Stacie L. Patterson Law Blog

An unusually high number of diagnosed cases of septicemia has raised concern that Prime Healthcare Services may be exaggerating the number of cases that they actually treat.  Septicemia is a type of blood poisoning that can be fatal if left untreated.  Medi-cal, pays higher reimbursements to hospitals for septicemia, compared to other hospital acquired infections.  In the fiscal year 2008, Prime Healthcare Services ranked in the 99th percentile for cases of septicemia.  This high ranking number leads critics to question why this group of hospitals treats so many more cases of the blood poisoning than others.  Another statistic shows that though Prime hospitals have a high number of septicemia cases, the number of patient deaths occurring from it is unusually low.  This anomaly could suggest the hospital isn't really treating septicemia, but merely diagnosing it for billing purposes.  It could also suggest, as Ajith Kumar, reimbursement management director of Prime Healthcare Services points out, that the higher rates of the blood infection stem from many factors.  Kumar acknowledges that while Prime hospitals do in fact have higher rates of septicemia, the numbers reflect the hospitals focus on early detection and treatment.

Kumar says that caregivers at Prime hospitals follow strict Medicare coding guidelines.  Such guidelines lead to earlier detection.  Kumar says that early detection and aggressive treatment results in better patient outcomes and lower mortality rates. Kumar also suspects that Prime hospitals report a higher number of septicemia cases because of the company's emphasis on emergency-room admissions.  "Sicker patients are being admitted", Kumar reports.  He also points out that in 2008 Prime Healthcare services lost more than $50 million for treating Medi-cal patients.

A previous Prime Healthcare Services employee, who is suing the company for wrongful termination, claims that nurse practitioners and physicians' assistants employed by Prime Healthcare Services were taught specifically how to document patients' conditions to allow the hospital to collect maximum insurance reimbursements.  The Service Employees International Union conducted the analysis that revealed the elevated numbers of septicemia in Prime hospitals, and forwarded their findings to lawmakers.  Since that time, a federal investigation has been launched against Prime Healthcare Services.  The Service Employees International Union represents about 150,000 hospitals and health-care workers in California and has previously been at odds with Prime Healthcare Services.  Ajith Kumar believes that the allegations are an attempt to extort concessions from Prime Healthcare Services to the union. 

If you have been charged with fraud, contact attorney Stacie L. Patterson.  (619) 269-8074