A health-care system serving the largest retirement community in the US has filed for bankruptcy after disclosing it potentially overbilled Medicare by at least $350 million, according to court filings.
The Villages Health System LLC, which operates clinics for retirees living in the Villages in Central Florida, said in a July 3 court filing that it logged patient diagnoses that “were not clinically supported or otherwise did not meet Medicare coding and payment guidance.”
TVH said it discovered the problem in August, disclosed it to the Department of Health and Human Services in December and sent a written notice to its patients. The health-care system filed Chapter 11 last week.
The bankruptcy comes weeks after the Trump administration announced plans to expand audits of Medicare Advantage plans, the type of coverage used by most of TVH’s 55,000 patients.
More than half of people on Medicare get benefits from private Medicare Advantage plans, which are operated by private insurers, Bloomberg has reported. A complicated system of diagnosis codes determine payments to the insurance companies in Medicare Advantage. Those plans are paid a monthly premium that is adjusted for how sick their members are.
TVH was formed in 2012 in collaboration with the University of South Florida and operates ten primary and specialty care clinics, according to court documents. The broader Villages area spans 57 square miles and houses more than 150,000 residents, according to its website. Last year, Kamala Harris’ husband Doug Emhoff made a stop to the retirement community, where Republicans outnumber Democrats three-to-one, as part of Harris’ presidential campaign.
Humana Inc.’s CenterWell Senior Primary Care unit has agreed to acquire TVH, a deal that must be approved by a bankruptcy judge and is subject to better offers in Chapter 11. TVH said the bankruptcy filing and proposed sale to CenterWell won’t interrupt its operations.
