[OrangeBlossomBaby]

Originally Posted by vintageogauge

And exactly how did they get scammed and what did they get scammed out of? They didn't say they gave them information, they already had their medical records so they would have had to scam someone else that had the records.

Scammer - got access to your name, phone number, and the fact that you are on Medicare. Purchased the information probably from some other scammer who harvested the info when you signed up for something online.

So they call and say what they say. You answer the questions. Now they know what medical conditions you have, where you buy your prescriptions, and who your doctor is. They know where you are, and how often you see your doctor and how often he prescribes those meds for those conditions.

So now they can plug all that info into THEIR system - and submit bills to Medicare on behalf of a doctor, who may or may not exist, using your actual doctor's bonafides, and Medicare pays them for doctor visits that never happened, to treat legitimate conditions of a legitimate patient that they already know about and are in their system. Another way would be to counterfeit prescription pads and have drugs sent to them in your name, for conditions they already have in their system and know to expect you to use. If you're unlucky, those drugs will have yearly, quarterly, or monthly limits - and if the scammers tap out your yearly allotment, it means you won't be able to get the drugs you need when you need them.

That's just two ways to scam you. Medicare fraud is BIG business. It costs Americans around $60 Billion per year.

[Bogie Shooter]

Originally Posted by elshackovillages

Because they are not required to. Seems they make their money taking only advantage plan holders.

What post is this referring to?

[BlueStarAirlines]

Originally Posted by Kahuna32162

Just received a call from from 2 people who identified themselves as investigators for the Department of Justice, looking into Medicare billing practices at the village’s health.

Definitely a scam. There are never two investigators for a phone call. In person-yes, but there is just one needed for an investigation call since it is recorded.

[Bogie Shooter]

Originally Posted by OrangeBlossomBaby

They did not commit fraud, they didn't try to commit fraud. NO PATIENT BILLING was compromised. There is no investigation, the DOJ is not involved. It is strictly a coding error that caused TVH to get too much money, and working "with federal agencies" means working with Medicare, to make sure the error is fixed and the money returned to the Medicare fund.

There is nothing interesting about it, and everyone who is a patient at TVH has received the e-mail explaining exactly what happened and exactly what's being done to correct it.

This is a good summary of the above posts.
Both the stupid posts and those giving valid information.

[Pat2015]

Originally Posted by OrangeBlossomBaby

They did not commit fraud, they didn't try to commit fraud. NO PATIENT BILLING was compromised. There is no investigation, the DOJ is not involved. It is strictly a coding error that caused TVH to get too much money, and working "with federal agencies" means working with Medicare, to make sure the error is fixed and the money returned to the Medicare fund.

There is nothing interesting about it, and everyone who is a patient at TVH has received the e-mail explaining exactly what happened and exactly what's being done to correct it.

You seem to know a lot about this. They did not commit fraud; there is no investigation; this was a coding error; etc. How do you know these things?

[Debbraham]

Originally Posted by Kahuna32162

Just received a call from from 2 people who identified themselves as investigators for the Department of Justice, looking into Medicare billing practices at the village’s health. I first thought it was a scam, but after hearing the personal information they had on our records, I was inclined to cooperate with their inquires.

They mostly wanted to confirm conditions listed in our files and confirm they were correct. Most conditions were not correct, especially type 2 diabetes.

I’ve thought for years that the Village’s Health was a scam. This active investigation might just be the tip of the iceberg.

Received an email from villages healthcare that they were cooperating with govt agencies about overpayment to the villages on Medicare. They had hired outside consultants to review how they were doing coding for patients and the coding practices were in error and resulted in the villages being overpaid by Medicare. So it’s probably not a scam but still err on the cautious side…contact villages healthcare to find out more.

[golfing eagles]

Originally Posted by Pat2015

Oftentimes it’s not the provider that discovered they were billing incorrectly as it’s CMS that flags them based on billings. TV says they are working with federal agencies which I’m certain they are based on overpayments. There is a possibility that an investigation has been opened up and the charges for services that shouldn’t have been billed are being considered as a civil fraud matter by DOJ. Sounds like they may have billed for services not rendered, or unnecessary tests and put in an incorrect diagnosis (in the OP’s case diabetes) to justify that. It will be interesting to see how this ends up playing out.

Absolutely no evidence of that at all, NONE. They stated they found irregularities and hired an outside consultant. Of course it is based on overpayments, nobody cares about underpayments. How can anyone reach the conclusion from available evidence that they charged for services not rendered??? That they ordered unnecessary tests??? Ridiculous assumption and it actually borders on libel. And remember, the only person to even mention the DOJ was the OP, who has clearly been scammed.

[mpcolonel]

[QUOTE=Kahuna32162;2397677]Just received a call from from 2 people who identified themselves as investigators for the Department of Justice, looking into Medicare billing practices at the village’s health. I first thought it was a scam, but after hearing the personal information they had on our records, I was inclined to cooperate with their inquires.

They mostly wanted to confirm conditions listed in our files and confirm they were correct. Most conditions were not correct, especially type 2 diabetes.

I’ve thought for years that the Village’s Health was a scam. This active investigation might just be the tip of the iceberg.[/QUOTE
You should never answer even the simplest questions. Ask their name, what office they work out of and if you want to provide them info. Hang up and look up their office number and call them to verify and then answer their question.

[OrangeBlossomBaby]

Originally Posted by Pat2015

You seem to know a lot about this. They did not commit fraud; there is no investigation; this was a coding error; etc. How do you know these things?

Because I got the e-mail, and I'm fairly literate, and know how to look things up.

[Pat2015]

Originally Posted by Bogie Shooter

This is a good summary of the above posts.
Both the stupid posts and those giving valid information.

The poster presumes a lot about the specifics of the overpayments, and is certain that there is no investigation. We’ll see how this ultimately works out.

[golfing eagles]

Originally Posted by Justputt

The DOJ would not be involved. You've been scammed. I've been involved in many cases where there were disputes with Medicare, including a full-blown RAC audit for every patient we treated with a specific kind of radiation therapy was called into question involving just under $1M. We won all but 1 case where the technique was used. Medicare interpretations are also inconsistent, and we've had to argue many times why a women's breast cancer couldn't be hypo-fractionated and depending on who does the peer-to-peer, sometimes we prevail and sometimes not, and when "not" the Medicare peer we find to be some pediatrician with zero radiotherapy training is just following a script! Medicare is the government, and they do screw up!

Ain't that the truth. Last thing a provider ever wants to do is ask CMS or a Medicare intermediary a question---you get 6 different answers and flagged for potential audit

[Pat2015]

Originally Posted by OrangeBlossomBaby

Because I got the e-mail, and I'm fairly literate, and know how to look things up.

So you got an email and know how to look things up and that’s your basis for your comments?

[Fenster]

Google the phone number. Call the local DOJ and US Attorney’s office.

[golfing eagles]

Originally Posted by Pat2015

I agree as I think it may be looked at as a potential fraud issue and not simple mistakes. I am also not convinced that this is something TV caught and reported vs an audit that flagged them by CMS at which time an investigation got opened up.

Not likely AT ALL.

[OrangeBlossomBaby]

Originally Posted by Pat2015

The poster presumes a lot about the specifics of the overpayments, and is certain that there is no investigation. We’ll see how this ultimately works out.

They
Were
Scammed.

The DOJ doesn't call people on the phone to investigate Medicare fraud, and ask people on the phone for diagnoses or other medical information. They just flat out don't do that. It's not a function of the Department of Justice.

THEY WERE SCAMMED.

Not sure how I can say that any clearer.