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Tenet Healthcare fined $42M for false Medicare claims

By Michael P. Tremoglie | Apr 11, 2012

WASHINGTON (Legal Newsline) -- Tenet Healthcare Corporation will pay $42.75 million to the federal government for violations of the False Claims Act, the Justice Department announced Tuesday.

It was alleged that Tenet was overbilling the Medicare program.

Tenet's inpatient rehabilitation facilities improperly billed Medicare for the treatment of inpatients. But these patient stays did not meet the standards to qualify for an IRF admission. IRFs are those who need an intense rehabilitation program. Patients at these facilities require more intensive treatment than is provided in other settings, such as acute care hospitals or skilled nursing facilities. Medicare pays IRFs at a higher rate.

DOJ claims between May 15, 2005, and Dec. 31, 2007, Tenet's IRFs nationwide committed these violations. The fine is the single largest recovery for inappropriate IRF admissions.

"The Department of Justice is committed to protecting the Medicare program against all types of overcharging by health care providers," said Stuart F. Delery, Acting Assistant Attorney General for the Justice Department's Civil Division. "As today's settlement demonstrates, inpatient rehabilitation facilities will not be permitted to bill Medicare for patients who were not qualified for admission."

"This settlement demonstrates our office's continued commitment to protect crucial Medicare dollars from fraud and abuse," said Sally Quillian Yates, U.S. Attorney for the Northern District of Georgia. "Inpatient rehabilitation facilities are expensive, and Medicare dollars should be reserved for patients who need the services-not for hospitals seeking to make money through improper billing."

"Tenet disclosed this matter to my office as required under its corporate integrity agreement (CIA)," said Daniel R. Levinson, Inspector General of the U.S. Department of Health and Human Services. "Our CIA reporting provisions have resulted in recovery of millions of taxpayer dollars back into the Medicare program."

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