February 9, 2012
Tenet Healthcare Corporation has consented to a $42.75 million settlement to resolve allegations by the U.S. government that the Dallas based company overbilled the federal Medicare program in connection with its inpatient rehabilitation facilities (IRFs). The Justice Department announced that the False Claims Act settlement is the government’s single largest involving inappropriate patient admissions to IRFs.
IRFs serve patients who require an intense rehabilitation using a coordinated, multidisciplinary team approach that is not available in ordinary rehabilitation settings like skilled nursing facilities or acute care hospitals. Because IRF patients need closer medical supervision and more intensive physical therapy than other recovering patients require, Medicare customarily reimburses IRFs at an increased rate to cover the increased level of care.
From 2005 to 2007, the Justice Department alleges that Medicare was improperly billed by Tenet for treatment of patients at Tenet’s IRFs owned and operated across the nation. The patients’ medical conditions did not comply with the standards necessary to justify IRF admission.
The Inspector General of the U.S. Department of Health and Human Services (HHS), Daniel R. Levinson, reported that it was Tenet that disclosed the improper billings to HHS, pursuant to the terms of the company’s corporate integrity agreement (CIA). According to Levinson, CIA reporting programs “have resulted in recovery of millions of taxpayer dollars back into the Medicare program.”
Health care fraud concerning a facility’s improper billing of Medicare is often discovered when facility doctors or employees step forward to report the fraudulent conduct. It takes real courage to put a stop to such abuses in the health care industry. To encourage potential whistleblowers to speak out, the qui tam provisions of the federal False Claims Act allow such persons to claim a share of any recovery by the government.
Waters & Kraus is a national firm with highly skilled lawyers practicing qui tam litigation in four offices, including Dallas, Los Angeles, San Francisco, and Baltimore. Our attorneys have decades of experience successfully representing whistleblowers in a variety of fraud cases. Contact us or call our attorneys at 800.226.9880 to learn more about our practice and how we can assist.
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