05/31/2011 // Los Angeles, CA, USA // Keller Grover LLP // Los Angeles whistleblower attorney Eric Grover California Whistleblower Lawyer
Los Angeles, CA (Los Angeles Whistleblower Attorney News)— Investigations into a California hospital chain are underway over allegations that they overbilled the Medicare system by errantly diagnosing patients with a blood infection that hospitals are paid a premium to treat, according to information from the San Francisco Chronicle.
A state investigation led by the California Department of Public Health last fall, looked at medical records from 2008 to 2009 at four Prime Healthcare Services-owned hospitals; in which they discovered 22 of the 120 patients diagnosed with the complex and deadly blood infection, known as septicemia, showed little symptoms associated with the disease, reports the Los Angeles whistleblower lawyer Eric Grover at Keller Grover LLP.
Signs of sepsis include a somewhat high or low temperature, an abnormal white blood cell count, or a high pulse or respiration rate, the state inspection reports.
A computer study of the medical records by the Service Employees International Union prompted the probe, after discovering that the septicemia rates among Medicare patients at Prime hospitals were more than triple the national average.
The concern lies with how hospitals are compensated by Medicare for treating such infections. Medicare pays bonuses of several thousand dollars per case for treating elderly patients with septicemia, federal records reported. According to Prime Healthcare’s chairman, Dr. Prem Reddy, his California hospitals were reimbursed about $9,000 for treating each septicemia infection.
Inspectors discovered that at a San Bernardino County hospital, a patient who displayed “no signs of infection,” was diagnosed with septicemia, while a patient at a Los Angeles County Hospital was diagnosed with septicemia although they had symptoms of a urinary tract infect. Hospitals are only reimbursed $6,000 for treating a urinary tract infection, $3,000 less than a septicemia infection.
These findings have also led the U.S. Department of Health and Human Services and the California attorney general’s office to launch an investigation into Prime for overbilling the government for treating septicemia among the elderly.
Some members of Congress even believe that Prime has overbilled the Medicare program by as much as $18 million, stated the Los Angeles whistleblower attorney.
In addition to the allegedly overbilled septicemia infections, California Watch found that Prime has reported high rates of malnutrition, which is also eligible for higher reimbursement from Medicare. The 2009 billing records at two Prime hospitals indicated that the hospital has also reported “extremely high rates of a rare nutritional disorder as kwashiorkor, among elderly patients. Kwashiorkor is widely associated with impoverished children in the Third World,” experts say.
Prime has and continues to strongly dispute the health department findings, by claiming the Prime Healthcare staff properly reviews patient medical records and submitted bills for treatment of sepsis accordingly.
Prime asserts that they would never “upcode” to increase reimbursement from Medicare or insurance companies. Prime claims they have an early intervention and treatment program for sepsis, which uses a more comprehensive set of indicators for septicemia than the state used in its investigations. In addition, Prime has drafted and submitted “plans for correction” to the state.
The state health department plans to pass its findings to auditors and investigators at Medi-Cal, who is also conducting another review of Prime Healthcare.
“It is important for healthcare companies to be held accountable for overbilling insurance companies and Medicare, because these costs are then passed down to the consumer, resulting in higher healthcare premiums and taxes. It is not fair for consumers to endure the burden of higher healthcare premiums and taxes because of greedy hospitals and healthcare professionals, asserted Eric Grover, a Los Angeles whistleblower lawyer.
If you are considering blowing the whistle on a fraud against the government or have information about other unlawful conduct by your employer and need the assistance of a qualified San Francisco Bay Area or Los Angeles whistleblower attorney, contact the Keller Grover California Whistleblower Lawyer today for a free consultation about your case.
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