Talk of The Villages Florida - Villages Health where did all the money go?

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Quote:

Originally Posted by Snowbirdtobe (Post 2444961)

The Villages has received over $361,000,000 in over payments from the FEDS.
The bankruptcy filings has the US taxpayers or Medicare listed as an unsecured creditor due 361 Million US $. Where is that money? That is $6500 per patient.
I noticed that the rent was paid to TV. The rent looks to be 1,135,000 per month, but no rent is forecast for October, Nov, or Dec in the pro-forma DIP budget.

“Villages Health where did all the money go”

Do you really have to ask that question?

Corrections/Clarifications/Info

Quote:

Originally Posted by tophcfa (Post 2445007)

The above Upcoding explanation is lacking. For a more complete understanding UPCODING MEDICARE: IS HEALTHCARE FRAUD AND ABUSE INCREASING? - PMC

I don't know where this information came from as far as sicker population, but it doesn't match my 40 years' experience. Generally, government Medicare vs MA plans are chosen based on preferences, e.g. I have MA because it covers dental, vision, hearing, gym, etc. and government Medicare doesn't. Medicare doesn't have "network providers", you go where you chose that takes Medicare, whereas MA plans have a network and the plan you chose determines how broad the network (mine covers all my doctors here and all my doctors up north.) As for Medicare vs MA payments "The plans must follow rules and standards set by Medicare. The federal government pays Medicare Advantage plans to provide all Medicare-covered benefits. If there is a difference between the amount a Medicare Advantage plan is paid by Medicare and the plan’s actual cost to provide benefits, the plan must use any savings to provide additional benefits or reduce costs for members of the plan. This is how some Medicare Advantage plans provide coverage for services such as routine vision care and routine dental care, which are not covered by Medicare."

As for where the money went; Pre-COVID, our hospital operated very lean and ran in the back. Post-COVID, our hospital was grossing more than it had ever grossed and was losing $2M/month mostly because of staffing costs, since many left the medical field and were replaced by travelers at nearly 3x cost. I wouldn't assume the money did more than plug holes in a sinking ship.... but I could clearly be wrong and time will tell.

From bing. . . whatever search engine

Beginning in 2025, CMS will conduct annual audits of every Medicare Advantage plan, which is a significant expansion from its previous practice of auditing roughly 60 plans per year.

TVH was probably too small to be one of the 60 lucky plans to be audited. .
so to assume that THV and every medicare Advantage Plan was government audited is wishful thinking. .

Quote:

Originally Posted by tophcfa (Post 2445007)

- The Villages Health (TVH) ran a unique business model for a large health care provider serving predominately a senior community. Unlike just about ever other similar health care provider, TVH primary care operation has not accept traditional medicare, only specific Medicare Advantage plans.

- Upcoding, when more diagnoses than are actually present are reported to increase medicare payments, are very rare with traditional Medicare and are almost exclusively limited to home care. On the other hand, upcoding has been widely abused with Medicare Advantage plans because under MA plans, payments are made on a risk-adjusted basis meaning higher risk scores (based on reported diagnoses) lead to higher payments.

- Despite the fact that patients with traditional Medicare and supplemental plans are generally sicker and require more health care than Medicare Advantage plan holders, Medicare Advantage plans pay out, on average, 22% more per patient than those with traditional medicare.

- Without audited financial statements, including a detailed sources and uses of funds statement, it is impossible to figure out what happened to the $$$ referenced by the author of this thread. That being said, based on the bankruptcy filing information, the amount of reported assets relative to liabilities certainly indicates the money wasn't retained in THV surplus account.

- A Florida Bankruptcy Judge preliminarily approved a $39 million debtor-in-possession (known as DIP financing) plan for TVH. DIP financing is a last ditch effort to raise money, often when in bankruptcy proceedings, to stay in operation during restructuring. DIP lenders require extremely stringent terms to insure their capital is protected, such as hard collateral and being court selected to be the first to be paid within the debtors capital structure. Based on TVH's reported assets, there won't be much money left after paying off the DIP loan for either their other creditors and the money owed to Medicare.

