Did Sampson's May 11 e-mail refer to May 8 notification to TENET Healthcare?

[L. Coyote]

From: US Attorney Firing: Voter Fraud, Medicare Fraud, WHICH IS IT ???
http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=853813&mesg_id=862205

Tenet was facing, on May 10, a (quoting Kyle Sampson's May 11 e-mail) "real problem we have right now with Carol Lam"

"Despite the disclosure that the jurors were never close to a unanimous decision, it is still unclear whether the government will attempt a third trial against Tenet. According to U.S. Attorney Carol Lam, the government will report to the court as to whether there will be a third trial, which announcement is expected on May 22, 2006......"

MUCH MORE >>>>>

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May 10, 2006
HHS Seeks to Knock Out San Diego Hospital

"The Office of the Inspector General for the Department of Health and Human Services is seeking the ultimate punishment against a San Diego hospital by seeking to bar it from participating in federal healthcare programs, most importantly Medicare and Medicaid...."

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Release of May 17, 2006 - Office of Inspector General
Tenet Agrees to Divest Alvarado Hospital

Inspector General Daniel R. Levinson announced today that the Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) and Tenet Healthcare Corporation reached an agreement concerning Tenet’s divestiture of Alvarado Hospital Medical Center (Alvarado). This agreement resolves OIG’s possible exclusion of Alvarado from participation in Medicare and all other Federal health care programs.

On May 8, 2006, OIG notified Tenet that OIG intended to propose to exclude Alvarado based on Alvarado’s alleged payment of kickbacks to physicians.

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[fooj]

1. Here's a little tidbit.

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=102x2841655

Feds arrest 38 in Medicare fraud crackdown
Source: Miami Herald


Feds arrest 38 in Medicare fraud crackdown
Home to ''prevalent'' Medicare fraud, South Florida is now also home to a federal-state strike force looking to root out medical schemes.
BY LESLEY CLARK
[e-mail]

WASHINGTON -- Calling South Florida a particularly ripe area for Medicare fraud, federal prosecutors Wednesday announced a crackdown on sham medical care companies, including the arrest of 38 people prosecutors say fraudulently billed the government for more than $142 million.
(snip)

''This kind of blatant fraud simply is intolerable.'' The companies purport to provide medical equipment, including wheelchairs and prosthetic limbs, but Leavitt said, most of the offices were empty, with only a name, phone number and alleged business hours posted on the door.
<snip>

[flyarm]

2. Tenet Healthcare :: Medicare Fraud

Medicare Fraud and the Outlier Scam
Tenet Healthcare :: Medicare Fraud. ... In the past couple of years, Shasta County, where Redding Medical Center is located, has lost all its HMO plans. ...

www.uow.edu.au/arts/sts/bmartin/dissent/documents/health/tenet_med_fraud.ht...

http://www.uow.edu.au/arts/sts/bmartin/dissent/documents/health/tenet_med_fraud.html


Medicare Fraud

What about past problems in General Hospitals
Tenets conduct in the 1990's scandal was a prime example of ruthless utilization manipulation although that term was not used at that time. Its recent policies and the numerous allegations made about it indicate that it has not changed one bit. As I indicated when I wrote a letter of complaint about Tenet's predecessor National Medical Enterprises' (NME) international operations in 1991, there cannot be so much smoke without a large fire.

The newly named Tenet Healthcare seemed to start with a clean slate after the fraud settlements of 1994 but these settlements related to its specialty division.

The press reported concerns about problems in NME's general hospitals in the early 1990's but these were either not investigated or not prosecuted. If the recent fraud settlements and the many allegations going back to 1992 are valid indications of what happened, then it may be that Medicare fraud was ongoing in Tenet's general hospitals during the period it was negotiating its 1994 settlement and signing its integrity agreement. In fairness some of the earlier offences may have been in hospitals purchased subsequently by Tenet. The exploitation of Medicare has continued in one form or another into the present.

