Tenet Healthcare

Last updated
Tenet Healthcare Corporation
Public company
Traded as NYSE:  THC
S&P 400 Component
Industry Healthcare
Founded1967
Headquarters Fountain Place
Dallas, Texas, U.S.
Key people
Ronald Rittenmeyer
(Executive chairman and CEO)
ServicesHospital management
RevenueDecrease2.svg US$18.313 billion(2018) [1] [2]
Increase2.svgUS$1.674 billion(2018) [1]
Increase2.svgUS$111 million(2018) [1]
Total assets Decrease2.svgUS$22.409 billion(2018) [1]
Total equity Decrease2.svgUS$-119 million(2018) [1]
Number of employees
115,500 (2018) [1] [3]
Subsidiaries United Surgical Partners International
Website www.tenethealth.com

Tenet Healthcare Corporation is a multinational investor-owned healthcare services company based in Dallas, Texas, United States. Through its brands, subsidiaries, joint ventures, and partnerships, [4] including United Surgical Partners International (USPI), [5] the company operates a number of facility types. [6] [7] [8] [9] At the end of 2018, Tenet had 115,500 employees and operated 68 hospitals with approximately 17,935 licensed beds, 23 surgical hospitals, and 475 outpatient centers. The company subsequently sold three hospitals in the Chicago area in January 2019, bringing the total hospital count to 65. [1]

Multinational corporation large corporation doing business in many countries

A multinational corporation (MNC) or worldwide enterprise is a corporate organization which owns or controls production of goods or services in at least one country other than its home country. Black's Law Dictionary suggests that a company or group should be considered a multinational corporation if it derives 25% or more of its revenue from out-of-home-country operations. A multinational corporation can also be referred to as a multinational enterprise (MNE), a transnational enterprise (TNE), a transnational corporation (TNC), an international corporation, or a stateless corporation. There are subtle but real differences between these three labels, as well as multinational corporation and worldwide enterprise.

An investor is a person that allocates capital with the expectation of a future financial return. Types of investments include: equity, debt securities, real estate, currency, commodity, token, derivatives such as put and call options, futures, forwards, etc. This definition makes no distinction between the investors in the primary and secondary markets. That is, someone who provides a business with capital and someone who buys a stock are both investors. An investor who owns a stock is a shareholder.

Dallas City in Texas, United States

Dallas, officially the City of Dallas, is a city in the U.S. state of Texas and the seat of Dallas County, with portions extending into Collin, Denton, Kaufman and Rockwall counties. With an estimated 2017 population of 1,341,075, it is the ninth most-populous city in the U.S. and third in Texas after Houston and San Antonio. It is also the eighteenth most-populous city in North America as of 2015. Located in North Texas, the city of Dallas is the main core of the largest metropolitan area in the Southern United States and the largest inland metropolitan area in the U.S. that lacks any navigable link to the sea. It is the most populous city in the Dallas–Fort Worth metroplex, the fourth-largest metropolitan area in the country at 7.5 million people as of 2018. The city's combined statistical area is the seventh-largest in the U.S. as of 2017, with 7,846,293 residents.

Contents

Since its founding in 1967, Tenet has expanded significantly. Among other major acquisitions and formations, Tenet founded Conifer Health Solutions in 2008, [10] MedPost Urgent Care in 2014, [11] and in 2013 acquired Vanguard Health Systems, Inc., an investor-owned hospital company whose operations complemented Tenet's existing business. [12] The acquisition created the third-largest investor-owned hospital company in the United States in terms of revenue and the third-largest in number of hospitals owned. [13] In 2015, Tenet acquired USPI, which created the largest operator of outpatient surgery centers in the United States. [5] In 2018, the company ranked 147th in the Fortune 500. [14]

Outpatient surgery, also known as ambulatory surgery, day surgery, day case surgery, or same-day surgery, is surgery that does not require an overnight hospital stay. The term “outpatient” arises from the fact that surgery patients may enter and leave the facility on the same day. The advantages of outpatient surgery over inpatient surgery include greater convenience and reduced costs.

