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At issue is a settlement agreement Tenet signed with the Department of Justice tied to allegations at two Atlanta-area subsidiaries. In 2016, Tenet signed a nonprosecution agreement with the Department of Justice and paid a $514 million fine related to resolving criminal charges and civil claims over a scheme by those subsidiaries to pay kickbacks in exchange for patient referrals. The NPA runs through Feb. 1, 2020, and covers all Tenet's 74 hospitals, including DMC, and other holdings in the U.S. Tenet said in its 10K filing that the company could have "breached the terms of the (non-prosecution agreement) by failing to promptly report 'evidence or allegations of actual or potential violations of the Anti-Kickback Statute' to the DOJ as required by the non-prosecution agreement." Tenet has acknowledged to the SEC that it "did not promptly report that Crain's Detroit Business had published an article in August 2017 alleging that Detroit Medical Center's termination of the employment of 14 nurse practitioners and physician's assistants was due, in part, to the company's concerns that their prior employment did not comply with the Anti-kickback Statute, the Stark law and the False Claims Act." The three federal laws regulate various aspects of hospital billing and attempt to prevent improper payments or other inducements to doctors for patient referrals. The False Claims Act imposes liability on people or companies who defraud governmental programs such as Medicare and Medicaid. Federal fraud investigators are highly attuned to any arrangement hospitals might have with physicians that would lead to paying doctors for patient admissions or diagnostic services performed by the hospital, health care lawyers have told Crain's. For example, blatant violations would be a hospital paying fees for admissions or services, but could also include offering doctors office leases at below market value, or free or discounted services like advanced-practice providers' coverage of private doctors' patients. Tenet's SEC filing also acknowledges that it did not report to the DOJ "a document request from the U.S. Attorney's Office for the Eastern District of Michigan and the Civil Division of the (Department of Justice) requesting that the company produce documents related to a civil investigation of DMC for potential violations of the Stark law, the Anti-kickback Statute and the False Claims Act related to the allegations contained in the Crain's article." Waldmann declined to comment on when Tenet knew of the federal investigation or whether there were concerns about potential civil violations related to the use of the advanced practice providers.

For the original version including any supplementary images or video, visit http://www.crainsdetroit.com/article/20180228/news/654046/us-attorney-investigating-dmc-over-possible-federal-anti-kickback

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