Report: Hospital Chain Billing Medicare for High Malnutrition Rates
Prime Healthcare Services has reported higher rates of malnutrition among seniors than many other nearby hospitals, according to a recent analysis by California Watch, the San Francisco Chronicle reports.
For its investigation, California Watch gathered data from California's Office of Statewide Health Planning and Development and conducted a statistical analysis of the information.
The analysis focused on Medicare beneficiaries ages 65 and older who received treatment at 254 California hospitals in 2009.
According to the California Watch analysis, Prime Healthcare in 2009 reported that 25% of its MedicareÂ patients were experiencing malnutrition, a complication that can allow hospitals to receive higher reimbursements from the federal government. The average state malnutrition rate for hospitalized seniors was 7.5% that year.
The analysis also found that in 2009:
- Prime Healthcare owned eight of the 10 California hospitals that reported the highest malnutrition rates among Medicare beneficiaries;
- Prime Healthcare treated 3.6% of the state's Medicare beneficiaries, but reported 12% of the state's malnutrition cases; and
- Prime Healthcare reported that 10.1% of its Medicare beneficiaries were diagnosed with the types of severe malnutrition thatÂ generate the largest treatment payments, while the statewide average for such conditions was 1.3%.
One type of severe malnutrition reported at Prime Healthcare hospitals was kwashiorkor, a childhood protein deficiencyÂ typically seen in some regions of developing countries.
EarlierÂ Scrutiny Over Septicemia Rates
The analysis of malnutrition rates follows an October 2010 California Watch report finding that state and federal authorities are investigating rates of septicemia infections at Prime Healthcare hospitals.
Authorities are attempting to determine whetherÂ the cluster of infections reflects serious medical problems or a potentially fraudulent billing practice known as "upcoding," in which hospitals overstateÂ diagnoses to receive higher reimbursements.
Prime Healthcare Response
Prime Healthcare officials have said in interviews and e-mails that their billing practices are legal and proper and that their hospitals file accurate Medicare claims.
Ajith Kumar, director of reimbursement management at Prime Healthcare, said the system's hospitals "cannot, have not and will not engage in 'upcoding' or Medicare fraud."
Kumar said the disparity in malnutrition rates "means there are patients going undiagnosed and untreated" at other hospitals (Wiliams et al., San Francisco Chronicle, 2/20).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.