This page examines the multiple Medicare fraud settlements and
related actions taken against Tenet Healthcare. It examines more
closely the outlier, stop-loss, workers compensation payments and the
Medicare DHS payments, all of which allowed the company to circumvent
the restrictions imposed by DRG payments. The more they hiked prices
the more they were paid under these systems. The range of other
investigations complaints and issues made about the company are
listed. These make the point that the fraud and outlier problems are
simply one manifestation of the severely dysfunctional polices
followed, and the existence of a corporate culture which would see
these as legitimate and go along with them.
The Outlier and Stop-Loss Payment Scandal
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.
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.
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
In June 2002 Tenet paid US $ 55,8 million to settle a series of Medicare fraud charges, some initiated by whistleblowers. These include
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.
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
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
also Tenet's $55.8-Million Payment Settles Claims LA Times June 19, 2002
In January 2003 Tenet agreed to settle whistle blower initiated allegations of pneumonia and septicemia upcoding made about 5 hospitals for $ 4.3 million.
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
"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
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.
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
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
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
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
"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
Tenet Says the IRS Seeking $269 Million New York Times (Reuters) June 2, 2003
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.
Mayne
Nickless was accused of cherry
picking in Australia in 2001. These extra payments are designed to
address this problem for a small number of selected cases.
Medicaid, the state and federal insurance for
the poor and disabled pays Disproportionate Share Hospital (DHS)
payments to compensate hospitals for the care they provide to
patients who cannot pay.
Ourtlier, Stop-loss, Workman's Compensation, and DHS extra payments
are all calculated using formulas based on the hospitals charges and
the higher they are the more money is paid. They provide an
opportunity to avoid the restrictions placed on profits by the DRG
system.
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
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.
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
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
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
By targeting payment systems outside DRG's Tenet was able to recreate the situation it had exploited so successfully in specialty hospitals in the 1990's scandal (2.2). During that period vast profits were generated by fanning community anxiety through marketing, encouraging health care screening in order to admit more patients often needlessly, carrying out as much treatment as possible (whether necessary or not), keeping people in hospital as long as possible, and charging as much as it could. The allegations suggest that this is happening again.
"Tenet is driving up the cost of health care in California for everyone," said Don DeMoro, executive director of the Institute for Health and Socio- Economic Policy, a nonprofit research group in Oakland. "Many of the charges for various cases and DRGs (diagnostic-related groups) are double for what everyone else is charging. That's an enormous red flag."
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Tenet has relied on "stop-loss provisions" to increase payments from insurers. Stop-loss provisions require insurers to reimburse Tenet more than the set per-diem for expensive cases. High list prices would trigger the stop- loss clause more often.
Stop loss "has become a back-door way (for hospitals) to rapidly increase compensation," said Chris Ohman, vice president at Blue Shield of California.
A hospital often can charge its list prices to insurers when people seek medical care outside their regular network -- if they fall ill while traveling,
But the bills (In one such case described) were another story. They've received an avalanche of bills for tens of thousands of dollars, the difference between what their insurer paid and what Tenet charged.
-- HMO withdrawals:
In the past couple of years, Shasta County, where Redding Medical Center is located, has lost all its HMO plans. HMOs said they pulled out because it was too expensive to do business there, citing - - - -- and the high sticker prices at Redding Medical Center. While HMOs increasingly are leaving other rural counties for similar reasons, Shasta still appears to stand out, both in cost and in treatment rate.
"In Shasta, we were seeing admits (hospital admissions) that were around two times higher than what we'd see in our book of business for the rest of the state," said George Anderson, a vice president at Health Net in Woodland Hills (Los Angeles County). Health Net pulled out of Shasta County in 1999. "Some of the more elective procedures, particularly in the surgical area, such as hysterectomies and colon surgeries, were much higher -- three or four times more than the rest of the state."
An analysis of state data by the service employees union shows that Tenet's charges in Shasta outpace its rivals by big margins. For a coronary bypass with cardiac catheterization, Tenet's Redding Medical Center charged $228,793 in 2000 -- 184 percent more than the average $80,500 charged by the other four hospitals in Shasta County.
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Uninsured people lack the resources to pay huge medical bills. But by charging them high prices, Tenet can run up a large figure for bad debt. That is then used to calculate how much state money Tenet collects for charity cases, said K.B. Forbes, spokesman for Consejo de Latinos Unidos. The Los Angeles advocacy group for Latinos has filed several lawsuits accusing Tenet of predatory pricing for uninsured patients.