Fraud related settlements are made without admitting guilt and companies pay large settlements while continuing to deny the allegations. Because of the serious consequences for patients and for the health care system this analysis assumes that there is some substance to the majority of allegations. Why else would a company whose success depends on its credibility pay these large settlements.



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Fraud settlements before the October 2002 scandal
In early 1999 an antitrust investigation was commenced into three hospitals in Florida. I do not know the outcome or if a financial settlement was negotiated.


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In regard to Morton Plant Mease, the Justice Department is looking for "conspiracies or agreements having the purpose or effect of unreasonably restraining competition in the sale of hospital services among hospitals in Northern Pinellas County, Florida," according to a civil investigative demand letter obtained by MODERN HEALTHCARE.
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He said the government appears most interested in whether Morton Plant and Mease hospitals shared information about their managed-care contracting. FLA. HOSPITAL PARTNERSHIP INVESTIGATED Modern healthcare Feb. 1, 1999
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In June 2002 Tenet paid US $ 55,8 million to settle a series of Medicare fraud charges, some initiated by whistleblowers. These include

$17 million for overcharging for laboratory services in 139 hospitals,
$10 million for over billing for rehabilitation services and false cost reports at Brotman Medical Center in Culver City (whistle blower initiated), and
$29 million in a case that accused Lifemark Hospitals of Florida (Palmetto General Hospital) of billing and cost-report violations for home health services dating from 1995 (whistle blower initiated),
At the time Tenet was accused of a much more extensive fraud going back many years and was still busy negotiating this with authorities. These settlements had no effect on Standard and Poor's ratings.


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Tenet Healthcare Corp., Santa Barbara, Calif., announced Tuesday it would pay $55.75 million to resolve civil charges relating to national clinical laboratory billing violations and fraud at two of its hospitals, although the company denied any wrongdoing.
The settlement announcement makes Tenet the third national for-profit chain to settle healthcare fraud allegations in the past two years.
Tenet settles fraud charges for $56 million, Modern Healthcare 19 June 2002



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The Palmetto settlement
The settlement agreement resolves allegations by the United States that the hospital's submissions to Medicare from 1994 to 1997 included false claims for home health services purportedly provided by three agencies in Dade, Islamorada and Key West, Florida. The government contended that these submissions included claims that contained or were based on false, fraudulent and misleading statements or omissions regarding the patient's medical condition, history and/or eligibility for coverage by Medicare. In addition, the United States asserted that the hospital's submissions included claims for services that were not reimbursable by Medicare because they were not rendered; were provided by unskilled, unlicensed or uncertified personnel; were based upon insufficient, forged or missing documents; and/or were never ordered by a physician.

The government further contended that certain cost reports Palmetto submitted between 1994 and 1997 improperly maximized its Medicare reimbursements through various means, including the reclassification of the costs of one of the home health agencies to the other two and the misallocation of certain capital related, operating, nursing administration, cafeteria and social service costs. Additionally, the United States contended that the hospital improperly claimed non-reimbursable billing fees paid to a related company; and also failed to disclose the related-party nature of that relationship. Lastly, the United States contended that the hospital improperly classified certain non-reimbursable acquisition costs as reimbursable consulting fees.

The civil settlement includes a full resolution of claims brought - - - - under the qui tam or whistleblower provisions of the False Claims Act. TENET HOSPITAL IN FLORIDA PAYS U.S. $29 MILLION TO RESOLVE FALSE CLAIMS ACT ALLEGATIONS Press Release US Dept Justice JULY 17, 2002

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also Tenet's $55.8-Million Payment Settles Claims LA Times June 19, 2002
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After the scandal broke
In January 2003 Tenet agreed to settle whistle blower initiated allegations of pneumonia and septicemia upcoding made about 5 hospitals for $ 4.3 million.


