Investigation shows hospital erroneously billed Medicare for infections

An investigation by state regulators concluded that hospital operator Prime Healthcare often billed Medicare to treat patients for septicemia when the condition likely did not exist, reports California Watch.

The investigation of Ontario, Calif.-based Prime by the California Department of Public Health is separate from an ongoing probe of Prime by the U.S. Department of Health and Human Services.

The CDPH's probe found that 22 of 120 patients diagnosed with septicemia showed few symptoms of the condition. At one Prime hospital, a patient was diagnosed with the condition, even though there was no sign of infection, according to CDPH inspectors. Seven other patients diagnosed with the condition at another Prime hospital likely had much less severe urinary tract infections.

Medicare pays a premium of about $6,000 to treat septicemia compared to more typical infections, suggesting to investigators that hospitals could use such a diagnosis to pump up billings. An investigation of Prime by the Service Employees International Union concluded that Prime billed Medicare for septicemia at three times the national rate.

Prime has contended its billings are accurate, and that the union is using its probes as leverage in contract negotiations. It contends that the findings by CDPH will eventually be reversed.

For more info:
- read the California Watch article
- read Prime Healthcare's statement


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