[Rwirish]

Billing issues occurred per TVH. You were scammed as DOJ investigators would not have called you.

[Shelbyh]

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.

From my experience with this situation, I have never heard of the DOJ conducting this type of investigation by calling patients to verify PIH. CMS would more likely look into this and not by calling you. I’m suspicious. If it was me I would have hung up or contacted the AG to discuss.

[christine J Toft]

Letters went from TVH by email stating they were having an issue that's got government agencies involved. They have to pay back Medicare. I'm guessing these are not simple mistakes.

[golfing eagles]

Originally Posted by tophcfa

Sounds like someone is trying to scam the OP. That being said, I wouldn’t be surprised if The Villages Health is being looked at closely. I’ve never heard of another health care operation that serves a senior population and won’t accept Medigap plans. Something about that smells very rotten.

Rotten??? Really???? How so????

Every health care provider has the right to decide which insurances they will and will not accept. We reviewed this every year when the contracts came around. So did every other practice in the country. Sorry you "never heard of this". It is neither "rotten" nor cause for TVH to be "looked at closely", I always wonder where people get these ideas from.

[Triker]

Having done medical billing before! You definitely have to watch it very close here.
Same procedure, twice in a year, same facility, same Dr , same anesthesiologist, same etc
billed two completely different ways.

[golfing eagles]

Originally Posted by christine J Toft

Letters went from TVH by email stating they were having an issue that's got government agencies involved. They have to pay back Medicare. I'm guessing these are not simple mistakes.

And I'm guessing they are simple mistakes, typically generated by EMR coding, and HIGHLY UNLIKELY to be intentional.

Read the letter----TVH conducted their own internal review, which is something most practices do----we would review each others coding and documentation to spot any problems. Having found "something". they then hired outside consultants to look into it further. "Government agencies", probably CMS (Center for Medicare Services), are required to be notified of any irregularity along these lines. THERE IS NO CONSPIRACY TO DEFRAUD PATIENTS, THIS IS NOT UNUSUAL AT ALL.

If jumping to conclusions without any knowledge of the processes involved were an Olympic sport, this thread would have multiple gold medal winners. And I would like to upgrade my assessment of the OPs chance of being scammed from 99.9999% to 100%.

[crash]

Originally Posted by OrangeBlossomBaby

Pretty sure you just got scammed by people taking advantage of billing errors and pretending to be members of the Dept. of Justice.

Got a letter from Villages Health saying there were billing discrepancies and they were working them through to come up with how much they were going to have pay back so not a scam.

[golfing eagles]

Originally Posted by Triker

Having done medical billing before! You definitely have to watch it very close here.
Same procedure, twice in a year, same facility, same Dr , same anesthesiologist, same etc
billed two completely different ways.

You have to watch all kinds of billing, everywhere. Mistakes happen----it does not constitute a conspiracy to defraud.

If you read the letter, no patient billing was affected by this event---meaning no one was "ripped off" or overpaid. This is most likely a glitch in the electronic submission of billing and coding between TVH and CMS with ABSOLUTELY NO EFFECT on patients or their pocketbooks

[golfing eagles]

Originally Posted by crash

Got a letter from Villages Health saying there were billing discrepancies and they were working them through to come up with how much they were going to have pay back so not a scam.

I think the gist of this thread is that the OP, having claimed to received phone calls from the DOJ asking to "verify" his health information is clearly a scam. No federal authority contacts anyone other than by snail mail. This goes especially for the IRS, where scams are a dime a dozen and yet people fall for them.

[MikeN]

I hope you didn’t give them any additional information. Confirm what they had only and request an in person meeting so you can make sure who you are talking to

[Bogie Shooter]

Originally Posted by golfing eagles

Rotten??? Really???? How so????

Every health care provider has the right to decide which insurances they will and will not accept. We reviewed this every year when the contracts came around. So did every other practice in the country. Sorry you "never heard of this". It is neither "rotten" nor cause for TVH to be "looked at closely", I always wonder where people get these ideas from.

Originally Posted by golfing eagles

And I'm guessing they are simple mistakes, typically generated by EMR coding, and HIGHLY UNLIKELY to be intentional.

Read the letter----TVH conducted their own internal review, which is something most practices do----we would review each others coding and documentation to spot any problems. Having found "something". they then hired outside consultants to look into it further. "Government agencies", probably CMS (Center for Medicare Services), are required to be notified of any irregularity along these lines. THERE IS NO CONSPIRACY TO DEFRAUD PATIENTS, THIS IS NOT UNUSUAL AT ALL.

If jumping to conclusions without any knowledge of the processes involved were an Olympic sport, this thread would have multiple gold medal winners. And I would like to upgrade my assessment of the OPs chance of being scammed from 99.9999% to 100%.

[PugMom]

i got an email telling me of a breach that was found in the code & billing sections. email also states it does & did not affect the treatments of medical care & standards

[Bogie Shooter]

Originally Posted by crash

Got a letter from Villages Health saying there were billing discrepancies and they were working them through to come up with how much they were going to have pay back so not a scam.

When you get the call, hang up.

[bowlingal]

The Villages Health ( primary care docs) only use Medicare Advantage. Only the specialists within the Villages Health use traditional Medicare. Why would the Department of Justice be calling about a Medicare issue? Wouldn't it be another agency, if at all? Don't ever believe your caller ID. Have them send you something in the mail.

[golfing eagles]

Originally Posted by PugMom

i got an email telling me of a breach that was found in the code & billing sections. email also states it does & did not affect the treatments of medical care & standards

I suggest you read that e-mail again, and then retract your post.

The letter states ABSOLUTELY NOTHING about a "breach"

It specifically stated that patient care and billing WAS NOT AFFECTED