Tenet indictment signals new era of healthcare fraud investigations

Dallas-based Tenet Healthcare agreed to pay approximately $514 million last October to resolve allegations the company paid kickbacks in exchange for patient referrals. Although Tenet settled the lawsuit, the federal government attached a name to the case last week when a former Tenet executive was charged for his alleged involvement in the scheme.   

In an indictment filed Jan. 24, John Holland, who previously served as senior vice president of operations for Tenet's Southern States Region and as CEO of North Fulton Medical Center in Roswell, Ga., is charged with one count of healthcare fraud and two counts of major fraud against the United States.

According to the Department of Justice, Mr. Holland and his co-conspirators circumvented Tenet's internal accounting controls to pay illegal kickbacks and bribes to a clinic that referred undocumented pregnant patients to Tenet hospitals for Medicaid-covered deliveries. Federal prosecutors allege the illegal scheme helped Tenet bill the Georgia and South Carolina Medicaid programs for more than $400 million.

The case against Mr. Holland, who has pleaded not guilty to the charges, highlights the government's interest in holding individuals — not just the organizations they work for — responsible for fraud.

Traditionally, healthcare companies were only expected to provide information about the underlying factual situation in a fraud investigation. However, these investigations have become more complicated, as the DOJ has taken a strong stance on pursuing healthcare executives involved in fraud cases to hold them personally responsible.

In a memo issued to federal prosecutors in September 2015, the DOJ provided guidance on steps it is taking to strengthen its pursuit of individual corporate wrongdoing. The repercussions of the memo — which has been dubbed the "Yates memo" after former Deputy Attorney General Sally Yates — are significant. One key change is that to be eligible for any cooperation credit, companies must provide the names of individuals involved in the fraud, no matter where they sit within the company.

Although it has been more than a year since the Yates memo was distributed, Linda Baumann, a partner with Arent Fox, told Bloomberg BNA there has been a recent increase in the number of healthcare fraud prosecutions against individuals. Ms. Baumann attributed the pause between the Yates memo and the ramp-up in individual fraud prosecutions to the time it takes to develop cases against those involved in healthcare fraud. She also said the recent increase may be due to the federal government's desire to finish investigations before the administration changed.

More articles on legal and regulatory matters:

8 latest healthcare industry lawsuits, settlements
Apology laws don't help physicians avoid malpractice suits, study finds
VA to pay DaVita $538M for allegedly underpaying for dialysis services

 

© Copyright ASC COMMUNICATIONS 2021. Interested in LINKING to or REPRINTING this content? View our policies by clicking here.

 

Featured Whitepapers

Featured Webinars