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Upcoding is the practice of improperly assigning a diagnosis code to a patient discharge that is not supported by the medical record for the purpose of obtaining a higher level of reimbursement from Medicare for that hospital discharge than the hospital would otherwise receive.

Three of the hospitals were named defendants in a False Claims Act qui tam or whistleblower suit filed by Health Outcomes Technologies, Inc. As a result of the settlement, Health Outcomes Technologies will receive $309,303 of the government's recovery.
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The claims in this suit are similar to allegations brought by the United States against 104 Tenet hospitals in an action filed in the federal court on January 9, 2003 in Los Angeles. FIVE TENET HOSPITALS IN FLORIDA PAY UNITED STATES $4.3 MILLION FOR ALLEGEDLY VIOLATING FALSE CLAIMS ACT Press Release US Department of Justice FEBRUARY 10, 2003

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"We believe it is important to stress that, in these settlements, the hospitals are acknowledging only that payments deemed improper were simply the result of error or oversight." Five Down, 104 to Go Hospital Compliance Wire February 10, 2003
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The Justice department also sued the company for US $323 million for overcharging Medicare by improper diagnostic codes between 1992 and 1998 in another 104 hospitals. The Justice Department had been negotiating with the company for some time. The settlement with the 5 hospitals and the previously settled allegations involving lab tests for $17 million were part of this process. Tenet denied the allegations made about these 104 other hospitals and refused to settle.


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The department said Tenet improperly assigned diagnosis codes for in-hospital stays in order to get paid higher reimbursements than it was entitled to between 1992 and 1998. The lawsuit was filed in Los Angeles against the Santa Barbara-based company.

The government is seeking triple damages, which could run as high as $323 million. The Justice Department sued Tenet Healthcare for up to $323 million Thursday, accusing the nation's second-largest hospital chain of overcharging Medicare for certain procedures to inflate its revenue. The Associated Press. January 3, 2003

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The U.S. Justice Department filed suit against Tenet Healthcare Corp., Santa Barbara, Calif., accusing the nation's second-largest hospital chain of manipulating Medicare DRG codes to fraudulently obtain millions of dollars in extra reimbursement. Much of the alleged misbehavior occurred while Tenet already was operating under a corporate integrity agreement with the government. Tenet not only violated the agreement but also lied to government officials by swearing it was in material compliance with the agreement, the government complaint alleges. Government files upcoding suit against Tenet Modern Healthcare January 9, 2003

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Most of the alleged upcoding at issue took place during a time when Tenet was under a Corporate Integrity Agreement with the Department of Health and Human Services. - - - Tenet, pursuant to its Corporate Integrity Agreement, falsely certified to the government that it was in compliance with the Medicare regulations and the terms of the Corporate Integrity Agreement, - - - - UNITED STATES FILES SUIT AGAINST TENET HEALTHCARE ALLEGING FALSE CLAIMS BILLINGS TO MEDICARE US Department Justice Press release January 9, 2003

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One of the reasons why hospitals are not prosecuted for substandard care is that while the whole picture is clear the process involves proving every one of large numbers of individual cases. Each will have different and conflicting medical opinions, rationalisations and possible alternative explanations. Government is flooded with more than it can handle. Individuals are therefore left to take on the giants and their lawyers independently. Tenet has tried to force the government to do this in this fraud case asking for each of the 104 hospitals to be tried separately.

Tenet Healthcare Corp. said the Justice Department should be forced to sue member hospitals individually on allegations that they submitted phony Medicare claims.

