Tenet Still Unsettled

"Tenet has already been party to a corporate integrity agreement and then, almost immediately, began its aggressive pricing" anyway, Skolnick says. "Clearly, that corporate integrity agreement didn't have its desired effect -- which was to change the culture of the company and get people used to doing things that don't get them in trouble."

Tenet investors held back from celebrating news of the Saint Barnabas settlement. They pushed the stock down 3 cents to $7.34 Friday.

Credit Suisse analyst Glen Santangelo probably expected better. In a research note published late Thursday, Santangelo portrayed the Saint Barnabas settlement as "encouraging" and reiterated his outperform rating on Tenet's stock.

"Although there seems to be more reasons against using the outcome at Saint Barnabas as a proxy for how to assess the Tenet situation, we believe the reasons for using it as a proxy are more compelling," wrote Santangelo, whose firm counts Tenet as a client. "We believe the U.S. attorney's office in Newark, in conjunction with the [Department of Justice], has created a framework on how they view these outlier cases, which in their purest form are all based on the same underlying issue. What seems to be obviously different is the timing and magnitude" of the settlements that result.

Despite appearances, Saint Barnabas didn't necessarily get off cheap. The health system has already wound up closing two of its original nine hospitals because of losses it suffered after its excess outlier payments dried up. It has since slashed costs and, next month, faces a big $45 million down payment on its $265 million fine. After that, Skolnick says, it will spend years paying "every drop of free cash flow" it has just to settle the score.

Moody's on Thursday placed the hospital system's debt under review for a possible downgrade as a result.