Tenet Healthcare, Medicare Overbilling, Texas 2007

Medicare Overbilling Scheme Lands Dallas-Based Tenet Healthcare in $42.75 Million Hole

Dallas-based Tenet Healthcare Corporation 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 announced today.

The settlement resolves allegations pertaining to the various inpatient rehabilitation facilities (IRFs) that Dallas-based Tenet has owned and operated throughout the country. IRFs are designed for patients who need an intense rehabilitation program that requires a multidisciplinary, coordinated team approach to improve their ability to function. 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. Today’s settlement is the United States’ single largest recovery pertaining to inappropriate admissions to IRFs.

“The Justice Department 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.”

Respondent: Tenet Healthcare Corporation

Citizen of: N/A

Crime Date: May 15, 2005 – Dec. 31, 2007

Sentence/Outcome: Tenet Healthcare Corporation agreed to pay $42.75 million to settle allegations of improperly billing Medicare.

Acknowledgments: Acting Assistant Attorney General Delery and U.S. Attorney Sally Quillian Yates expressed appreciation to the Justice Department’s Civil Division, the U.S. Attorney’s Office for the Northern District of Georgia, the FBI, and the U.S. Department of Health and Human Services’ Office of Inspector General and Centers for Medicare and Medicaid Services for their collaboration in investigating this matter.

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