The U.S. Department of Justice announced on February 11, 2020 that Tenet Healthcare Corporation and its affiliated hospital Desert Regional Medical Center (DRMC), a general medical and surgical hospital located in Palm Springs, California, have agreed to pay $1.41 million to resolve allegations that they violated the False Claims Act by knowingly charging Medicare for implanting unnecessary cardiac monitors.
Medicare only reimburses services and treatments that are reasonable and medically necessary. The settlement resolves allegations that DRMC knowingly charged Medicare for unnecessary cardiac monitors (often called loop recorders) that DRMC cardiologists implanted in beneficiaries from 2014 to 2017.
The settlement resolves allegations filed in a lawsuit by a former DRMC employee, under the qui tam provisions of the False Claims Act, which permit private individuals to sue for false claims on behalf of the government and to share in any recovery. The civil lawsuit is docketed in the Central District of California and is captioned United States ex rel. Grace v. Tenet HealthCare Corp.; St. Francis Hospital-Memphis; Desert Regional Medical Center; and Apollo MD, Case No. 17-CV-1481. As part of this settlement, the whistleblower will receive $240,789 as his share of the government’s recovery.
An Assistant Attorney General for the U.S. Department of Justice’s Civil Division stated with regard to the settlement, “Providers that bill for unnecessary services and devices contribute to the soaring cost of health care. The Department of Justice holds accountable those providers that impose unnecessary treatments upon patients and pass the inflated costs on to federal health care programs.”
The Special Agent in Charge for the Office of Inspector General of the U.S. Department of Health and Human Services stated, “Invasive medical procedures, such as implanting heart monitors, 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.”
The U.S. Department of Justice stated in announcing the settlement, “The claims resolved by this settlement are allegations only and there has been no determination of liability.”
If you have information regarding false claims having been submitted to Medicare, Medicaid, TRICARE, other federal health care programs, or to other federal agencies/programs, and the information is not publically known and no actions have been taken by the government with regard to recovering the false claims, you should promptly consult with a False Claims Act attorney (also known as qui tam attorneys) in your U.S. state who may investigate the basis of your False Claims Act allegations and who may also assist you in bringing a qui tam lawsuit on behalf of the United States, if appropriate, for which you may be entitled to receive a portion of the recovery received by the U.S. government.
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