Hospitals Seek $25 Million From Kaiser in Pay Dispute
On Wednesday, Prime Healthcare Services, a for-profit hospital chain, announced that eight of its hospitals are suing Kaiser Permanente for $25 million, alleging that Kaiser failed to reimburse them for emergency services provided to Kaiser members, the East Bay Business Times reports.
Prime Healthcare claims that Kaiser denied claims in their entirety, paid only small portions of claims and reimbursed hospitals at rates far below the "reasonable and customary value" of the services.
Prime Healthcare also said that physicians in Kaiser's Emergency Provider Response Program pressure hospitals that do not contract with Kaiser to declare a patient "stable" in order to transfer a patient more quickly to a Kaiser facility, the Business Times reports (Hogarth, East Bay Business Times, 2/13).
Kaiser has been hit with similar lawsuits from at least three other hospital operators in recent years. The Department of Managed Health Care also has fined Kaiser for not "consistently and appropriately" paying for out-of-network care (Darcé, San Diego Union-Tribune, 2/14).
Jim Anderson, spokesperson for Kaiser, said the insurer had not yet received the litigation, although he added, "We are aware there are issues between the two organizations."
The hospitals suing Kaiser include:
- Chino Valley Medical Center, Chino;
- Desert Valley Hospital, Victorville;
- Huntington Beach Hospital;
- La Palma Intercommunity Hospital;
- Montclair Hospital Medical Center;
- Paradise Valley Hospital, National City;
- Sherman Oaks Hospital & Grossman Burn Center; and
- West Anaheim Medical Center (Hogarth, East Bay Business Times, 2/13).
Nathan Kaufman, a health care industry consultant in San Diego, said Prime's conflicts with Kaiser could be driven by the company's unconventional business model. Prime typically works without HMO contracts, which allows its hospitals to charge whatever they want for services (San Diego Union-Tribune, 2/14). 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.