CLAIMS AND LAWSUITS | NOTE 10. CLAIMS AND LAWSUITS We operate in a highly regulated and litigious industry. As a result, we commonly become involved in disputes, litigation and regulatory matters incidental to our operations, including governmental investigations, personal injury lawsuits, employment claims and other matters arising out of the normal conduct of our business. We record accruals for estimated losses relating to claims and lawsuits when available information indicates that a loss is probable and we can reasonably estimate the amount of the loss or a range of loss. If a loss on a material matter is reasonably possible and estimable, we disclose an estimate of the loss or a range of loss. In cases where we have not disclosed an estimate, we have concluded that the loss is either not reasonably possible or the loss, or a range of loss, is not reasonably estimable, based on available information. Governmental Reviews and Lawsuits Healthcare companies are subject to numerous investigations by various governmental agencies. Further, private parties have the right to bring qui tam or “whistleblower” lawsuits against companies that allegedly submit false claims for payments to, or improperly retain overpayments from, the government and, in some states, private payers. We and our subsidiaries have received inquiries in recent years from government agencies, and we may receive similar inquiries in future periods. The following matters, which have been previously reported, are pending. · Clinica de la Mama Investigations and Qui Tam Action— We received a subpoena in May 2012 from the Office of Inspector General (“OIG”) of U.S. Department of Health and Human Services in Atlanta seeking documents from January 2004 through May 2012 related to the relationship that certain of our Georgia and South Carolina hospitals had with Hispanic Medical Management, Inc. (“HMM”). HMM was an unaffiliated entity that owned and operated clinics that provided, among other things, prenatal care predominantly to uninsured patients. The hospitals contracted with HMM for translation, marketing, management and Medicaid eligibility determination services. The civil investigation is being conducted by the Civil Division of the U.S. Department of Justice (“DOJ”), the U.S. Attorney’s Office for the Middle District of Georgia and the Georgia Attorney General’s Office, while a parallel criminal investigation is being conducted by the Criminal Division of the DOJ and the U.S. Attorney’s Office for the Northern District of Georgia. The investigations arose out of a qui tam action captioned United States of America, ex. rel. Ralph D. Williams v. Health Management Associates, Inc., et al. filed in the U.S. District Court for the Middle District of Georgia. We and four of our hospital subsidiaries are defendants in the qui tam action, which alleges that the arrangements the hospitals had with HMM violated the federal and state anti-kickback statutes and false claims acts. Both the Georgia Attorney General’s Office, on behalf of the State of Georgia, and the U.S. Attorney’s Office, on behalf of the United States, have intervened in the qui tam action. We submitted answers to the complaints filed by the relator, the State of Georgia and the United States in July 2014 following the court’s denial of our motions to dismiss in June 2014. This civil matter had been stayed since July 2014 pending further proceedings in the criminal case described below; however, on June 22, 2015, the court entered an order partially lifting the stay and allowing limited discovery to proceed. In a Bill of Information filed on July 23, 2014 with the U.S. District Court for the Northern District of Georgia, Atlanta Division, the U.S. Attorney for that District asserted charges of one count of criminal conspiracy against a former owner of HMM (a non-employee of Tenet) related to the agreements between HMM and the Tenet hospitals described above. In a separate Bill of Information also filed with the court on July 23, 2014, the U.S. Attorney asserted charges of one count of criminal conspiracy against a former employee of a Tenet hospital, but such charges relate to an unaffiliated entity. On April 10, 2015, the DOJ informed us that our four hospital subsidiaries that are defendants in the qui tam action have also been designated as targets of the government’s criminal investigation. On May 6, 2015, we received a grand jury subpoena pursuant to which the DOJ informed us that it is seeking additional documents pertaining to the four hospitals, as well as other hospitals in our Southern region. These are hospitals that might have had interactions during the period from January 2000 through May 2015 with certain individuals who are targets of the pending criminal investigation. We are in the process of producing responsive documents to this subpoena. As previously disclosed, if we or our subsidiaries are determined