Tenet asked a federal judge in Los Angeles to exclude the company as a defendant in a suit seeking $323 million in damages. That would give prosecutors the more difficult task of proving fraud against individual hospitals in the Santa Barbara-based chain. Tenet Seeks Suits of Individual Hospitals LA Times (Bloomberg News) June 11, 2003

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"It's the antithesis of what you want to do in law enforcement," says Eichenwald at the Times. "You don't want to create the impression that if you create enough crime, if its thousands and thousands of documents, well, the government can't handle it." Health-care industry rife with fraud ::Government swamped by $1.5 trillion in paperwork MSNBCNews Nov 12, 2002
In June 2003 the Internal Revenue Services demanded US $269 in additional taxes including interest for the years 1995-7. What Tenet did wrong is not disclosed but as always it is contesting this


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Tenet Says the IRS Seeking $269 Million New York Times (Reuters) June 2, 2003

[flyarm]

3. Tenet has been aggressively pushing up retail hospital charges

http://www.uow.edu.au/arts/sts/bmartin/dissent/documents/health/tenet_med_fraud.html
The Outlier and Stop-Loss Payment Scandal
Outlier and other payments

snip;
Tenet vastly inflated its prices in order to be able to claim large outlier payments from Medicare, similar large "stop-loss" payments from managed care companies, extra payments from Workers Compensation, and "DSH" payments from Medicaid. Its dramatic recovery from a low at the end of 1999 to a market darling in October 2002 was largely due to a massive increase in these outlier, stop loss and related payments. Outlier and stop loss rates were 23-26% in Tenet hospitals compared with 3-5% in other hospitals.

"Outlier" payments, "stop-loss" payments and a similar system for workers compensation cases provide remuneration for complicated and costly procedures which are not adequately covered by the Diagnosis Related Groups formula used for reimbursement in the USA. Without them corporations have "cherry picked" cases treating only healthy patients and targeting short term complication free procedures. The old, frail and potentially complicated were turned away.



snip;

Even so, the fact that Tenet has been aggressively pushing up retail hospital charges -- which the company acknowledged last week -- does matter for patients, hospitals and the health-care industry. Wall Street analysts say they think Tenet deliberately raised its list prices to maximize special payments it receives from Medicare.

And now some of them are questioning whether Tenet's pricing policy allowed it to collect excessive amounts of certain payments from another government program: Medicaid, - - - -
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So, if the hospital raised its retail charge for the coronary procedure to $120,000, and the Medicare reimbursement remained the same at $20,000, the hospital could calculate its outlier payments based on the higher $100,000 unpaid charge. Thus, the greater the increase in retail charges, the greater the outlier payments.
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Although hospitals closely guard the retail rates for procedures and supplies, public records show how rapidly prices have been rising at some Tenet hospitals. Tenet Under Closer Exam :: Pricing policy may have resulted in excessive Medicaid payments, some analysts say. LA Times November 11, 2002

[flyarm]

4. Tenet gamed the outlier system

http://www.uow.edu.au/arts/sts/bmartin/dissent/documents/health/tenet_med_fraud.html

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Tenet gamed the outlier system


Tenet's policy of securing market dominance allowed it to markedly increase prices and so secure higher payments in these areas. It targeted complex cardiac, orthopaedic, neurology and other high risk cases which qualified for these payments. It sought to increase the admission of these cases and provide more of these services. At the same time it reduced costs. In 2002 it was paid $763 million by Medicare in outlier payments. Total stop-loss, Workers Compensation and DHS payments have not been disclosed.


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Tenet's strategy, especially at the company's seven teaching hospitals, ensures Tenet hospitals will treat a high number of patients with medically complex conditions. Those cases are the kind that trigger Medicare outlier payments-the extra money Medicare pays on cases in which the cost of treatment far exceeds the DRG reimbursement.

