Agency Lacks Evidence To Cite Prime Healthcare’s Billing Issues
California's Department of Public Health has saidÂ it does not have appropriate evidence to cite Prime Healthcare facilities over medical records that were incomplete or inaccurate,Â California Watch reports (Jewett/Williams, California Watch, 10/5).
Prime Healthcare has been under scrutiny over alleged overbilling for the bloodstream infection sepsis and a rare form of malnutrition called kwashiorkor (California Healthline, 7/11).
The septicemia investigation began last year in response to a study released by the Service Employees International Union. The study found that Prime Healthcare's hospitals reported septicemia rates that were more than triple the national average.
Medicare pays several thousand dollars in bonus payments per case for the treatment of elderly patients with septicemia.
A state investigation found that 22 out of 120 patients diagnosed with septicemia at Prime hospitals showed few symptoms of the condition (California Healthline, 5/9).
Details of the Action
DPH noted that it hadÂ not ruled outÂ fraud as a reason for theÂ highÂ septicemia rates.
Kathleen Billingsley, deputy director of DPH, said the findings of the state's reports on the septicemia and malnutrition investigations have been forwarded to Medi-Cal auditors and the HHS Office of Inspector General. Medi-Cal is California's Medicaid program.
She said it is the responsibility of federal officials to review billing issues.
Suzanne Richards, chief clinical officer at Prime, said, "We are pleased that [DPH] considered all of the evidence presented by the hospitals and independent physicians in finding that there were no deficiencies related to the diagnosis and coding of septicemia."
Prime also has denied claims made by Kaiser Permanente Health Plan that the health system inflated the number of septicemia cases to boost profit (California Watch, 10/5).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.