to have violated the anti-kickback statutes in connection with the civil matter discussed above, the government could require us to reimburse related government program payments received during the subject period and assess civil monetary penalties including treble damages. If we or our subsidiaries are determined in the criminal proceeding to have violated the anti-kickback statutes, the sanctions could also include exclusion from participation in federal healthcare programs or criminal sanctions against current or former employees of our hospital subsidiary companies or the hospital companies themselves. Because these criminal investigations and proceedings are at an early stage, it is impossible at this time to predict with any certainty the terms, or potential impact on our business or financial condition, of any potential resolution of these matters. We will continue to vigorously defend against the government’s allegations. Management has established a reserve of approximately $20 million to reflect the low end of the range of probable liability in connection with the civil matter discussed above. However, changes in the reserve may be required in the future as additional information becomes available, and the ultimate amount required to resolve such matter could materially exceed the reserve. The following matters, which have been previously reported, have recently been resolved. · Implantable Cardioverter Defibrillators (“ICDs”) — Fifty-six of our hospitals have been subject to a DOJ review commenced in March 2010 to determine whether ICD procedures performed at the hospitals from 2002 to 2010 complied with Medicare coverage requirements. In July 2015, we reached final agreement with the DOJ to resolve the investigation for $12.1 million, which was fully reserved as of June 30, 2015 and paid on August 3, 2015. · Review of Conifer’s Debt Collection Activities —Syndicated Office Systems, LLC, a wholly owned indirect subsidiary of Conifer Health Solutions, LLC doing business under the name Central Financial Control (“CFC”), in August 2013 and July 2014 received Civil Investigative Demands from the U.S. Consumer Financial Protection Bureau (“CFPB”). In January 2015, CFC began discussions with the CFPB to address the agency’s concerns that in limited instances CFC had not fully complied with certain notification requirements under federal consumer protection laws. On June 18, 2015, CFC stipulated to a Consent Order issued by the CFPB to resolve the matter. Under the Consent Order, CFC must implement plans for consumer redress and compliance with federal consumer protection laws and must provide periodic reports to the CFPB over five years. CFC also agreed to forgive approximately $ 0.3 million in consumer debt and to pay $5.6 million under the Consent Order. Based on the status of discussions with the CFPB, in May 2015 management increased the reserve previously established for this matter from $1.7 million at December 31, 2014 to $5.2 million as of June 30, 2015. Antitrust Class Action Lawsuits Filed by Registered Nurses in Detroit and San Antonio In Cason-Merenda, et al. v. VHS of Michigan, Inc. d/b/a Detroit Medical Center, et al. , filed in December 2006 in the U.S. District Court for the Eastern District of Michigan, a certified class composed of the registered nurses (exclusive of supervisory, managerial and advanced practical nurses) employed by eight unaffiliated Detroit-area hospital systems allege those hospital systems, including Detroit Medical Center (“DMC”), violated Section §1 of the federal Sherman Act by exchanging compensation-related information among themselves in a manner that has reduced competition and suppressed the wages paid to such nurses. A subsidiary of Vanguard acquired DMC in January 2011, and we acquired Vanguard in October 2013. All of the defendant hospital systems, other than DMC, have settled. The matter is now set for trial to commence in September 2015. Absent settlement of this matter, we will continue to vigorously defend ourselves against the plaintiffs’ allegations. We cannot predict with any certainty the terms of any potential resolution of this matter. In Maderazo, et al. v. VHS San Antonio Partners, L.P. d/b/a Baptist Health Systems, et al. , filed in June 2006 in the U.S. District Court for the Western District of Texas, a purported class of registered nurses employed by three unaffiliated San Antonio-area hospital systems allege those hospital systems, including Baptist Health System, and other unidentified San Antonio regional hospitals violated Section §1 of the federal Sherman Act by conspiring to depress nurses’ compensation and exchanging compensation-related information among themselves in a manner that reduced competition and suppressed the wages paid to such nurses. The lawsuit was filed by the same group of class action attorneys who filed several similar cases around the country in the