<i>Fortune</i> 500 Annual list compiled and published by Fortune magazine

The Fortune 500 is an annual list compiled and published by Fortune magazine that ranks 500 of the largest United States corporations by total revenue for their respective fiscal years. The list includes publicly held companies, along with privately held companies for which revenues are publicly available. The concept of the Fortune 500 was created by Edgar P. Smith, a Fortune editor, and the first list was published in 1955. The Fortune 500 is more commonly used than its subset Fortune 100 or superset Fortune 1000.

History

1967–1999

Tenet was founded in 1967 by attorneys Richard Eamer, Leonard Cohen and John Bedrosian as National Medical Enterprises (NME) and headquartered in Los Angeles, California. [15] By 1975, NME owned, operated, and managed 23 hospitals and a home health care business. [15] [16] In the 1970s, NME expanded into hospital construction and bought five Florida hospitals. By 1981, NME owned or managed 193 hospitals and nursing homes, and became the third-largest healthcare company in the U.S. [15] In the mid-1980s, NME shifted its focus to specialty hospitals. By 1990, the company had 200 hospitals in its network and was the second-largest hospital company in the U.S. [15] [16]

Los Angeles City in California

Los Angeles, officially the City of Los Angeles and often known by its initials L.A., is the most populous city in California, the second most populous city in the United States, after New York City, and the third most populous city in North America. With an estimated population of four million, Los Angeles is the cultural, financial, and commercial center of Southern California. The city is known for its Mediterranean climate, ethnic diversity, Hollywood and the entertainment industry, and its sprawling metropolis. Los Angeles is the largest city on the West Coast of North America.

California State of the United States of America

California is a state in the Pacific Region of the United States. With 39.6 million residents, California is the most populous U.S. state and the third-largest by area. The state capital is Sacramento. The Greater Los Angeles Area and the San Francisco Bay Area are the nation's second- and fifth-most populous urban regions, with 18.7 million and 9.7 million residents respectively. Los Angeles is California's most populous city, and the country's second-most populous, after New York City. California also has the nation's most populous county, Los Angeles County, and its largest county by area, San Bernardino County. The City and County of San Francisco is both the country's second-most densely populated major city after New York City and the fifth-most densely populated county, behind only four of the five New York City boroughs. The state is home to five of the top-10 most expensive cities in the United States.

After some scandals in the early 1990s (see below), NME divested its specialty facilities. [15] Tenet possessed a dominant market share in Southern California at the time and envisaged the same prospects in South Florida, Louisiana, Texas, and the Philadelphia, Pennsylvania area. In 1994, NME bought American Medical Holdings for $3.35 billion, which strengthened its presence in Southern California and South Florida, and extended into New Orleans, Louisiana and Texas. [17] [18] Following completion of the acquisition, NME changed its name to Tenet Healthcare Corporation. [17] In 1996, Tenet CEO Jeffrey Barbakow moved Tenet's headquarters from Santa Monica, California to Santa Barbara. [19] In 1998, Tenet purchased eight Philadelphia hospitals owned by the bankrupt Allegheny Health, Education & Research Foundation for $345 million. [20]

Southern California Place in California, United States

Southern California is a geographic and cultural region that generally comprises California's southernmost counties, and is the second most populous urban agglomeration in the United States. The region contains ten counties: Imperial, Los Angeles, Orange, Riverside, San Bernardino, San Diego, Santa Barbara, San Luis Obispo, Ventura, and Kern counties.

South Florida Place in Florida, United States

South Florida is a geographic and cultural region that generally comprises Florida's southernmost counties, including Miami-Dade, Broward, and Palm Beach. It is the fourth most populous urban agglomeration in the United States. It is one of Florida's three most common "directional" regions, the others being Central Florida and North Florida. It includes the populous Miami metropolitan area, the Everglades, the Florida Keys, Treasure Coast, and other localities. South Florida is the only part of the continental United States with a tropical climate.

