[golfing eagles]

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.

Absolutely!!!! I'm afraid there are only a few "voices of reason" on this thread. The rest seem to be self-proclaimed "experts" with no idea of what they are spouting out about.

[MrFlorida]

The DOJ calling a civilian , now that's a good one !

[golfing eagles]

Originally Posted by 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.

And yet, knowing 10,000 times as much as other posters about this subject, I would be surprised if the DOJ was involved at all---perhaps in some investigation about UHC, but not specifically TVH.

Also, what you don't know, is that EMRs automatically calculate BMI based on the patients height and weight, and then spits out a suggested diagnosis of "overweight", "obese", or "morbidly obese". I had a 22 year old triathlete with 11% body fat characterized as "obese", because the BMI calculation in EMRs don't distinguish between muscle and fat weight. What's worse, those Optum "quality assurance" idiots now required me to give the patient a printed handout (from our paperless office) about the dangers of obesity and a diet. If I didn't, I was a "bad doctor". The idiot physicians labelled by Optum as "good" handed this irrelevant information out willy-nilly like a good puppet. What's even more amazing is that just about everyone has bought into this Optum nonsense as if were the gospel truth, or even a good program. In reality it is absolute crap that caters to the least common denominator---kind of like no quack left behind.

[golfing eagles]

Originally Posted by Pat2015

You seem to know a lot about this. They did not commit fraud; there is no investigation; this was a coding error; etc. How do you know these things?

She knows the same way that I do---we are EXPERTS in this field, unlike those who have spouted out a bunch of garbage on this thread.

[OrangeBlossomBaby]

Originally Posted by Pat2015

How do you know there is no investigation or potential fraud

Actually you're right. There's rampant fraud and the CIA is investigating The Villages Health and all of its Medicare patients for fraud. They've hooked up the satellites from Russia and are beaming signals down with Jewish space lasers to the TVH breakroom microwave, which has cameras in it that record all the documents the illegal alien doctors steal out of the file room on their way to lunch every day.

There. Happy now?

[Pat2015]

Originally Posted by golfing eagles

Absolutely no evidence of that at all, NONE. They stated they found irregularities and hired an outside consultant. Of course it is based on overpayments, nobody cares about underpayments. How can anyone reach the conclusion from available evidence that they charged for services not rendered??? That they ordered unnecessary tests??? Ridiculous assumption and it actually borders on libel. And remember, the only person to even mention the DOJ was the OP, who has clearly been scammed.

Nothing libel to say that there might be an investigation.

[Pat2015]

Originally Posted by golfing eagles

Not likely AT ALL.

And you know this how?

[OrangeBlossomBaby]

Originally Posted by golfing eagles

She knows the same way that I do---we are EXPERTS in this field, unlike those who have spouted out a bunch of garbage on this thread.

My field is investigative journalism. It requires a highly honed and trained set of critical thinking skills, and formal education in separating the wheat from the chaff. I don't always get it right but I can spend hours, days, and even weeks investigating topics of interest. Law, history, and medicine are topics of interest to me. So I can delve pretty deep into medical texts, the bibliographies of those texts, the CDC documentation, FDA documentation - and then if there's an FDA law that seems off, I'll check the history of that law, and then the history of the people who passed the law... when I lived up north I worked a temp job at Yale Hospital and had access to all kinds of medical tidbits of information - and medical law.

When I was in college we took a 4-day trip to Washington DC and spent time on Capitol Hill talking to Congress, Senate, met a few judges, sat in on a symposium with Ralph Nader, visited the Library of Congress. I've sat in on major court cases, including a HUGE murder trial involving a drunk cop who committed murder at the King Arthur Motel in Chelsea (Boston) . Commonwealth v. McLeod :: 1985 :: Massachusetts Supreme Judicial Court Decisions :: Massachusetts Case Law :: Massachusetts Law :: US Law :: Justia I had to look up state laws at the Boston Public Library (this was before the internet was available).

A neighbor wanted to know how her fiancé could legally adopt her son, when her ex-husband was MIA and she couldn't find him to give consent. So I read three out of 17 (at the time) volumes of the Connecticut General Statutes to learn the entire procedure and every law regarding adoptions, paternity, marriage to a woman with children from a former husband, etc.

Reading things and "looking stuff up" is a big hobby that takes most of my time. Education for its own sake is a priority, and has been since I was a little kid.

[Pat2015]

Originally Posted by OrangeBlossomBaby

Actually you're right. There's rampant fraud and the CIA is investigating The Villages Health and all of its Medicare patients for fraud. They've hooked up the satellites from Russia and are beaming signals down with Jewish space lasers to the TVH breakroom microwave, which has cameras in it that record all the documents the illegal alien doctors steal out of the file room on their way to lunch every day.

There. Happy now?

Kind of a ridiculous comment. I was a Special Agent for the Federal Government and did Medicare Fraud investigations which is the basis for my comments. Happy now?

[Number 10 GI]

Originally Posted by golfing eagles

And yet, knowing 10,000 times as much as other posters about this subject, I would be surprised if the DOJ was involved at all---perhaps in some investigation about UHC, but not specifically TVH.

Also, what you don't know, is that EMRs automatically calculate BMI based on the patients height and weight, and then spits out a suggested diagnosis of "overweight", "obese", or "morbidly obese". I had a 22 year old triathlete with 11% body fat characterized as "obese", because the BMI calculation in EMRs don't distinguish between muscle and fat weight. What's worse, those Optum "quality assurance" idiots now required me to give the patient a printed handout (from our paperless office) about the dangers of obesity and a diet. If I didn't, I was a "bad doctor". The idiot physicians labelled by Optum as "good" handed this irrelevant information out willy-nilly like a good puppet. What's even more amazing is that just about everyone has bought into this Optum nonsense as if were the gospel truth, or even a good program. In reality it is absolute crap that caters to the least common denominator---kind of like no quack left behind.

Some years back the Army started cracking down on overweight soldiers, and there were a lot of them that were fat. There was a young soldier in my unit that was a body builder. He had muscles! There wasn't an ounce of fat on him but because of his stocky body and all the muscles he was determined to be overweight due to his height and weight ratio. The unit commander told him he had to lose enough weight to meet the arbitrary height to weight standard or be discharged from the military. The guy nearly starved himself trying to meet the standard but just couldn't do it. Finally, he had enough of the harassment and started writing letters to his congress critters. A medical review stated that he was not overweight, in excellent health, and his fat content was below the standard for a man his age. His "overweight" problem was muscle weight, not fat.

[golfing eagles]

Originally Posted by OrangeBlossomBaby

Actually you're right. There's rampant fraud and the CIA is investigating The Villages Health and all of its Medicare patients for fraud. They've hooked up the satellites from Russia and are beaming signals down with Jewish space lasers to the TVH breakroom microwave, which has cameras in it that record all the documents the illegal alien doctors steal out of the file room on their way to lunch every day.

There. Happy now?

You forgot to mention that the "smart" people are wearing tin foil hats

[golfing eagles]

Originally Posted by Pat2015

Nothing libel to say that there might be an investigation.

hence the word "borders"

[golfing eagles]

Originally Posted by Pat2015

And you know this how?

Already explained

[golfing eagles]

Originally Posted by Pat2015

Kind of a ridiculous comment. I was a Special Agent for the Federal Government and did Medicare Fraud investigations which is the basis for my comments. Happy now?

I'm sorry, but the posts that you have already made would suggest otherwise---so no, not happy

[Jayhawk]