Reply #50: OIG Executes Tenet Corporate Integrity Agreement = Unprecedented Provisions [View All]

[L. Coyote]

OIG NEWS
Office of Inspector General
For Immediate Release
330 Independence Ave., SW.
September 28, 2006
For the full CIA document:
http://oig.hhs.gov/fraud/cia/agreements/TenetCIAFinal.pdf


OIG Executes Tenet Corporate Integrity Agreement
Unprecedented Provisions Include Board of Directors Review

Inspector General Daniel R. Levinson announced today that the Office of Inspector
General (OIG) of the U.S. Department of Health & Human Services has reached an agreement
with Tenet Healthcare Corporation on a Corporate Integrity Agreement (CIA). The CIA is part
of Tenet’s resolution of its civil and administrative liability for a wide range of investigated
conduct, including Diagnosis Related Group (DRG) upcoding, improper outlier payments,
kickbacks to physicians, and other fraudulent activities.

“OIG is committed to protecting the integrity of Federal health care programs, and
today’s Corporate Integrity Agreement with Tenet Healthcare Corporation contains
comprehensive and unprecedented provisions designed to prevent future harm to the programs.
OIG expects Tenet to fully comply with the requirements of the Corporate Integrity Agreement,
and we will closely monitor Tenet’s compliance with its terms,” said Inspector General Daniel R.
Levinson.

In June 2006, Tenet agreed to pay over $900 million to the United States to resolve its
liability under the False Claims Act and related authorities. Specifically, the Federal government
had alleged that Tenet submitted claims for payment to Medicare using DRG codes that Tenet
could not support or were improperly assigned to patient records in order to increase
reimbursement to Tenet hospitals. Tenet also allegedly inflated its charges substantially in
excess of any increase in the costs associated with patient care, which resulted in improper
outlier payments.

The CIA, which has a five year term, will cover Tenet, its wholly­owned subsidiaries and
affiliates, and all hospitals and other health care facilities managed or controlled by Tenet.
Under the CIA, Tenet will implement a comprehensive compliance program that includes
corporate, regional, and hospital compliance officers; compliance policies and training; an
employee hotline and reporting mechanism; and mandatory reporting and repayment of
overpayments. In addition, Tenet is required to engage independent review organizations to
review Tenet’s DRG claims, outlier payments, physician relationships, and clinical quality
management.

The CIA also includes unprecedented provisions requiring ....

In consideration of Tenet’s obligations under the CIA, OIG has agreed to release and
refrain from instituting any administrative action seeking exclusion of Tenet from participation
in Medicare, Medicaid, and other Federal health care programs under section 1128(b)(7) of the
Social Security Act for the investigated conduct. ........