"We think it is part of a corporate culture that looks at opportunity and tries to aggressively collect money and make profits," Forbes said. Profiting from health care :: Hospital chain's steep prices blamed for raising costs for all San Francisco Chronicle November 14, 2002
It is interesting that in 1993 the
West
Australian Health Department
(6.8)
advised the health minister to set up a process to rid the state of
Tenet/NME and revise regulatory processes to cope with similar
threats. One of the hypothetical models to show how the system could
be similarly exploited was heart disease screening. Had Tenet been
allowed to stay in Australia this prophetic example might now be with
us today.
One of the hearsay and unconfirmed stories about Tenet/NME's
international division which I heard in 1990/1 but never repeated
publicly as I had no proof involved increasing profits by excessive
investigation including unwarranted invasive cardiac procedures.
Tenet's deliberate targeting of complex cases and its manipulation of compensatory payments is a disgrace. These were set in place to be fair to the companies and to discourage them from cherry picking. Their tactics illustrates the impossibility of providing ethical and responsible health care in a market driven system, particularly one where investors call the tune. What sort of people stab you in the back when you are trying to help them? What sort of pressures make them do it?
Also, shouldn't we now start questioning whether any for-profit healthcare company that pursues such an aggressive path toward maximizing profits is a good thing for patients, payers and the healthcare system as a whole? It's not the for-profit status that bothers me; it's the public ownership. Healthcare isn't just any other business, and the need to satisfy investors with earnings growth each quarter drives some executives to do things they might not do otherwise.Tenet's turn :: Another for-profit under scrutiny raises questions about publicly traded chains Modern Healthcare November 18, 2002
In this situation we should be concerned about the likelihood that
This is exactly what NME did in the
late 1980's and early 1990's. They have shown no signs of reforming
their culture or their market practices. It is therefore very
probable that the allegations of fraudulently overcharging Medicare,
poor care, and unnecessary procedures are valid and that the
practices are systemic.
Most of us would consider the deliberate overpricing and manipulation of weaknesses in Medicare to boost profits to this extent as blatant fraud. The response of the market suggests that they know this. Dr Pearce and his shareholder group clearly believe this. An analysis performed by them indicated that Tenet could have to pay up to $6 billion. This is improbable as the government does not levy fines which would force large health care companies out of business or which would seriously compromise care. The social costs of the collapse of a major hospital provider are prohibitive.
Tenet Healthcare Corp. (THC.N) could face up to $6 billion in legal liabilities to the federal government from the way it charged to treat Medicare patients with unusual costs, a shareholder group said on Monday.
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The group, which is headed by Dr. M. Lee Pearce, conducted its own research with six attorneys about the Centers for Medicare and Medicaid rules and the potential exposure and legal penalties, including the possibility of treble damages under the law. Tenet Group Sees Up to $6 Bln Liability New York Times (Reuters) April 7, 2003
While admitting that its practices were
overly aggressive Tenet claimed that its practices were legal and
some analysts seemed to agree. The company and its CEO claim that
they did not know of the "outlier" problem until outsiders exposed
it.
The problem in dealing with this company is that it has a history of
denial, dishonesty and deception going back probably 20 years and its
recent statements are not credible. It is not possible to believe
anything it says and most of its claims if not frankly dishonest
contain an element of deception. Most worrying is that much of this
is self deception.
The Company's annual report on form 10-K stated, in each of the last three years, that outlier payments in the following year will be lower than the base year. In view of the increased outlier payments these statements were obviously untrue. It is also obviously material, given the decline in the stock price when the correct information was made public. Tenet also failed to disclose the importance of the outlier payments to Tenet's financial results. Letter to Tenet's board by Dr Pearce December 2002
On 29th October 2002 an analyst
identified the outlier problem and advised negatively on Tenet's
share value. The problem had also been identified by an insurer
acting for the government. The company received notification of a
nationwide audit of its billing practices at the same time. Tenet
delayed a week before notifying shareholders. Its share price
plummeted.
Federal Medicare authorities had also picked up the anomaly and
immediately started an audit of Tenet's outlier payments. In January
2003 Tenet received a subpoena from the Department of Justice seeking
documents related to Medicare outlier payments. It remains to be seen
whether this results in fraud charges but the government is taking
steps to block the loophole provided by outlier payments. This will
have large impact on profits. Also in January the California
Assembly's Committee on Health started a hearing to inquire into
Tenet's billing practices.
In February the California Public Employees Retirement System
released a report documenting that Tenet charge to its beneficiaries
were 46% higher than the average and its stop-loss payments 23-26%
compared with 3%.
The US Securities and Exchange Commission (SEC) had started an informal investigation of insider trading soon after the scandal broke. In July 2003 it started a full investigation into Tenet's business practices including its outlier and stop-loss payments. It subpoenaed documents.
