Overpayment is an interesting term.

What makes you think that TVH doesn't have outside auditors that they pay to consult on exactly these issues? (They do). The real question is: What happens when the auditors you pay say everything is OK but the auditors for a potential buyer says it's not? I suppose CMS gets the final word (they did), and the final word is "you owe us a lot of $$$"

Maybe, maybe not. I'm sure TVH will get to "entertain" an army of forensic accountants.

And I don't understand how anyone can post that this was criminal fraud without knowing the facts or understanding the process. That's OK, as I said, the villagers are out with torches and pitchforks. I would prefer holding off on the accusation of criminal fraud until and unless the DOJ charges them and a judge/jury convicts them. But that's only American due process and presumption of innocence. Mob mentality on social media is much better :1rotfl::1rotfl::1rotfl:

The word isn't "interesting", it's "accurate"

Hold on a minute here. That statement was written by a lawyer and reviewed by several other lawyers before being put out there as a statement. I’m sorry, but I don’t think we can make any assumptions from a statement written by someone whose sole responsibility is to protect the subject.

Bigger picture thought here. Forget about upcoding responsibilities, intent, blame, where did the $$ go, etc…. The bigger picture here is that before this event came to light, the Villages already arguably had both not enough and substandard health care relative to the size of the senior population. For an area dominated by a senior population, where availability of quality healthcare is extremely important, this could have serious consequences. Think about it, the largest health care provider serving the community is now operating out of bankruptcy, holding on by a thread using DIP financing to stay operational while a bankruptcy court decides its fate. Like everyone else, I’ve read the carefully crafted public statements coming from TVH and CenterWell (Humana) about how this is all going to turn out wonderful for TVH patients. Unfortunately, it’s very difficult to envision a scenario where reality and those statements intersect. Make no mistake, Humana is a publicly traded company taking a strategic risk in acquiring TVH with the intent of vertical integration. Their strategy is to be the dominant health care provider in the ever growing senior marketplace. On the positive side for Humana, vertical integration can provide them with cost savings and effeciencies, which would lead to higher profits. On the negative side for patients, vertical integration can crowd out competition, leaving Humana with a quasi monopoly. For the consumer, competition is a wonderful thing. Think about a scenario where Comcast was the only internet provider in your area, not ideal to say the least.

Bottom line, this introduces more risk to a marketplace that already is pushing the health care system to the brink. Add to that the fact that the place is growing at a breakneck pace with no end in sight. I think that’s the big picture people should be focusing on.

Traditional Medicare only pays 80% hence most of the 22% difference in payments for MA vs Traditional Medicare

Finally getting closer to the problem. Money goes from Medicare to Advantage Plan and then to TVH. And if you don't think the Advantage Plan isn't involved in the coding I seriously doubt it. Also involvement with Universities for research and new building may affect at what rate codes are paid. Interesting how UHC stock has tanked this year. Fraud. abuse, loopholes and mistakes can all be involved.

I agree. Nor can we assume it means something different than what it states either.

I still want to know what happened to the money
 

They own no real estate as far as I can tell.
If the money was used to overpay docs and staff a new owner can't afford to maintain that.
If the money was used to over coddle the patients a new owner can't afford that.
Both of these things will be a problem for the patients trapped in TVH.
If the money was spent on making the Brownwood facility a wonderful place or burned in the parking lot that should have no effect on the ability for the new owner of serve the patients.

And Next
 

While the speculation goes on ... and on...
The next part is of more concern.
If Humana takes over, they have said they will treat all patients of Medicare and insurances.
This means more patients, in and outside of the Villages. Longer appointment times, etc, etc.
Add that to Humana's less than stellar reputation for care, may mean TVH is no longer an option for care. In that case, there is no excess availability of care options in the area....
Ponder that for a bit.
Yea, the money trail is interesting, but the above is more concerning, at least to me.

Suffice it to say the bankruptcy laws are way above my pay grade. Perhaps this man said it best: “These Capitalists generally act harmoniously and in concert, to fleece the people.” Abraham Lincoln January 11, 1837.

I would think that by examining TVH financial statements over the period in question can quickly determine where the money went. As I said earlier in this thread still think that Hamlet got it right, Something is Rotten in Denmark.

Funny how innocent till proven guilty works when charged. O wait, you have to get lawyer to prove yourself innocence.