same time frame, including one against DMC in Detroit, as discussed in the Cason-Merenda proceeding described above. The suit seeks unspecified damages (subject to trebling under federal law), interest, costs and attorneys’ fees. The parties have engaged in discovery related to the issue of class certification, and the plaintiffs filed a motion to certify the class in April 2008. The case has been stayed since that time. On July 22, 2015, the court granted plaintiffs’ July 2013 motion to lift the stay and re-open discovery in this matter. Because these proceedings are at an early stage, it is impossible at this time to predict their outcome with any certainty; however, we believe that the ultimate resolution of this matter will not have a material effect on our business, financial condition or results of operations. We will continue to seek to defeat class certification and vigorously defend ourselves against the plaintiffs’ allegations. Ordinary Course Matters We are also subject to other claims and lawsuits arising in the ordinary course of business, including potential claims related to, among other things, the care and treatment provided at our hospitals and outpatient facilities, the application of various federal and state labor laws, tax audits and other matters. Although the results of these claims and lawsuits cannot be predicted with certainty, we believe that the ultimate resolution of these ordinary course claims and lawsuits will not have a material effect on our business or financial condition. In addition, in October 2014, we received court approval of a final agreement to settle a previously disclosed class action lawsuit captioned Doe, et al. v. Jo Ellen Smith Medical Foundation , which was filed in the Civil District Court for the Parish of Orleans in Louisiana in March 1997. The plaintiffs pursued a claim for tortious invasion of privacy due to the fact that in April 1996 patient identifying records from a psychiatric hospital we closed in 1995 were temporarily placed in an unsecure location while the hospital was undergoing renovations. The court certified a class of over 5,000 persons; however, only eight individuals (in addition to the two plaintiffs) were identified in the class certification process. The plaintiffs asserted each member of the class is entitled to common damages under a theory of presumed “common damage” regardless of whether or not any members of the class were actually harmed or even aware of the incident. To avoid protracted litigation, the parties settled this matter in June 2014 for a maximum potential payment of $32.5 million, subject to the number and type of claims asserted by the class members. The payment for all undisputed common damages claims was made in April 2015, and a payment representing a portion of the attorneys’ fees was paid in June 2015. The payment for the remaining attorneys’ fees and administrative costs, as well as the undisputed individual damages claims, was made on August 3, 2015. We had made an initial deposit of $5.5 million into an escrow account in late November 2014 and, based on low class participation as of March 31, 2015 (the end of the claims period), management reduced the reserve for this matter from $11.5 million at December 31, 2014 to $8.0 million, recorded in discontinued operations, to reflect its then-current estimate of probable remaining liability. In total, we paid $13.6 million to settle this matter. New claims or inquiries may be initiated against us from time to time. These matters could (1) require us to pay substantial damages or amounts in judgments or settlements, which, individually or in the aggregate, could exceed amounts, if any, that may be recovered under our insurance policies where coverage applies and is available, (2) cause us to incur substantial expenses, (3) require significant time and attention from our management, and (4) cause us to close or sell hospitals or otherwise modify the way we conduct business. The table below presents reconciliations of the beginning and ending liability balances in connection with legal settlements and related costs recorded during the six months ended June 30, 2015 and 2014 : Balances at Litigation and Balances at Beginning Investigation Cash End of of Period Costs Payments Other Period Six Months Ended June 30, 2015 Continuing operations $ $ $ $ $ Discontinued operations — $ $ $ $ $ Six Months Ended June 30, 2014 Continuing operations $ $ $ $ $ Discontinued operations — $ $ $ $ $ For the six months ended June 30, 2015 and 2014 , we recorded costs of $17 million and $15 million, respectively, in continuing operations, primarily related to costs associated with various legal proceedings and governmental reviews. During the six months ended June 30, 2015 , we reduced a previously established reserve for a legal matter in discontinued operations by approximately $3 million based on updated claims information. |