[sallyg]

Overpayment is an interesting term.

[golfing eagles]

Originally Posted by Altavia

I don't understand how an auditor who has never seen nor has access to the patient information can dispute a diagnosis?

What would the patient impact have been if treatment was based on the auditors diagnostic interpretation?

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 $$$"

[golfing eagles]

Originally Posted by lkagele

Not sure I really agree. Your theory might make sense with a business that produces products. TVH, however, provides services and the capital outlay to expand a service business is much less than is needed to expand manufacturing capabilities. The listed assets certainly don't indicate those overpayments went to purchase tangible assets.

Pfizer sold $100 billion in vaccines yet its stock went from the low 30's to the low 20's. So, just like Pfizer's profits, I think this overpayment money went somewhere it should not have.

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

[golfing eagles]

Originally Posted by Joecooool

I don't understand how some people are saying it was an over billing issue and its OK because they self reported.

What?

They get audited by the government. They probably self-reported because they knew they were going to get found out in an audit.

These Medicare Advantage Plan companies know full well what the rules and regulations are. They have legal teams, internal compliance officers, and they have to be trained and qualified to hold those positions.

No pass should be given to people who perpetrated this fraud against the American taxpayers. They need to be arrested, charged, convicted, fined, imprisoned, and then banned from ever working in the healthcare industry again.

But no way that will happen. Someone up top will make a political "donation", and all of this will be swept away with no one being held accountable.

Get caught stealing $750 worth of crap from Walmart, and you go to jail for 5 years. Defraud Medicare for hundreds of millions of dollars - and - well look what happened to Rick Scott... PolitiFact | Rick Scott '''oversaw the largest Medicare fraud''' in U.S. history, Florida Democratic Party says

It's a big club, and you ain't in it.

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

[golfing eagles]

Originally Posted by sallyg

Overpayment is an interesting term.

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

[collie1228]

Originally Posted by golfing eagles

It sounds like an admission that a mistake was made, nothing more. Actually, it may indicate nothing more than a difference of opinion on exactly what the diagnostic and billing codes actually require to meet the criteria set forth.

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.

[tophcfa]

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.

[dpmers]

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

[Burgy]

Originally Posted by Aces4

Yes and the old adage, "It was fun while it lasted", comes to mind. One wonders how much of this is going on all over the country.

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.

[golfing eagles]

Originally Posted by collie1228

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.

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

[Snowbirdtobe]

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.

[Mikee1]

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.

[justjim]

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.

[Stu from NYC]

Originally Posted by golfing eagles

Villages Health where did all the money go?

A legitimate question. Let me speculate with an analogy, since I doubt it is under the CEO's mattress:

You own Snowbird Enterprises, a company that manufactures and sells widgets solely to the US Government at $2.00/widget. You start with one factory and a staff of 6, but your business grows fairly rapidly due to the demand for widgets. You make some profit, and use that to build more factories, hire more people and attract new professional widget makers. Maybe there's some cash, maybe not, since the books pretty much balance. And because you were dealing with a government bureaucracy, both when setting up your business and as an ongoing concern, you hired outside consultants to make sure you were doing everything right, including the pricing of widgets. Those auditors tell you all along that everything is being done by the book.

Time goes by, like 12 years, and you decide to sell your widget business, so you start negotiating with Widget Mart. To your dismay, they look at your widget pricing and tell you they disagree with the consultants you've hired----it is their opinion that you've been manufacturing type xyz5 widgets, which the government is only allowed, by law, to pay $1.50 each. You look at the difference between xyz5 and the xyz4 widgets that you've been selling, and it still isn't clear who's right since the definition of these widgets is extremely vague and subject to interpretation. So you report to the government that you MAY have been charging too much for widgets. And of course that agency agrees that they paid too much and you now owe them $360 million.

But you don't have $360 million, not even close. You have buildings, and equipment that is generally only good for making widgets, payroll, and bills for utilities and supplies, but no cash---because that's where the money went

Simplistic example, but the general message is accurate.

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.

[Topspinmo]

Originally Posted by golfing eagles

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

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