Louisiana State of the United States of America

Louisiana is a state in the Deep South region of the South Central United States. It is the 31st most extensive and the 25th most populous of the 50 United States. Louisiana is bordered by the state of Texas to the west, Arkansas to the north, Mississippi to the east, and the Gulf of Mexico to the south. A large part of its eastern boundary is demarcated by the Mississippi River. Louisiana is the only U.S. state with political subdivisions termed parishes, which are equivalent to counties. The state's capital is Baton Rouge, and its largest city is New Orleans.

2000–2013

In 2002, one of Tenet's hospitals came under scrutiny for its surgical practices and another was investigated in a kickback scheme (see below). [21] Federal investigations into the company's billing practices, particularly those related to Medicare, began late in 2002, leading to a decline in Tenet’s stock price of about 70%. [15] [19] In 2003, Trevor Fetter became CEO of Tenet and started Commitment to Quality, an initiative to improve the “quality, safety, service and outcomes of the care and services” provided by Tenet. [22] [23] To rebuild its ethics and compliance programs, Tenet hired a chief compliance officer to report directly to the company’s board of directors. [24] [25] In 2003, Tenet sold or closed 14 hospitals and closed more than 20 facilities in 2004 to achieve its financial performance goals. [26] [27] Also in 2004, Tenet moved its headquarters from Santa Barbara, California to Dallas, Texas. [19] In 2006, Tenet agreed to pay $725 million to the Justice Dept. to settle allegations of unusually high Medicare payments to Tenet hospitals in 2000 to 2002. [28] [29] Tenet also entered into a 5-year corporate integrity agreement with the U.S. Department of Health & Human Services that required the company to provide detailed financial reports on its patient mix, collection rates and accounts receivables. [30] [31] In 2007, Tenet appointed former Florida governor Jeb Bush to its board of directors to improve its reputation. [32]

A kickback is a form of negotiated bribery in which a commission is paid to the bribe-taker in exchange for services rendered. Generally speaking, the remuneration is negotiated ahead of time. The kickback varies from other kinds of bribes in that there is implied collusion between agents of the two parties, rather than one party extorting the bribe from the other. The purpose of the kickback is usually to encourage the other party to cooperate in the illegal scheme.

Medicare (United States) United States single-payer national social insurance program

Medicare is a national health insurance program in the United States, begun in 1966 under the Social Security Administration (SSA) and now administered by the Centers for Medicare and Medicaid Services (CMS). It provides health insurance for Americans aged 65 and older, younger people with some disability status as determined by the Social Security Administration, as well as people with end stage renal disease and amyotrophic lateral sclerosis.

Trevor Fetter is an American businessman, the lead independent director of The Hartford Financial Services Group, and the former president, CEO, and chairman of Tenet Healthcare. He is a Senior Lecturer in the General Management unit of Harvard Business School (HBS), teaching Leadership and Corporate Accountability in its MBA program; his alma mater, where he is also a founding member of the HBS Healthcare Initiative Advisory Board, and a former member of the Board of Dean's Advisors. He has appeared several times on the “100 Most Influential People in Healthcare" list compiled by Modern Healthcare.

In 2008, Tenet launched Conifer Health Solutions, a healthcare services company. [10] [33] As of 2018, Conifer served approximately 800 clients in the United States [34] and processed $30 billion in net revenue annually. [35] In early 2009, the price of Tenet stock briefly dipped below $4 per share after cresting above $200 per share in 2002. [36] By the end of 2009, the company rebounded to become the S&P 500’s number 2 performer, with an operating revenue and net profit of $9 billion and $181 million, respectively. [37] [38] [39]

In May 2011, Tenet’s board rejected a $7.3 billion takeover bid from Community Health Systems, Inc. [40] The deal would have created the largest hospital company in the U.S. [40] In April 2012, Tenet agreed to pay $42.75 million to resolve allegations that it improperly billed Medicare between 2005 and 2007. [41] An internal investigation by Tenet revealed Medicare billing irregularities, and the company reported itself to the U.S. government. In May 2012, Tenet sold Diagnostic Imaging Services, Inc., its former diagnostic imaging center business in Louisiana. In August 2012, Tenet sold its Creighton University Medical Center in Nebraska. [6] In 2013, Tenet acquired Vanguard Health Systems, based in Nashville, Tennessee, in a deal worth $4.3 billion. [42] [43] Through its acquisition of Vanguard, Tenet acquired 28 hospitals and 39 outpatient centers that served communities in Arizona, California, Illinois, Massachusetts, Michigan and Texas. [6] [43] [44] The acquisition created the third-largest for-profit hospital chain in the U.S. in terms of revenue and the third-largest in number of hospitals owned. [13] [45] Through the end of 2013, Tenet’s stock price increased 816 percent, from $4.60 to $42.12, over the previous five years. [46]

