Tenet Pays $42 Million To Settle Medicare Billing Charges Over IRFs

Inpatient rehabilitation facilities (“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.   

However, when a provider bills Medicare for the treatment of patients at its IRFs when, in fact, patient stays did not meet the standards to qualify for an IRF admission, the provider may be violating the federal False Claims Act.
 
Now, Tenet Healthcare Corporation has agreed to pay $42.75 million to settle allegations that it violated the False Claims Act by overbilling the federal Medicare program for IRFs. The settlement – the United States’ single largest recovery pertaining to alleged inappropriate admissions to IRFs – resolves allegations pertaining to the various IRFs that Dallas-based Tenet has owned and operated throughout the country.