s going to be a fire sale. Also, it’s $360 million owed to the government, and Florida Blue is filing against them for another $25 million. Lot’s more insurance companies will be adding on as the Specialists take all kinds of insurance and the fraudulent billing scheme would not just be the government and BCBS.

As far as I can tell, the $25 million is part of the overall $360 million. I’ve been asking myself, why would Florida Blue dive into this hornets nest to recover $25 million, which is chump change for a Company like Blue Cross and Blue Shield? My best guess is it’s not about the $25 million, it’s about preventing the possibility of a dangerous legal precedent being set. If the bankruptcy court ultimately lets TVH off the hook for the $360 million, then CMS might go after the likes of United Healthcare, Florida Blue, and Humana to recover the funds. If CMS were to successfully do that, it would set a legal precedent that any health care provider, similar to TVH, could simply file chapter 11 and force over billing liabilities onto the insurance companies they have MA contracts with. That scenario would create a very dangerous precedent for insurers, potentially exposing them to unquantifiable liabilities and change the whole landscape of the Medicare Advantage business for them.

[drducat]

Originally Posted by tophcfa

As far as I can tell, the $25 million is part of the overall $360 million. I’ve been asking myself, why would Florida Blue dive into this hornets nest to recover $25 million, which is chump change for a Company like Blue Cross and Blue Shield? My best guess is it’s not about the $25 million, it’s about preventing the possibility of a dangerous legal precedent being set. If the bankruptcy court ultimately lets TVH off the hook for the $360 million, then CMS might go after the likes of United Healthcare, Florida Blue, and Humana to recover the funds. If CMS were to successfully do that, it would set a legal precedent that any health care provider, similar to TVH, could simply file chapter 11 and force over billing liabilities onto the insurance companies they have MA contracts with. That scenario would create a very dangerous precedent for insurers, potentially exposing them to unquantifiable liabilities and change the whole landscape of the Medicare Advantage business for them.

The court can't discharge the 361 million owed the federal government CMS. Nor can it discharge a penalty that is mandatory for things like this. It won't matter if it is fraud or otherwise a penalty can't be included.

[Rainger99]

Originally Posted by dewilson58

Welcome to USA..................innocent until proven guilty.

You are correct that in a criminal action, the burden is always on the government. However, this is not a criminal action. It is a bankruptcy action. And it has different burdens of proof.

When a creditor files a bankruptcy claim using the correct official form and with supporting documents, it is treated as "prima facie evidence" of its validity and amount.

Prima facie evidence means the claim is presumed to be correct on its face.

The creditor's burden at this stage is simply to file the claim properly and on time.

If the debtor (or another interested party) objects to the claim, the burden of proof shifts to that objecting party.

I haven’t seen any evidence that TVH has objected to any claims, much less produce any evidence that the claims are defective.

[tophcfa]

Originally Posted by Rainger99

You are correct that in a criminal action, the burden is always on the government. However, this is not a criminal action. It is a bankruptcy action. And it has different burdens of proof.

When a creditor files a bankruptcy claim using the correct official form and with supporting documents, it is treated as "prima facie evidence" of its validity and amount.

Prima facie evidence means the claim is presumed to be correct on its face.

The creditor's burden at this stage is simply to file the claim properly and on time.

If the debtor (or another interested party) objects to the claim, the burden of proof shifts to that objecting party.

I haven’t seen any evidence that TVH has objected to any claims, much less produce any evidence that the claims are defective.

Very interesting, was not aware of that. So if the debtor (TVH) objects to the creditors claims, the burden of proof shifts to them to prove the claims are false. If they don’t object, then the claims are considered correct. By this logic, the creditors are forcing disclosure/discovery onto the party filing for bankruptcy (TVH). Kind of puts TVH between a rock and a hard place if they are indeed trying to avoid opening up their books to full discovery. It will be interesting to see if TVH objects to any of the creditor claims, exposing them to discovery?

[Bill14564]

Originally Posted by tophcfa

Very interesting, was not aware of that. So if the debtor (TVH) objects to the creditors claims, the burden of proof shifts to them to prove the claims are false. If they don’t object, then the claims are considered correct. By this logic, the creditors are forcing disclosure/discovery onto the party filing for bankruptcy (TVH). Kind of puts TVH between a rock and a hard place if they are indeed trying to avoid opening up their books to full discovery. It will be interesting to see if TVH objects to any of the creditor claims, exposing them to discovery?

Or, TVH replies, "yes, that is correct, that is one of our debts and that is why we are restructuring under Chapter xx."

Did the creditors file a claim against the TVH assets under bankruptcy rules or did they file something different and outside those rules? I really don't know (or particularly care) but the details will matter quite a bit in court.