2014

In 2014, Tenet ranked #229 in the annual Fortune 500 list of the largest American companies. [45] In March 2014, Tenet formed a partnership with the Yale New Haven Health System to create a healthcare delivery network in Connecticut. [47] Then in May 2014, Tenet announced plans to partner with the Texas Tech University Health Sciences Center in El Paso to develop a new 140-bed teaching hospital on the city’s west side. [48] Tenet launched MedPost Urgent Care in May 2014, which is a national network of urgent care centers. [11] Previously, Tenet's urgent care locations often took on the names of nearby Tenet hospitals. At the time of the rebranding, MedPost had 23 facilities, with six in Texas, and others in Arizona, California, Florida, Georgia, Mississippi, Missouri and Tennessee. [49] [50] In June 2014, Tenet acquired a majority interest in Texas Regional Medical Center, a 70-bed community hospital in Sunnyvale, Texas, east of downtown Dallas. [51] Also that month, Tenet opened Resolute Health Hospital in New Braunfels, Texas. The 128-bed hospital is located on a 56-acre “wellness” campus near San Antonio, Texas, and was Tenet's 79th hospital and 19th in Texas at the time. [52] [53]

In July 2014 Tenet announced that Saint Mary's Hospital in Waterbury, Connecticut would be acquired by a subsidiary of the company, with the hospital's religious directives and uncompensated care policies remaining intact. This continued a trend of Tenet allowing a model of common ownership, where each acquired hospital has its own agreement conditions. [54] This deal, and three others Tenet had planned in the state, unraveled when Tenet expressed concern with the conditions on the sale set by the state of Connecticut. The Waterbury hospital was ultimately purchased by Trinity Health. [55]

On August 1, 2014 Tenet acquired Emanuel Medical Center, [56] a 209-bed hospital operated by the Swedish Evangelical Covenant Church located in Turlock, California, [57] bringing the number of Tenet's hospitals at the time to 80 nationwide. [56] Tenet announced in December 2014 that they had signed a letter of intent with the Baptist hospital system in Birmingham, Alabama to form a joint venture to own and operate the four Baptist hospitals plus Brookwood Medical Center, already owned by Tenet. Tenet would be the joint venture's majority owner. [58]

As of the fourth quarter 2014, Tenet had turned a profit, explained by higher admissions and revenue (admissions through Medicaid increased by 20.5% after the Affordable Care Act). Hospital admissions also saw an increase during the last quarter of 2014, while the company's bad debt expense ratio decreased. At the same time, its full year financial projections affirmed a price of $1.32 to $2.4 per share with revenue of $17.4 to $17.7 billion, [59] with its earnings topping $1.95 billion. [60] On May 7, 2015, the Tenet board of directors appointed Trevor Fetter, Tenet's then president and CEO, as chairman of the board. [61] In 2015, the company moved from No. 229 to No. 170 on the Fortune 500. [62]

2015–2016

In March 2015, Tenet announced an agreement to acquire a majority interest in United Surgical Partners International (USPI), which would make Tenet the largest operator of outpatient surgery centers in the United States. [5] The June 2015 acquisition of USPI almost doubled Tenet's prior count of 210 outpatient centers. [6] [58] [63] [64] Tenet also announced an agreement to acquire Aspen Healthcare in Great Britain. [5] On June 16, Tenet finalized their acquisition of Aspen Healthcare Ltd. and USPI. The USPI transaction raised the number of outpatient centers operated by Tenet to over 400, over double what they had operated prior. It also again made Tenet a multinational company, as Tenet acquired nine British healthcare facilities. [4] Bill Wilcox remained CEO of USPI, and Kyle Burtnett of Tenet joined USPI as chief integration officer, among other roles. Through the deal, USPI retained its independent branding. [4]

