Outlier Payments Sample Clauses

Outlier Payments. HealthSouth received outlier payments from January 1, 2002 through September 30, 2003 for eleven inpatient facilities acquired by HealthSouth from NME in 1993. The outlier payments were based on the Medicare cost-to-charge ratios contained in the 1994 cost reports for those facilities. Those 1994 cost reports contained false Favorable Lease Claims as described in Article II, Paragraph G(4)(b)(6). The false Favorable Lease Claims inflated the cost-to-charge ratios in the 1994 cost reports, resulting in outlier overpayments between January 1, 2002 and September 30, 2003. The relevant facilities are identified on Attachment E.

Outlier Payments. From October 1, 1995 through August 7, 2003, the Tenet Entities allegedly submitted or caused to be submitted claims to the Government Health Care Programs for inpatient and outpatient outlier payments that the Tenet Entities were not entitled to receive because (a) the Tenet Entities allegedly had artificially and purposely inflated the charges billed for inpatient and outpatient care substantially in excess of any increase in the costs associated with that care, (b) as a result, the Xxxxx Entities allegedly improperly received outlier payments that were further inflated because they were computed pursuant to statewide average cost-to-charge ratios that should not properly have applied, and (c) the Xxxxx Entities allegedly billed for inpatient and outpatient services and supplies not provided to patients. Certain of these claims were submitted by hospitals identified in the relators’ Complaint filed in U.S. ex rei. [Under Seal] x. Xxxxx Healthcare Corporation. et al., Case No. 02-8309, (E.D. Pa.). As a result of these artificially inflated and allegedly false claims, the Tenet Entities allegedly caused the Government Health Care Programs to pay to Tenet money that lawfully belonged to the United States in that it exceeded the amount Tenet would have received had these claims not been artificially inflated and false.

Outlier Payments. From October 1, 1995 through August 7, 2003, the Xxxxx Entities allegedly submitted or caused to be submitted claims to the Government Health Care Programs for inpatient and outpatient outlier payments that the Xxxxx Entities were not entitled to receive because (a) the Xxxxx Entities allegedly had artificially and purposely inflated the charges billed for inpatient and outpatient care substantially in excess of any increase in the costs associated with that care, (b) as a result, the Xxxxx Entities allegedly improperly received outlier payments that were further inflated because they were computed pursuant to statewide average cost-to-charge ratios that should not properly have applied, and (c) the Xxxxx Entities allegedly billed for inpatient and outpatient services and supplies not provided to patients. [**] As a result of these artificially inflated and allegedly false claims, the Xxxxx Entities allegedly caused the Government Health Care Programs to pay to Xxxxx money that lawfully belonged to the United States in that it exceeded the amount Xxxxx would have received had these claims not been artificially inflated and false.