FBI interviews patient about alleged Prime Healthcare upcoding, privacy breach

The Federal Bureau of Investigation (FBI) last week interviewed a patient, following reports that Prime Healthcare Services violated patient privacy when two executives at Prime-owned Shasta Regional Medical Center showed a patient chart to media outlets, California Watch reports.

Federal agents interviewed Darlene Courtois for more than an hour, asking her about her 2010 hospital stay at Shasta Regional, according to the article. California Watch previously reported that the hospital billed Medicare for kwashiorkor--a severe form of malnutrition that typically affects famine victims--when Courtois said she did not receive treatment for such a condition.

FBI agents last month also interviewed two Prime Healthcare coders about billing practices following allegations of Medicare billing fraud for rare and serious conditions at high rates, according to California Watch.

Prime's Shasta Regional Medical Center has billed Medicare in the past two years for more than 1,000 kwashiorkor cases, which is 70 times the statewide rate, according to the investigative watchdog.

The FBI also asked Courtois about a possible patient privacy breach. Hospital CEO Randall Hempling and Chief Medical Officer Dr. Marcia McCampbell shared Courtois's information with the Redding Record Searchlight, as well as the Los Angeles Times, without the patient's permission.

Prime said that Courtois had "voluntarily disclosed her medical records as part of an inflammatory news story by California Watch" and therefore waived her privacy rights.

Presented with the medical information, the Record Searchlight did not publish the kwashiorkor story after reviewing the documents shared by the CEO and CMO, as well as the hospital spokesperson, according to today's editor's note from Silas Lyons. Lyons said that Record Searchlight did not feel comfortable because of discrepancies related to the California Watch report and the patient chart. California Watch reported that a dietitian never reviewed Courtois's case, but the chart showed evidence of such, Lyons wrote. California Watch also reported that there was no specific mention of "protein malnutrition," associated with kwashiorkor, but the file did contain a reference to "protein malnutrition," Lyons continued.

"I'm far from an expert in Medicare billing, but presented with such clear documentation on the one hand, and with Medicare having declined to discuss the specific Shasta Regional coding process with California Watch on the other, I grew even more uncomfortable with the story's strong suggestion that a kwashiorkor code was plainly out of line," Lyons wrote.

The he-said, she-said nature of the alleged Medicare billing fraud and a possible HIPAA violation makes for a complicated case. However, it certainly has garnered enough attention in which the FBI has become involved, as California Watch reported.

For more information:
- read the California Watch article
- read the editor's note from The Record Searchlight

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