Prime Billed for High Number of Rare Ailments, Data Show
Former Prime Healthcare Services staff have said in interviews and court testimony that they were urged to record common medical conditions as more severe ailments to boost the chain's Medicare reimbursements. A recent California Watch analysis of Medicare billing data from 2010 focused on three such medical conditions. The analysis found that the number of malignant hypertension cases that Prime logged was 11 times higher than the statewide average. Hospitals that report the condition can earn about $3,000 more. In addition, six of the seven California hospitals that reported the highest rates of encephalopathy -- which can earn hospitals $7,000 more if they treat the condition as a complication of pneumonia -- were owned by Prime. At the same time, the data show that Prime handled 77% of cases of autonomic nerve disorder -- which can earn hospitals an additional $5,000 if coded properly -- even though Prime treated just 3.6% of the state's Medicare patient population.
- "Hospital Chain Billing Medicare for High Number of Uncommon Disorders" (Jewett/Doig, California Watch, 10/14).