Prime hospital allegedly bills at six times state rate for heart failure

A hospital owned by California chain Prime Healthcare Services has allegedly been billing Medicare to treat patients for heart failure at rates far higher than the national average, reports California Watch.

According to analysis of Prime's billing data for Chino Valley Medical Center east of Los Angeles, nearly one-third of its Medicare patients in recent years suffered from acute heart failure--a rate nearly six times the average for California.

California Watch notes the hospital billed Medicare for virtually no heart failure patients in 2006, just prior to Medicare initiating a rule change that allowed a bonus for treating such cases. Between 2008 and 2010, the hospital treated nearly 2,000 patients for the ailment. In 88 percent of those cases, the diagnoses was billed in a way that would trigger the extra payments.

"You don't see (hospitals) where 35 percent of the Medicare population has heart failure," Dr. Gregg Fonarow, medicine professor at UCLA and director of the Ahmanson-UCLA Cardiomyopathy Center told California Watch. "Even 10 percent would be unusual."

Prime officials disputed the report by California Watch, a non-profit investigative journalism group that has been scrutinizing Prime's billing practices. Anthony Glassman, a Prime attorney, said the analysis was "faulty, unfair and biased." He added that Chino Valley treated such a large number of heart failure patients because many are admitted from nearby nursing homes and through the hospital's emergency department.

For more information:
- here's the California Watch article
- read California Watch's article on heart failure and sepsis patients