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.

Dedicated HMO groups and Concierge groups don't accept Medigap plans. There are lots of them.

There was an article in 12/31 Wall St Journal about United Health Care Medicare advantage adding diagnoses to patients records. The more diseases they can reference for a patient the more the doctors and UHC get paid monthly by Medicare. The article specifically mentions a case in the Villages Health Care where they listed a body builder as morbidly obese! The Villages HC refused to comment. My wife is quite active and healthy, but her VHC medical record sounds like a train wreck. This is in fact overbilling Medicare and is likely fraud. Wouldn't be surprised DOJ is investigating and VHC is coming clean.

This is happening across UHC to the tune of $4.6 Billion from 2019 to 2022. Not unique to UHC, but they are the worst offenders. Apparently UHC patients are several times sicker than original Medicare. Apparently, the Govt set this system up for Medicare Advantage insurers to be paid more for sicker patients. Any system can be gamed. And it will be.

Agreed. And since TOTV messages are public, bad actors now can learn that OP is susceptible to being scammed and do him/her more harm. (Don’t scoff. AI/ bots scrape websites like this for information.)

I suggest OP ask the website administrators to delete this thread for OP’s protection.

How do you know there is no investigation or potential fraud

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.

What post is this referring to?

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.

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

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?

Villages healthcare
 

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.

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.

Scam?
 

[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.

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

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.

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

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

Do some research
 

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

Not likely AT ALL.

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.

Absolutely!!!! I'm afraid there are only a few "voices of reason" on this thread. The rest seem to be self-proclaimed "experts" with no idea of what they are spouting out about.

The DOJ calling a civilian , now that's a good one !

And yet, knowing 10,000 times as much as other posters about this subject, I would be surprised if the DOJ was involved at all---perhaps in some investigation about UHC, but not specifically TVH.

Also, what you don't know, is that EMRs automatically calculate BMI based on the patients height and weight, and then spits out a suggested diagnosis of "overweight", "obese", or "morbidly obese". I had a 22 year old triathlete with 11% body fat characterized as "obese", because the BMI calculation in EMRs don't distinguish between muscle and fat weight. What's worse, those Optum "quality assurance" idiots now required me to give the patient a printed handout (from our paperless office) about the dangers of obesity and a diet. If I didn't, I was a "bad doctor". The idiot physicians labelled by Optum as "good" handed this irrelevant information out willy-nilly like a good puppet. What's even more amazing is that just about everyone has bought into this Optum nonsense as if were the gospel truth, or even a good program. In reality it is absolute crap that caters to the least common denominator---kind of like no quack left behind.

She knows the same way that I do---we are EXPERTS in this field, unlike those who have spouted out a bunch of garbage on this thread.

Actually you're right. There's rampant fraud and the CIA is investigating The Villages Health and all of its Medicare patients for fraud. They've hooked up the satellites from Russia and are beaming signals down with Jewish space lasers to the TVH breakroom microwave, which has cameras in it that record all the documents the illegal alien doctors steal out of the file room on their way to lunch every day.

There. Happy now?

Nothing libel to say that there might be an investigation.

And you know this how?

My field is investigative journalism. It requires a highly honed and trained set of critical thinking skills, and formal education in separating the wheat from the chaff. I don't always get it right but I can spend hours, days, and even weeks investigating topics of interest. Law, history, and medicine are topics of interest to me. So I can delve pretty deep into medical texts, the bibliographies of those texts, the CDC documentation, FDA documentation - and then if there's an FDA law that seems off, I'll check the history of that law, and then the history of the people who passed the law... when I lived up north I worked a temp job at Yale Hospital and had access to all kinds of medical tidbits of information - and medical law.

When I was in college we took a 4-day trip to Washington DC and spent time on Capitol Hill talking to Congress, Senate, met a few judges, sat in on a symposium with Ralph Nader, visited the Library of Congress. I've sat in on major court cases, including a HUGE murder trial involving a drunk cop who committed murder at the King Arthur Motel in Chelsea (Boston) . Commonwealth v. McLeod :: 1985 :: Massachusetts Supreme Judicial Court Decisions :: Massachusetts Case Law :: Massachusetts Law :: US Law :: Justia I had to look up state laws at the Boston Public Library (this was before the internet was available).

A neighbor wanted to know how her fiancé could legally adopt her son, when her ex-husband was MIA and she couldn't find him to give consent. So I read three out of 17 (at the time) volumes of the Connecticut General Statutes to learn the entire procedure and every law regarding adoptions, paternity, marriage to a woman with children from a former husband, etc.

Reading things and "looking stuff up" is a big hobby that takes most of my time. Education for its own sake is a priority, and has been since I was a little kid.

Kind of a ridiculous comment. I was a Special Agent for the Federal Government and did Medicare Fraud investigations which is the basis for my comments. Happy now?

Some years back the Army started cracking down on overweight soldiers, and there were a lot of them that were fat. There was a young soldier in my unit that was a body builder. He had muscles! There wasn't an ounce of fat on him but because of his stocky body and all the muscles he was determined to be overweight due to his height and weight ratio. The unit commander told him he had to lose enough weight to meet the arbitrary height to weight standard or be discharged from the military. The guy nearly starved himself trying to meet the standard but just couldn't do it. Finally, he had enough of the harassment and started writing letters to his congress critters. A medical review stated that he was not overweight, in excellent health, and his fat content was below the standard for a man his age. His "overweight" problem was muscle weight, not fat.

You forgot to mention that the "smart" people are wearing tin foil hats:1rotfl::1rotfl::1rotfl:

hence the word "borders"

Already explained

I'm sorry, but the posts that you have already made would suggest otherwise---so no, not happy

Well sounds like you’ve got all the answers about me and this matter based on the email you got, and your research. My 20 years as a Federal Agent resulting in multiple Medicare civil fraud settlements and criminal referrals certainly can’t compete with that.

Yes, they would have contacted you by letter, maybe in person. All the data they have were from massive attacks on institutions.

DONT EVER give account information to an incoming phone call. Decline, block, contact the agency they claim to be representing directly by using information on their official sites.

I actually know quite a bit about Medicare fraud as I was a Federal Agent that investigated Medicare providers for “over billing.” That’s why I said that there might be an ongoing investigation and it will be interesting to see how it will be resolved.

Some of the "critical thinkers" can't critically think past their own experiences. I am tangling with a coding mess on a bill right now and I have to wonder how much of these coding issues are errors or intentionally coded for higher payment.

In my case they admit to the error, still have the bill on my account and it's taking over 2 months to get the mistake corrected. It now has to go to a board to nullify the charge. What a joke! For clarification, this case does not involve the Villages Hospital.

Been there with incorrect billings, and it shouldn’t take multiple attempts to get it corrected. Sorry for what you are going through!