- Below is a statement from Latham and Watkins, a firm hired to help CenterWell (Humana) in the acquisition of TVH Assets, while not taking on the Liabilities. One thing is for certain, CenterWell is diving into a hornets nest, as evident by the long list of attorneys with various areas of expertise, retained to guide them through this process. No one in their right mind would dive into a hornets nest without lots and lots of protection. One can only imagine how much money the health care provider will spend on attorneys fees, rather than providing health care.

The Villages Health (TVH), announced that it has entered into a "stalking horse" Asset Purchase Agreement with CenterWell Senior Primary Care, the nation's largest senior-focused value-based primary care provider. The agreement provides for CenterWell, the healthcare services business of Humana Inc., to acquire TVH's assets as a going concern, including eight primary care centers and two specialty care centers. A Court order approving the sale, following an auction process during which other parties may submit an offer to purchase TVH's assets, will be a condition of the transaction moving forward and closing.

Latham & Watkins LLP represents CenterWell in the transaction with a corporate deal team led by Washington, D.C. partner Brian Mangino and New York partner Amber Banks and New York counsel Richard Quay, with associates Alice Bradshaw, Lauren Stern, and Daniel Maggen. Advice was also provided on intellectual property matters by Washington, D.C. partner Morgan Brubaker, with associate Tyra Richmond; on healthcare regulatory matters by Washington, D.C. partners Jason Caron and Joseph Hudzik, Chicago partner Terra Reynolds, and Washington, D.C. counsel Nicole Liffrig Molife, with associates Chad Leiper, Megan Lich, Margaret Rote, and Danielle Scheer; on data privacy matters by Bay Area partner Heather Deixler, with associates Kathryn Parsons-Reponte and Priyanka Krishnamurthy Crissman; on insurance matters by Century City partner Kirsten Jackson and New York counsel Alexander Traum; on tax matters by Washington, D.C. partner Andrea Ramezan-Jackson, with associate Nolon Blaylock; on benefits matters by Washington, D.C. partner David Della Rocca and Washington, D.C. counsel Laura Szarmach, with associate Rebecca Fishbein; on labor matters by New York counsel Sandra Benjamin, with associate Jenny Bobbitt; on real estate matters by New York partner Dara Denberg and New York counsel Shira Bressler, with associate Sarah Jeon; on finance matters by New York partner Kendra Kocovsky, with associate Benedict Bussmann; on environmental matters by New York counsel David Langer, with associate Tal Carmeli; and on restructuring matters by Washington, D.C./New York partner Andrew Sorkin and Chicago partner Caroline Reckler, with associates Isaac Ashworth and Brian Rosen.

- Just reporting some relevant facts here, what actually happened to the $$ is up to ones interoperation of the facts.

As a retired litigation attorney, I stand in awe of CenterWell employing 39 attorneys to handle the acquisition of The Villages Health. Between the lawyers and the lender providing DIP financing, the bones of TVH will be picked clean and bleached as white as if they had laid for years in the desert.

Quote:

Originally Posted by lawgolfer (Post 2445520)

WOW!

and so the increasing cost of medical insurance must be driven by the legal system. .

:boom:

:censored: :mad: :throwtomatoes:

Quote:

Originally Posted by Snowbirdtobe (Post 2444961)

To add to your "where is the money" question; let's just assume it was all used to support TVHC services and quality. If that were the case, and this revenue source is no longer going to be legally available, what services and quality will suffer? Hmmmm

Quote:

Originally Posted by lawgolfer (Post 2445520)

Full employment for lawyers. We should make 90% of the lawyers find another career that would help our economy.

Quote:

Originally Posted by JeepsterGlenn (Post 2445409)

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Patients most likely also overpaid TVH facilities and doctors through their deductibles and copays due to the inflated procedure codes. For example if the procedure should have been coded to pay $100 and instead was coded to pay $200. Then the patient pays $200 in their deductible up to max deductible (and/or a percent of the $200 in their copay amount). Will these overpayments get reimbursements?