That strategy, combined with what the company now acknowledges have been aggressive increases in its listed gross charges, has been a rocket booster for the proportion of Tenet's Medicare revenue generated from outlier payments. The company's proportion far exceeds those of large urban hospitals, its for-profit competitors and even top academic hospitals
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In the fiscal year ended May 31, 2000, Tenet took in $351 million in outlier payments, 3.1% of its $11.4 billion in net revenue. By fiscal 2002, that figure had more than doubled, to $763 million, 5.5% of its $13.9 billion in net revenue. After reviewing every patient record for fiscal 2002 that resulted in an outlier payment, Tenet determined that $429 million of those outlier payments, or 56%, came from just 11 of its hospitals-seven in California, three in Pennsylvania and one in Texas. Stormy weather :: Echoes of Columbia/HCA heard as Tenet overhauls management amid scrutiny of outlier payments and investor protests Modern Healthcare November 11 2002

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While hospitals generally receive about 5 percent of their Medicare reimbursements from these special payments, Tenet received roughly 25 percent. U.S. to Review Big Payments for Medicare New York Times November 13, 2002

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Tenet's outlier payments from Medicare rose from $351 million in 2000 to $564 million in 2001 and $763 million in 2002. Barbakow has said that aggressive pricing contributed to the surge. Tenet raises prices more quickly than competitors :: Union asks state to look at charges San Francisco Chronicle November 20, 2002

[L. Coyote]

5. Payments rose from $351 million in 2000 to $763 million in 2002

Useful info. Says a lot about why Lam was after these guys = "Tenet's outlier payments rose from $351 million in 2000 to $763 million in 2002..."

[flyarm]

7. YEP!!!!!!!! AMAZING HUH?????? A MIRACLE..LIKE THE BOGUS SURGERIES THEY DID!!

[flyarm]

6. TENET MEDICAL AND REDDING MEDICAL CENTER

http://www.hackardlaw.com/hl/x_redding.html

REDDING MEDICAL CENTER
Background

In October 2002, the FBI raided the Department of Cardiology at Redding Medical Center ("RMC") as part of an on-going healthcare fraud investigation. Dr. Chae Moon, a cardiologist, and Dr. Fidel Realyvasquez, a cardiothoracic surgeon, were investigated for performing unnecessary, highly invasive coronary procedures on patients, including heart catheterizations, angioplasty and open heart surgeries.

It was estimated that 50% of the procedures performed were unnecessary. Tenet Healthcare has paid $54 million to the federal government to repay the amount they fraudulently overcharged Medicare and other federal and state healthcare programs.

More than 700 cases were filed against Tenet in Shasta County Superior Court. Hackard & Holt was an active member in the litigation process and settlement negotiations during this campaign. A global settlement was reached with Tenet and the doctors in 2004 totaling $419 million. Hackard & Holt obtained substantial settlements for all of their clients.

For more information see the Washington Post article »






http://www.hackardlaw.com/hl/d_news_redding-fbiraid.html

HACKARD & HOLT IN THE NEWS
At California Hospital, Red Flags and an FBI Raid:
State Regulators Cited Concerns but Say They Couldn't Force Change
By Gilbert M. Gaul
Washington Post Staff Writer
Monday, July 25, 2005; A09
Originally published at Washingtonpost.com

SNIP:

It took a whistle-blower to alert the FBI about what turned out to be one of the nation's worst examples of overzealous medicine. But warning signs about Redding were in plain sight for years, documents show. That they were ignored goes a long way toward explaining the breakdown in oversight of the nation's health providers.

The FBI's raid spawned waves of allegations that are still playing out. A criminal investigation was opened. Hundreds of civil lawsuits were filed. Redding's owner, Tenet Healthcare Corp., agreed to pay the federal government $54 million to settle allegations of unnecessary care, without admitting wrongdoing, and to sell the hospital or risk having it barred from Medicare. The hospital is now called Shasta Regional Medical Center.



SNIP:

Still later, Tenet said it would pay $395 million to 769 patients who said they underwent unneeded cardiac procedures at Redding. Moon's cardiology group also settled with patients, paying $24 million to 345 plaintiffs.




SNIP:

When state regulators returned to Redding in late 2002, "it was almost the same as three years ago," Way said. In one 11-month period, doctors had performed 3,240 cardiac catheterizations, a number comparable to a major teaching hospital, Way said. Only six had been reviewed.