The Department of Health and Human Services contacted Tenet about performing an audit to make sure the payments were appropriate, Tenet said, and the agency will examine how the payments were calculated. The federal inquiry coincides with increasing analyst concern about the issue, and Tenet has insisted that it is entitled to these special payments. Tenet Faces Agency Audit Of Payments For Medicare Excerpted by SEIU from the New York Times, November 7, 2002:
Officials at the Department of Health and Human Services said the audit, which was first made known to Tenet on Oct. 28, was prompted by concerns raised by a contractor that processes Medicare claims for the government.
Department officials declined to provide details, but said the audit would examine "outlier payments" made to Tenet's hospitals nationally.
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Analysts said both the audit and the fact that Tenet waited more than a week to disclose it presented problems. U.S. to Audit Tenet Hospital Bills LA Times November 7, 2002
Tenet Healthcare Corporation (NYSE: THC) said that it received today an administrative investigative demand subpoena from the Department of Justice seeking documents related to Medicare outlier payments.
The demand requests documents from Tenet and 19 hospitals owned by its subsidiaries. Fifteen of the 19 hospitals are located in California; the remaining facilities are in Texas, Pennsylvania and Louisiana. The demand focuses on the time period from January 1, 1997 through the present. Tenet Receives DOJ Demand for Information Regarding Medicare Outlier Payments Tenet Healthcare web site January 02, 2003
The Securities and Exchange Commission has subpoenaed Tenet Healthcare Corp., Santa Barbara, Calif., for patient-billing records dating back to 1997, Tenet said. The subpoena indicates the SEC has elevated its 8-month-old probe of Tenet into a formal investigation. The SEC began an informal inquiry in November, shortly after Tenet's relatively high Medicare outlier payments were revealed. The subpoena demands billing documents dating back to May 31, 1997, and covers documents related to stop-loss payments as well as to outlier payments. Like federal outlier payments, stop-loss payments made by private health plans are meant to compensate providers for extraordinarily costly cases. The SEC also asked for documents related to increases in Tenet's gross charges, SEC subpoenas Tenet in outlier payments probe Modern Healthcare July 9, 2003
The many other investigations and the many lawsuits are an integral part of Tenet's misconduct and they are all part of the same broad problem. Tenet's claims that most of these are separate issues is obvious nonsense. They are all a consequence of its practices. The utlier problem is simply one visible manifestation of corporate thinking and policy. It cannot be separated from the pressure to do unnecesary operations.
Most of these are addressed in other pages. Two are referred to in the extracts below. Note the suggestion that doctors have been pressured to keep patients in hospital longer than required. In the 1990's policies were set in place in Tenet/NME hospitals specifying how long each patient should stay based on the amount of money the insurer would pay and not on the diagnosis or patient's clinical condition.
The California Assembly Health Committee will open hearings in January to investigate whether Tenet and other hospital chains charged health maintenance organizations and the state too much for services and drugs, said Assemblyman Dario Frommer (D-Los Feliz), the committee chairman.
Tenet executives will be asked to testify and turn over records and pricing schedules. Frommer vowed to subpoena hospital officials if necessary. State Investigates Billing Practices of Tenet, Others LA TIMES December 5, 2002
The hearings, expected to start in January, would largely focus on allegations that Tenet Healthcare overbilled patients, HMOs and the state, as well as charges that a pair of Redding doctors performed unnecessary operations.
The committee is expected to hear from doctors who say they were told to keep patients hospitalized longer than necessary. The committee also will explore whether the for-profit hospital chains tweaked rules to pad patients' bills. Legislators to eye billings by hospitals The Sacramento Bee December 5, 2002
"Our system tolerates a wide variation in pricing that's not related to a variance in quality of care or patient satisfaction," Allen Feezor, assistant executive director of CalPERS, told the Assembly Health Committee. Tenet Criticized at Assembly Hearing LA Times (Associated Press) February 7, 2003
Tenet Healthcare Corp., Santa Barbara, Calif., is under fire again for high charges. A new report prepared for the California Public Employees Retirement System said Tenet hospitals charged CalPERS beneficiaries 32% more per discharge than other large hospital systems in California and 46% more than the statewide average. The study covered the first 10 months of 2002. The report was prepared by Blue Cross of California, CalPERS' third-party administrator, in preparation for a hearing tomorrow on hospital pricing by a committee of the state Assembly. The report also noted that Tenet's 188-bed Redding (Calif.) Medical Center and 392-bed Doctors Medical Center in Modesto, Calif., had high stop-loss rates -- 23% and 26%, respectively, compared with the 3% average among Blue Cross network hospitals. New report slams Tenet on eve of Calif. hearing Modern Healthcare February 3, 2003