That's not how Medicare Advantage works. This didn't affect the patient's billing AT ALL.

Quote:

Originally Posted by Topspinmo (Post 2445478)

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

No need for a lawyer if you're not being charged with anything.

The Government isn't charging TVH with anything. The overpayments happened in 2024, not in 2025. This isn't something new or all that recent. There is no current fraud investigation happening with TVH as a target.

Quote:

Originally Posted by CoachKandSportsguy (Post 2445487)

From bing. . . whatever search engine

Beginning in 2025, CMS will conduct annual audits of every Medicare Advantage plan, which is a significant expansion from its previous practice of auditing roughly 60 plans per year.

TVH was probably too small to be one of the 60 lucky plans to be audited. .
so to assume that THV and every medicare Advantage Plan was government audited is wishful thinking. .

The auditing at TVH took place in 2024.

Quote:

Originally Posted by dpmers (Post 2445447)

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

You’re missing the point entirely. The government doesn’t care how much private insurance companies pay, they care about how much they pay out of the rapidly dwindling Medicare fund. Medicare Advantage plans were created in an attempt to team up with private insurance companies, as an alternative to traditional Medicare, in an effort to save costs and help shore up the Medicare financial situation. So far, the experiment has failed miserably. Despite the aggregate population of traditional Medicare subscribers being sicker than the Medicare Advantage population, it is estimated that Medicare pays 22% more for Medicare Advantage enrollees than it would have spent if those beneficiaries were enrolled in traditional Medicare. That’s an amount that translates into $83 billion for 2024 alone. And if you don’t want to believe me, look it up. It was reported to congress by MedPac, a nonpartisan and independent legislative branch charged with providing the US congress with analysis and policy advice on the Medicare program. The bottom line here is that something has to give with the whole Medicare Advantage program, it’s not working as intended.

Quote:

Originally Posted by tophcfa (Post 2445567)

Medicare Advantage plans were created in an attempt to team up with private insurance companies, as an alternative to traditional Medicare, in an effort to save costs and help shore up the Medicare financial situation.

It was created by Congress after the insurance lobby bribed them into it. The only intention was to move government funded care into private insurance firms. That's it. Any benefit that would have ever happened would have been purely a coincidence.

And of course that didn't happen.

Quote:

Originally Posted by tophcfa (Post 2445567)

It is estimated that Medicare pays 22% more for Medicare Advantage enrollees than it would have spent if those beneficiaries were enrolled in traditional Medicare. That’s an amount that translates into $83 billion for 2024 alone….The bottom line here is that something has to give with the whole Medicare Advantage program, it’s not working as intended.

If MA was supposed to save the government money but is actually costing more, do people expect MA to be abolished?

Quote:

Originally Posted by Rainger99 (Post 2445599)

If MA was supposed to save the government money but is actually costing more, do people expect MA to be abolished?

Perhaps, but a more likely scenario would be that Medicare pays less to private insurers per patient, forcing up Medicare Advantage premiums and resulting in less benefits being offered that are not offered to traditional Medicare subscribers. Those benefits could include things like Dental, Vision, and Hearing coverage as well as stuff like free health club membership. If that happens, many more new Medicare enrollees are likely to select traditional Medicare, with a supplemental plan, versus Medicare Advantage plans. Those currently on MA plans are also more likely to switch to traditional Medicare, assuming they can pass medical underwriting.

Quote:

Originally Posted by OrangeBlossomBaby (Post 2445550)

The auditing at TVH took place in 2024.

most likely the first time, so the upcoding occurred for several years to get to 300+ million. However, the point of the post is that many assume that all MA plans are audited by CMS, and that is not correct.

Also, I didn't read by whom the audit was performed, CMS or independent / non CMS for TVH, but I read alot about everyone being audited by CMS. . . I doubt the Leapfrog did their audit to find the issue.