Early in September 2015, [65] [66] Tenet acquired a majority interest in a three-hospital system in Tucson, Arizona, when Tenet, Dignity Health and Ascension Health formed a joint venture to own and operate the Carondelet Health Network. [65] [66] [67] The three hospitals' names remained unchanged, with close to 1,000 new beds added to the Tenet healthcare system as a result. [65] The acquisition of Carondelet Health Network raised the total number of Tenet's general acute care hospitals to 83. [66] On May 11, 2015, it was announced that the Tenet-operated Abrazo Health, acquired in 2013 as part of the Vanguard transaction, had been renamed Abrazo Community Health Network. [68]

After first announcing the deal in March 2015, [69] in January 2016 Tenet Healthcare closed a deal to form a joint venture [70] with the non-profit organization [71] Baylor Scott and White Health, with plans for the joint venture to own and operate a number of hospitals in North Texas. [70] The hospitals [70] were all rebranded under the Baylor name over the coming months: [72] Baylor Scott & White Medical Center — Centennial, [72] Baylor Scott & White Medical Center – White Rock, [73] Baylor Scott & White Medical Center – Lake Pointe, [74] and Baylor Scott & White Medical Center – Sunnyvale. [75]

On October 3, 2016, it was announced that Tenet had agreed to pay a $514 million settlement in an agreement with the Department of Justice. [76] According to the lawsuit filed in 2014, four hospitals then owned by Tenet had collaborated in a "kickback" scheme with Clinica de la Mama to increase hospital referrals of Medicaid patients, [77] with two of Tenet's former subsidiaries admitting to "conspiring to defraud Medicaid." [77] According to Modern Healthcare, as part of the agreement, the "federal government acknowledged that individuals at the hospitals withheld information from Tenet about the agreements and circumvented Tenet's policies and procedures to prevent such illegal conduct." [77]

In 2015, Tenet announced the acquisition of Baptist Health System of Birmingham, Alabama. Tenet's own Brookwood Medical Center in Birmingham would be included in the merger. The merger was finalized in 2016 and the new subsidiary was renamed Brookwood Baptist Health. [78]

In September 2016, an agreement between Tenet and Humana Inc, a health insurance company based in Louisville, Kentucky, came to an end, putting Tenet's facilities and physicians out-of-network for patients with Humana insurance, including those covered through commercial plans, Medicare Advantage, Healthcare Marketplace Exchange, Medicaid and TRICARE. [79] [80] A new agreement was reached in May 2017 and hospital outpatient centers and physicians returned to Humana Inc's network in June 2017. [81]

2017–present

Tenet Healthcare announced that the sale of three Houston hospitals and other facilities to HCA Healthcare was finalized in August 2017. The transaction was reported at $750 million in proceeds. [82] In August 2017, Glenview Capital Management removed two of its representatives from the Tenet board [83] over strategy disagreements with the board. [84] In September 2017 [85] there were "speculative" press reports [86] that Tenet was considering "strategic options" such as a sale. [85] In October 2017, the press reported that a sale was no longer being considered. Trevor Fetter stepped down as CEO in October 2017, and Ron Rittenmeyer was named CEO in addition to his position of executive chairman. [83] Tenet increased its ownership in USPI to 95 percent in April 2018. [87]

In August 2018, Tenet divested entirely from the United Kingdom. [88] In the United States in 2018, Tenet Healthcare sold the for-profit MacNeal Hospital, in Berwyn, Illinois, to the non-profit regional Roman Catholic Loyola Medicine. [89] In January 2019, Tenet Healthcare sold its three remaining Chicago-area for-profit hospitals to Los Angeles-based Pipeline Health, which is partially owned and operated by Eric E. Whitaker. The three hospitals in the sale were Louis A. Weiss Memorial Hospital, Chicago; Westlake Hospital, Melrose Park, Illinois; and West Suburban Medical Center, Oak Park, Illinois. [90] [91] Then, in February 2019 Whitaker announced that Pipeline Health would close Westlake Hospital within five months, keeping the other two open. [92]

