“a four years’ long scheme” is the exact wording used by the Blue Cross attorneys in the bankruptcy court filing. See page 3, subsection 6, and read it for yourself.

It’s doubtful that the attorneys are trying to impress the bankruptcy court judge with click bait. I’m sure that wording was carefully thought out before being included in the court filing.

Really. I thought he whole point of endless motions and legal theatrics IS to impress a judge or jury, and in this case sway public opinion and that of government investigators as well.

There seems to be a dispute as to the definition of clickbait.

Clickbait uses sensational, misleading, or curiosity-provoking headlines and images to drive traffic to content that may not deliver on its promise.

In other words, 99.9% of all social media :1rotfl::1rotfl::1rotfl:

It wouldn’t impress a judge or jury to make false claims in a court filing when the real facts come out during discovery. Peeling back the onion, it appears that both United Health Care and Blue Cross are pushing for the court to engage in a thorough discovery process, while TVH is pushing for an expedited sale while attempting to bury the discovery process. One is free to read into that as they choose.

But haven't you already read into it for us by "peeling back the onion?"

TVH seems to be pressing forward with the sale. UHC and BC are attempting to slow the sale. Any statements as to their motives are conjecture.

Agree, but wouldn’t you also agree, that generally speaking, parties that would benefit from all the facts being discovered would want to put on the brakes so there is time for a thorough discovery process can take place?

Sure, but is this about benefiting from all the facts being discovered or is this about slowing the sale in order to increase pressure on the other party to capitulate in some way? I don't know. Certainly, all parties are working towards their individual self interests but that is not evidence of some nefarious scheme or ulterior motive.

No dispute on my end.

The statement is sensationalism.
This is what lawyers do............in court and out of court.
A "scheme" has not been proven.

I see your point, but why would the other party capitulate under pressure if they felt they did nothing wrong? Thinking logically, they should welcome a lengthy process, including a thorough and full discovery, as this would exonerate them. There is no doubt all parties are working towards their individual self interests.

And neither has TVH proved that there was no scheme.

However, Florida Blue has made a very specific statement in their papers:

They state that "a Florida Blue investigation revealed that in payment year 2024, the Debtor had falsely added the following diagnoses into patient files:
Diagnostic Code 48 for "Coagulation Defects and Other Specified Hematological Disorders," and Diagnostic Code 22 related to “specified Heart Arrhythmias.”

That does not look like clickbait.

Except for TOTV!

The reported reason is they have a cash flow problem and are finding it hard to make payroll. Also, their patients are worried and the longer this goes on the more likely it is that they will lose some.

Other possibilities notwithstanding, there are good business reasons for TVH to want the sale to close quickly. Being exonerated is a small consolation if the business fails in the meantime.

(and yes, there are other possibilities)

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.

This is a very, very interesting post.

First of all, TVH doesn't have to prove there was no "scheme", the burden of proof is upon the accusers

Secondly, ICDM-10 diagnostic codes are generally 7 digits with 2 digit modifiers---but there are some less specific codes for generalized diagnoses, the one for coagulation defects is actually D68.8

That being said, remember my point all along has been that nobody knows what happened so nobody should rush to judgement, especially with torches and pitchforks.
But if I can "conjecture", as I've been accused, of, let's consider this, and I'll direct it at "Coagulation Defects and Other Specified Hematological Disorders" as an example

Anyone taking aspirin, even 1/4 of a baby aspirin per day, has platelet dysfunction by definition---that's the purpose of taking it. If a physician wants to make a big deal out of this and use that "Coagulation Defects and Other Specified Hematological Disorders" diagnosis, they should put something, anything, in the note---"I discussed aspirin use with the patient", "The patient denies excessive bruising", the patient has not had nosebleeds", etc. And that would totally justify the submission of that code, which might result in a higher payment.

They might believe that simply having aspirin in the patient's medication list would suffice because all physicians know this. However, the bean counters would have no idea and would look for something in the progress note to justify the use of that diagnosis. But overall, since TVH physicians are on salary, no single physician would have a reason to push the limits that far. To make it work there would have to be a conspiracy of 60 or 70+ providers , which is highly unlikely

But, to speculate further, what IF someone at the coding level or even higher on the food chain directed those coders to "add" the diagnosis of D68.8 to anyone with aspirin in their medication list??? Strictly speaking it's 100% legitimate, EXCEPT none of the progress notes would indicate anything relating to aspirin use. Hence the term "The documentation failed to support the diagnosis submitted", and now you have "overbilling". It's possible. Or somebody with access and who is tech savvy could simply program the EMR to add that diagnosis to anyone on aspirin.

So let's just see how the story develops. Unfortunately, at this point, the only winners that I see emerging from this are the lawyers.