[FredMitchell]

I would recommend that you set your phone to not accept calls from numbers that are not in your Contacts. Then at best, some random caller can only leave a voice mail. Scammers generally don't have time for that and move on.

Legitimate callers will leave a message and you can return a call, if you want to. Scammers will rarely have a number for a return call. That leaves them open to more law enforcement risk.

Of course, this assumes that you are not using an old fashioned land-line.

Regardless of what type of phone(s) you use, enter the number into the do not call registry. It is a federal offense - extremely rarely enforced - for a caller to violate.

FYI, you can look up your contact info. It was illegally published, likely many times, months ago. Research how to do it. Then put a stop on all credit searches with all credit agencies. At the same time, have them remove all previous addresses.

[G.R.I.T.S.]

Hang up!

[dshoberg]

Originally Posted by melpetezrinski

Here is an excerpt from what I just received from The Villages Health (“TVH”) "we discovered a problem with some of our Medicare billing practices. Upon discovering a potential problem with our Medicare billing this past Fall, TVH hired outside consultants to conduct an in-depth review of our coding and billing practices. Based on our investigation, we determined that
beginning in 2020, TVH implemented certain billing processes and practices that were not consistent with Medicare payment policies. This resulted in TVH receiving more money from the Medicare program than if billed correctly.
With these consultants, we are now working to identify the financial impact of these billing errors and are in the process of repaying the Medicare program for any overpayments that resulted from the billing issue. In addition to
starting work with relevant government agencies to return the overbilled Medicare funds, we have also already begun to implement a range of new internal safeguards to assure that an error such as this will not recur. The occurrence of these errors has since been self-reported to the proper U.S. government agencies, and we expect a smooth process as we work diligently to make right with the Medicare program itself—all with the goal of continuing to provide you with the best possible care you’ve rightfully come to expect from all of us at TVH."

I received the same email...

[1golfergal]

Originally Posted by golfing eagles

And now let's add the rest of the statement-----This event did not impact any patient care OR ANY PATIENT BILLING This is not uncommon with EMRs, they found a problem, notified CMS and will pay any overpayments back. I doubt the DOJ is even involved, and I'm 99.9999% sure the OP was scammed/phished.

Yep. I worked for them... they don't call. DUH! They will, however, do in-person interviews.... I mean, seriously, how would they know who is on the other end of the phone?
PHISHING..... hang in there... call #2 is coming:

[virtualcynthia]

Call the Villages health, explain what happened and ask how you can protect yourself from Medical Identity Theft. Check your bills for any unusual charges. Freeze your credit reports.

The moral of the story is never give information over the phone unless you initiated the call. Don’t use any number they give you. Hang up and call the source directly.

[Pat2015]

Originally Posted by melpetezrinski

Here is an excerpt from what I just received from The Villages Health (“TVH”) "we discovered a problem with some of our Medicare billing practices. Upon discovering a potential problem with our Medicare billing this past Fall, TVH hired outside consultants to conduct an in-depth review of our coding and billing practices. Based on our investigation, we determined that
beginning in 2020, TVH implemented certain billing processes and practices that were not consistent with Medicare payment policies. This resulted in TVH receiving more money from the Medicare program than if billed correctly.
With these consultants, we are now working to identify the financial impact of these billing errors and are in the process of repaying the Medicare program for any overpayments that resulted from the billing issue. In addition to
starting work with relevant government agencies to return the overbilled Medicare funds, we have also already begun to implement a range of new internal safeguards to assure that an error such as this will not recur. The occurrence of these errors has since been self-reported to the proper U.S. government agencies, and we expect a smooth process as we work diligently to make right with the Medicare program itself—all with the goal of continuing to provide you with the best possible care you’ve rightfully come to expect from all of us at TVH."

Oftentimes it’s not the provider that discovered they were billing incorrectly as it’s CMS that flags them based on billings. TV says they are working with federal agencies which I’m certain they are based on overpayments. There is a possibility that an investigation has been opened up and the charges for services that shouldn’t have been billed are being considered as a civil fraud matter by DOJ. Sounds like they may have billed for services not rendered, or unnecessary tests and put in an incorrect diagnosis (in the OP’s case diabetes) to justify that. It will be interesting to see how this ends up playing out.

[Justputt]

The DOJ would not be involved. You've been scammed. I've been involved in many cases where there were disputes with Medicare, including a full-blown RAC audit for every patient we treated with a specific kind of radiation therapy was called into question involving just under $1M. We won all but 1 case where the technique was used. Medicare interpretations are also inconsistent, and we've had to argue many times why a women's breast cancer couldn't be hypo-fractionated and depending on who does the peer-to-peer, sometimes we prevail and sometimes not, and when "not" the Medicare peer we find to be some pediatrician with zero radiotherapy training is just following a script! Medicare is the government, and they do screw up!

[elshackovillages]

Because they are not required to. Seems they make their money taking only advantage plan holders.

[Pat2015]

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.

I agree as I think it may be looked at as a potential fraud issue and not simple mistakes. I am also not convinced that this is something TV caught and reported vs an audit that flagged them by CMS at which time an investigation got opened up.

[Pat2015]

Originally Posted by Justputt

The DOJ would not be involved. You've been scammed. I've been involved in many cases where there were disputes with Medicare, including a full-blown RAC audit for every patient we treated with a specific kind of radiation therapy was called into question involving just under $1M. We won all but 1 case where the technique was used. Medicare interpretations are also inconsistent, and we've had to argue many times why a women's breast cancer couldn't be hypo-fractionated and depending on who does the peer-to-peer, sometimes we prevail and sometimes not, and when "not" the Medicare peer we find to be some pediatrician with zero radiotherapy training is just following a script! Medicare is the government, and they do screw up!

Actually DOJ and CMS both investigate Medicare fraud and in this case TV has already admitted that they overbilled so I don’t see where the government is at fault here.

[OrangeBlossomBaby]

Originally Posted by Pat2015

Oftentimes it’s not the provider that discovered they were billing incorrectly as it’s CMS that flags them based on billings. TV says they are working with federal agencies which I’m certain they are based on overpayments. There is a possibility that an investigation has been opened up and the charges for services that shouldn’t have been billed are being considered as a civil fraud matter by DOJ. Sounds like they may have billed for services not rendered, or unnecessary tests and put in an incorrect diagnosis (in the OP’s case diabetes) to justify that. It will be interesting to see how this ends up playing out.

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.

[OrangeBlossomBaby]

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.

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

[Rheinl271]

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.

[spinner1001]

Originally Posted by golfing eagles

And now let's add the rest of the statement-----This event did not impact any patient care OR ANY PATIENT BILLING This is not uncommon with EMRs, they found a problem, notified CMS and will pay any overpayments back. I doubt the DOJ is even involved, and I'm 99.9999% sure the OP was scammed/phished.

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.

[Pat2015]

Originally Posted by OrangeBlossomBaby

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.

How do you know there is no investigation or potential fraud