Operations

Tenet Healthcare Corporation employs approximately 115,500 people. [1] Through its brands, subsidiaries, joint ventures, and partnerships with companies such as United Surgical Partners International (USPI), [6] [58] at the end of 2018, Tenet operated 68 acute and specialty hospitals and 475 outpatient centers in the United States. Also in the United States, Tenet operated 23 surgical hospitals. The company subsequently sold three hospitals in the Chicago area in January 2019, bringing the total hospital count to 65. [1] [93] [94] Tenet subsidiaries own or lease and operate a number of medical office buildings, all located on or near Tenet hospital campuses. [4] Tenet subsidiaries also operate free-standing and provider-based outpatient centers, including diagnostic imaging centers, ambulatory surgery centers, off-campus emergency departments and urgent care centers. [6]

Awards and recognition

Tenet Healthcare has received various honors for the company, including its operations and leadership. [95] In 2013, the American Heart Association recognized Tenet as a “Platinum Fit-Friendly Company.” [96] Tenet’s board of directors was named the Outstanding Board of Directors for a Public Company by the Dallas Business Journal [97] in September 2014. [98]

Philanthropy

In 2002, the Tenet Healthcare Foundation awarded a $1 million grant to provide financial support to Latino nursing students. [99] In 2004, Tenet Healthcare Foundation, Tenet’s charitable giving arm, awarded $2.78 million to support accelerated undergraduate and graduate nursing degree programs at five nursing colleges in Southern California, South Florida, Georgia and Texas. [100] In 2012, Tenet joined GE and Verizon in supporting the launch of the Clinton Health Matters Initiative, created by the William J. Clinton Foundation to build on its work on global health and childhood obesity. [101] In Tenet’s “2013 Sustainability Report: Tenet Cares,” the company stated that its support for local communities that year totaled $545 million in uncompensated care and $158 million in charity care. [46] In 2014, Tenet Healthcare was a presenting sponsor of the third annual Clinton Foundation Health Matters Conference in La Quinta, California. [102]

Controversies

Psychiatric fraud

In the early 1990s as National Medical Enterprises, the company was accused of committing fraud by admitting thousands of psychiatric patients who did not need hospitalization and then charging these patients inflated prices. [103] In 1991, the federal government investigated the company for fraud and conspiracy. [104] In 1993, law enforcement raided company offices in an attempt to show that the company was defrauding patients and insurance companies. [105] In 1994, the company paid $2.5 million to settle lawsuits from 23 patients at its psychiatric hospitals. [106] Again in 1994, National Medical Enterprises settled fraud charges with the United States and 28 states involving payments of a record $380 million at the time and federal guilty pleas on eight criminal counts by two of its units. The company also agreed to a 5-year corporate integrity agreement with the U.S. Department of Health and Human Services. [107]

Unnecessary heart surgeries

In the late 1990s through the early 2000s, Redding Medical Center (at the time, a Tenet-owned hospital), was investigated for performing unnecessary heart surgeries on over 600 patients. To settle these allegations, Tenet agreed to pay a $54 million fine to the federal government and the state of California, without admitting wrongdoing. This settlement did not preclude civil or criminal charges against individuals of the company. [108] In order for the hospital to continue receiving Medicare reimbursements, Tenet was compelled by federal regulators to sell the hospital which was subsequently renamed Shasta Regional Medical Center. [109] In 2004, Tenet paid an additional $395 million to 769 patients to settle litigation for the unnecessary surgeries. [110] The scandal and subsequent federal investigation are described in the book Coronary: A True Story of Medicine Gone Awry by author Stephen Klaidman. [111] [112] [113]

Medicare fraud

In June 2006, Tenet agreed to pay $725 million in cash and give up $175 million of Medicare payments for a total of $900 million in fees to resolve claims it defrauded the federal government for over-billing Medicare claims during the 1990s. To finance the settlement, they sold 11 hospitals in four states including Memorial Medical Center (see below). [114] [115] [116] In September of that year, Tenet entered into a 5-year corporate integrity agreement with the U.S. Department of Health and Human Services. [30] [31] That agreement expired on September 27, 2011.

