Prime Healthcare Hospital Chain Bills Medicare for Rare—and Expensive—Diseases

Monday, October 17, 2011
Prem Reddy

Already under investigation for questionable billings, the hospitals of Prime Healthcare Services are also accused of fraudulently charging Medicare for a variety of unusual medical conditions that pay more than ordinary illnesses.

According to California Watch, the hospital chain has been the most aggressive of any in California when billing for rare disorders. At least nine former Prime employees have said the company’s owner and chairman of the board, Dr. Prem Reddy, encouraged staff to record common medical conditions as more serious ailments, in order to receive larger reimbursements from Medicare.
Malignant hypertension (bleeding eyes) is a more serious form of hypertension that accounts for about 1% of cases…except at Prime HealthCare hospitals. It brings into a hospital about $3,000 extra for each case. Prime has reported caring for malignant hypertension cases at seven times the statewide average. At Desert Valley Hospital in Victorville 37.9% of hypertension case were deemed malignant.
Autonomic nerve disorder is a rare condition that California hospitals in general report seeing in about 1 of 6,667 elderly Medicare patients. At Prime HealthCare hospitals the rate is 1 out of 75.
Prime hospitals also have the highest rates of encephalopathy (brain swelling) in California—five times the state average.
Earlier this year, it was reported that the hospital chain has claimed to care for unusually high numbers of patients suffering from malnutrition—rates normally found among starving children in developing countries.
-Noel Brinkerhoff, David Wallechinsky
Hospital Chain Billing Medicare for High Number of Uncommon Disorders (by Christina Jewett and Stephen K. Doig, California Watch)


Louise Too 8 years ago
When is something going to be done about this? He's getting rich, our medicare system is being drained with illegal claims AND WORSE loved ones are dying because they refuse to transfer out so that they can bill for more days of intensive care etc. How many more will grieve as I do for a loved one that should not have died, before something is done???

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