Healthcare News & Insights

Tenet self-discloses over billing, pays Medicare $43M

During a 2007 internal review, Tenet Healthcare Corp.’s compliance department uncovered overpayments at one of its rehabilitation units at a Georgia facility. The company disclosed the overpayments to the government, which led to an investigation and a $42.75 million settlement to Medicare. 

This settlement resolves allegations – made under the False Claims Act (FCA) – that Tenet overbilled Medicare for the treatment of patients at inpatient rehabilitation facilities (IRFs).

The allegations stem from admissions at 25 IRFs between May 15, 2005 to Dec. 31, 2007. According to the Justice Department, the Dallas-based hospital operator billed Medicare for patients who didn’t meet the standards for admission to IRFs. And since IRFs are designed for patients who require more intense therapy and closer medical supervision, they get paid more than acute care hospitals or skilled nursing facilities.

This settlement is part of the government’s 2009 Health Care Fraud Prevention and Enforcement Action Team (TEAM) initiative and its effort to reduce and prevent Medicare and Medicaid financial fraud. To date it’s the single largest U.S. recovery involving inappropriate inpatient rehab admissions.

Tenet self-disclosed the overbilling because it was required by the corporate integrity agreement it was operating under.

Tenet officials said they’d already set aside the funds for the settlement, and will pay it in the second quarter.

Under the FCA, the Justice Department has recovered more than $6.6 billion since January 2009 in cases involving fraud against federal healthcare programs.

Currently, Tenet runs 50 hospitals, close to 100 outpatient health centers, but only eight IRFs.

What do you think about the settlement? Is the government making an example of Tenet or is it fair? Share your thought below in the comments box.


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