“What those changes have done is put healthcare providers on notice,” said Anna Grizzle, a member of the law firm Bass, Berry & Sims. “It's in healthcare providers' best interest to self-police. Agencies will look favorably on companies that come forward.”
Yet Scott Becker, a partner at McGuireWoods, noted that the $43 million payment is potentially chilling. “This becomes a real impediment for someone wanting to come forward,” he said. “People self-report and then wind up surprised at the size of the settlement. It's become a regular line-item in the budget.”
Tenet's settlement came out of a 2007 review that uncovered overpayments at an inpatient rehabilitation unit at a Georgia facility; the overpayments stemmed from admitting patients who could have been treated with a lower level of care, according to a Tenet news release.
Ultimately, the investigation found improper admissions practices at 25 rehabilitation units from 2005 to 2007. Tenet reported the overpayments to HHS' inspector general's office as required under a corporate integrity agreement entered as part of a previous settlement.
The settlement is the first in recent years to involve inpatient rehabilitation admissions, prompting the question of whether the government might take a closer look at this area, said Laurence Freedman, a partner at Patton Bogg.
Lisa Estrada, a partner at Arent Fox, agreed the scrutiny may increase. “This popped up in the OIG's work plan as a new area of focus,” she said. She added that issues of eligibility and level of care also have appeared in investigations of hospices and home health agencies, noting a $10.56 million December settlement with hospice Diakon Lutheran Social Ministries, Allentown, Pa.
Becker suggested that large healthcare groups keep audits consistent across their facilities in order to minimize the potential for a compliance breach. “Before you self-report, you have to make sure you're more aware of everything else going on in the system,” he said.