Currently, the Villages Health takes Advantage plans from UnitedHealthcare, Humana, and Florida Blue.

Has there been any statement from UHC or Florida Blue that they will stay with TVH - especially if Humana owns it?

As someone who spent 45 years around hospitals and medical system diagnostics, Asianthree, OBB and GE are speaking reality.

I thought with Medicare Advantage Plans, the Payments from Medicare were essentially as Rainger laid out. A "monthly payment per patient", based on their level of need.

I thought traditional Medicare (NON Advantage Plans) made payments per what OBB laid out.

It can't be both ways. Either they pay a "lump sum" per month, based on a Patient's level of complication or they pay individually, for specific procedures.

It sounds to me, like two separate and distinct Medicare fraud/over-billing/mis-coding. In one instance, the patient's general health/complications are inflated for a larger monthly payment.

In the other instance, the patient's individual procedures are miscoded or exaggerated.

Which is it?

Those aren’t facts.

Post a link to the bankruptcy filings that support their statements.

No. CMS also pays MA plans incentive bonuses when plans surpass certain patient health benchmarks.

Medicare Advantage Quality Bonus Payments Will Total at Least $12.7 Billion in 2025 | KFF

Bonus payments to a MA plan can be millions of dollars.

CMS pays a MA plan periodic risk-based rates plus potentially bonuses. Then the plan pays the MA clinic (provider) based on whatever contract terms the plan and clinic negotiate.

That wasn't the question.

The question is, does Medicare for Advantage plans pay a "lump sum per patient" (as Rainger said) or do they pay per individual visit/procedure (as OBB said)?

I doubt it can be both ways. OBB's scenario of the "bunion story" presumes Medicare is invoiced for and pays, for each individual visit and/or procedure. I don't think that's the case with Medicare Advantage Plans. I think Medicare simply pays a "lump sum" per patient, depending on the patient's overall health condition. ("Bonuses" are irrelevant to the question).

Probably not, more likely to prioritize the best interests of the creditors.

For me, The biggest issue with TVH is that they only take Medicare advantage plans which I think is a huge mistake.
Also, there can never be a monopoly in the health care system in TV. There are more drs outside of the TVH system so people have many choices on who to see. Also, no dr is dedicated to 1 company. There is so much turnover in drs around here, no company could state they will have this specialist tomorrow. My wife, before she was on Medicare, was going to drs in the TVH system that disappeared before her next 6 month visit so she was constantly having to re-establish with a new dr. Now being on a Medicare supplement plan g plan, she has seen the same dr at other facilities.

I think you would find the high turnover rate is due to the fact that there are just as many, if not more, physicians at TVH that are near the end of their career than those at the beginning of theirs. Young doctors tend to want to be near urban areas and suburbs with children for playmates for theirs. There is little attraction for a young family in a 55+ retirement community. Plus, the salaries are higher elsewhere.

I guess I needed to have chosen a different profession to understand all of this, but I didn't. What I do understand (I think) is that the Village Health System is on the hook for $300,000,000 in over-billing to United Health. So, will someone please answer me this:

1. Where did that money end up, and who profited from it?

2. With that amount of fraud involved, who was responsible for it, and why haven't criminal charges been filed?

3. Will United Health still be our primary insurance provider, or will they bow out?

If somebody doesn't get some time (prison) out of this, then my faith in the justice system will have eroded even further.

UnitedHealth has their own Medicare billing issues with the Government that dwarfs the Villages Health issue.

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Pay who? The MA plan or clinic?

Regardless, neither described by Rainger and OBB is necessarily true for MA. If the MA financial model were simple, there would be less disagreement and confusion.

It wasn't losses. They overbilled Medicare and got caught from the government DOGE audit.

Based on the fact that Medicare is saying TVH "over-billed" them, that must mean that Medicare pays TVH directly (which surprises me). It sounds like the Insurance carrier is just a "middle man", providing management of the patient/doctor relationship.

With 100's of posts on the subject, it seems someone must actually know the formula for how TVH gets it's revenue and from whom. Again, Rainger & OBB's characterizations of the payment structure/arrangement are diametrically opposed ... two separate and distinct arrangements.

Does Medicare pay TVH a specific amount per patient, regardless of what or how many procedures they have (adjusted only for bonuses and/or "complexity" level of their conditions) ....

Or ... does Medicare pay TVH per visit and/or per procedure, as OBB claimed in the bunion story.

& how does the insurance company get paid, if they're not billing Medicare directly?

Call me crazy, but if no one understands how billing and payments actually work, how does anyone have an opinion on who's getting pork'd and how?

That statement couldn't be more wrong! They MAY HAVE "overbilled", depending on which interpretation of ICDM-10 diagnostic criteria is applied. This was discovered during negotiations for being acquired by Humana, and self-reported to CMS BEFORE DOGE EVEN EXISTED, BEFORE THE ELECTION AS WELL.