High malnutrition rates at Prime Healthcare hospitals raise doubts

Hospitals operated by Prime Healthcare Services have reported higher rates of a Third World nutritional disorder and malnutrition in its Medicare patients, California Watch reports.

California Watch's analysis of state health records shows that hospitals with Prime Healthcare, a Southern California-based chain, far exceed state and regional averages. The share of malnutrition cases at Prime hospitals is more than three times that of other California hospitals (25 percent vs. 8 percent). The percentage of kwashiorkor cases among seniors was more than 11 times the rate at other California hospitals (2.3 percent vs. 0.2 percent).

Prime Healthcare is already under investigation by state and federal authorities for possible Medicare fraud related to unusually high rates of septicemia among its older patients.

Prime Healthcare reported treating more than 6,800 malnourished seniors last year. More than 2,700 were diagnosed with severe forms of malnutrition, such as kwashiorkor, a protein deficiency associated with children in famine-stricken regions. A diagnosis of malnutrition or kwashiorkor can boost a hospital's Medicare reimbursement by thousands of dollars.

Experts say Prime's rates are suspect, raising questions whether the rise in malnutrition reports resulted from clinical or business decisions.

"When you see such a big spike, you have to wonder what's really going on," said Shannon Brownlee, acting director of the New America Foundation think tank's Health Policy program.

Prime denies that it has been involved in fraud. "Prime Healthcare hospitals cannot, have not and will not engage in 'upcoding' or Medicare  fraud," Ajith Kumar, director of reimbursement management, wrote in an email. In upcoding, which is illegal, hospitals overstate patients' diagnoses on billing records to obtain bonus payments that can amount to millions of dollars.

The allegation that Prime Healthcare hospitals use a diagnosis of malnutrition to increase reimbursement "is baseless and nothing more than another example of SEIU distorting the facts in order to mislead the public and extort concessions from Prime Healthcare," the company said in an announcement.

To learn more:
- read the California Watch investigative report
- read the statement from Prime Healthcare Services