Tenet Healthcare Corporation and its affiliated Palm Springs, Calif., hospital Desert Regional Medical Center (DRMC) have agreed to pay $1.41 million to the U.S. government to settle False Claims Act allegations that the organization knowingly charged Medicare for unnecessary procedures.
According to a release from the Department of Justice, Medicare only reimburses hospitals for services and treatments that are deemed “reasonable and medically necessary.” Tenet and DRMC cardiologists were accused of implanting patients with needless cardiac monitors between 2014 and 2017 and submitting those claims to Medicare.
“Providers that bill for unnecessary services and devices contribute to the soaring cost of healthcare,” Jody Hunt, assistant attorney general for the DOJ’s civil division, said in the statement. “The Department of Justice holds accountable those providers that impose unnecessary treatments upon patients and pass the inflated costs onto federal healthcare programs.”
Timothy B. DeFrancesca, the special agent in charge for the Office of Inspector General within the U.S. Department of Health and Human Services, agreed, noting that invasive medical procedures like these “are not without risk.”
“Therefore, when these procedures are medically unnecessary, as contended in this case, people in government health programs are put at needless peril, and taxpayers end up with the bill,” he said.
Michael Grace, a former DRMC employee, first filed allegations against his parent company under the qui tam provisions of the False Claims Act, which allows him to share in any government recovery. In this case, Grace will receive $240,789.