Tenet Healthcare Corp. has agreed to pay the United States $42.75 million to settle allegations that it violated the False Claims Act by overbilling the federal Medicare program, the Justice Department has announced.
The settlement resolves allegations pertaining to the various inpatient rehabilitation facilities (IRFs) that Dallas-based Tenet owned and operated throughout the country. Because the patients treated at these facilities require more intensive rehabilitation therapy and closer medical supervision than is provided in other settings, such as acute care hospitals or skilled nursing facilities, Medicare generally pays IRFs at a higher rate for rehabilitation care than it pays for such care in other settings.
The Justice Department alleged that between May 15, 2005, and Dec. 31, 2007, Tenet improperly billed Medicare for the treatment of patients at its IRFs when, in fact, these patient stays did not meet the standards to qualify for an IRF admission. The settlement is the United States' single largest recovery pertaining to inappropriate admissions to IRF, said Stuart F. Delery, acting assistant attorney general for the Justice Department's Civil Division.
"The Department of Justice is committed to protecting the Medicare program against all types of overcharging by healthcare providers," Delery says. "Inpatient rehabilitation facilities will not be permitted to bill Medicare for patients who were not qualified for admission."
Tenet disclosed the overcharging as required under its corporate integrity agreement, according to the Justice Department.
The settlement is part of the government's emphasis on combating healthcare fraud and is another step for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced by Attorney General Eric Holder and Kathleen Sebelius, secretary of the Department of Health and Human Services, in May 2009. The partnership between the two departments has focused on efforts to reduce and prevent Medicare and Medicaid fraud.
The Justice Department has used the False Claims Act to recover more than $6.6 billion since January 2009 in cases involving fraud against federal healthcare programs. The Justice Department's total recoveries in False Claims Act cases since January 2009 are more than $8.8 billion.
Tenet Healthcare Corp. has agreed to pay the United States $42.75 million to settle allegations that it violated the False Claims Act by overbilling the federal Medicare program, the Justice Department has announced.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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