Hurricane Katrina

In August 2005, Tenet-owned Memorial Medical Center in New Orleans, LA was struck by Hurricane Katrina. During and immediately following the storm, several hundred patients, visitors and staff sought medical care and shelter in the building. The hospital became surrounded by flood waters, which submersed the lower floors of the building, rendering the facility's emergency generators inoperable. Hospital staff were left to care for patients without electricity, sanitation, air conditioning, or adequate food and drinking water. The hospital was evacuated over the course of several days, during which time 45 patients died within the hospital building. It was alleged that staff intentionally hastened the death of several patients by administering lethal doses of sedatives and pain medication. In July 2006, Dr. Anna Pou and nurses Lori Budo and Cheri Landry were arrested after being charged by Louisiana Attorney General Charles Foti of second-degree murder in the deaths of four patients. [117] In August 2007, a New Orleans grand jury declined to indict the three women and a New Orleans judge expunged their arrest records. In July 2007, Dr. Pou sued Foti for defamation and damage to her career. [118] In June 2006, Tenet announced it planned to sell Memorial Medical Center and three other hospitals in the greater New Orleans area. [119] In July 2009, Gov. Bobby Jindal approved by a bill passed by the Louisiana Legislature to reimburse Pou’s legal fees, which totaled more than $450,000. [120] [121]

Tax dodging and lobbying

In December 2011, the non-partisan organization Public Campaign criticized Tenet Healthcare for spending $3.43 million on lobbying and not paying any taxes during 2008–2010, instead getting $48 million in tax rebates, despite making a profit of $415 million, and increasing executive pay by 19% to $24 million in 2010 for its top 5 executives. [122]

Florida pediatric heart surgery standards

In 2015, CNN reported that Tenet had lobbied the governor of Florida Rick Scott and Republican Party Florida legislators in order to remove hospital standard rules for pediatric heart surgeries, after one of its hospitals failed to meet standards. Both the officials and Tenet denied any wrongdoing, with Tenet stating to the press that "at no time have we discussed the pediatric cardiac standards with the governor or his office, or with any elected official or anyone on their staff... our opinion was not sought on the standards nor have we expressed a position on the possible repeal of the standards or the role of the Cardiac Technical Advisory Panel." [123] Florida Health released a statement indicating that the legal basis for the removal of pediatric surgery standards had been revoked in 2001. This revocation invalidated the standards and it was an oversight that they were not formally stricken from record until 2015. [124]

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Catholic Health Initiatives

Catholic Health Initiatives (CHI) is a national nonprofit health system with headquarters in Englewood, Colorado. CHI is a nonprofit, faith-based health system formed in 1996 through the consolidation of three Catholic health systems. It is one of the nation's largest healthcare systems.

United Surgical Partners International (USPI) was founded in 1998, is an American ambulatory care company based in Addison, Texas. It was founded by Don Steen in 1998.

Shasta Regional Medical Center, formerly known as Redding Medical Center, is one of two major hospitals that are located in Redding, California. It opened in 1945 and currently has 246 beds with an acute care facility and has become a regional medical center serving far Northern California. It is also the first fully accredited chest pain center in northern California.

Surgical Care Affiliates, Inc. (SCA), is one of the largest providers of outpatient surgery in the United States. Based in Deerfield, Illinois, the company has a network of more than 200 ambulatory surgery centers (ASCs) located in 35 states performing 1 million procedures a year. In March 2017, SCA joined the OptumCare division of Optum.

Imaging Advantage is an evidence-based radiology service company based in Santa Monica, California. The company provides comprehensive radiology solutions to health centers and radiology groups. Naseer Hashim is the company's CEO.

Brookwood Baptist Health Hospital in Central Alabama, United States

Brookwood Baptist Health is a network of hospitals, outpatient centers and clinics headquartered in Birmingham, Alabama. It is owned by Dallas-based Tenet Healthcare. The system is the result of a merger between Brookwood Medical Center and Baptist Health System.

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