Billing Practices Questioned at Local Hospitals

Thousands of patients misdiagnosed with costly diseases

By Lauren Steussy
|  Friday, Dec 16, 2011  |  Updated 4:45 PM PDT
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Billing Practices Questioned at Local Hospitals

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A local healthcare provider may have misdiagnosed thousands of Medicare patients with bizarre –and costly – diseases.

Prime Healthcare Services “aggressively billed” these patients for rare diseases such as malnutrition, according to an extensive investigation by California Watch.

The investigation highlighted an overweight Medicare patient treated for kwashiorkor, an illness that typically afflicts starving children living through African famines.

The woman said she never even knew she was diagnosed with the illness, and her medical records do not show any treatment for kwashiorkor. The illness required treatment that cost her Medicare insurance about $6,700, according to a California Watch analysis of billing information obtained under the federal Freedom of Information Act.

Non-profit investigative reporting center California Watch began investigating the healthcare provider’s Medicare records about one year ago. From 2008 to 2010, they found Prime billed Medicare for 1,030 cases of kwashiorkor.

Prime’s spokesperson denied accusations that the company’s doctor’s misdiagnosed Medicare patients. The spokesperson insisted that billing practices were accurate and in full legal compliance.

The spokesperson also suggested that if there were any misdiagnoses, they were purely the result of technical glitches in computerized coding.

Prime Healthcare owns and operates 14 hospitals in California, two of which are in San Diego:  Alvarado Hospital in San Diego and Paradise Valley Hospital in National City.

Alvarado Hospital has not been investigated, according to the Chief of Staff Elect Ted Mazer.

"Although two prior Alvarado workers have allegedly accused Prime of impropriety, and have recently been mentioned in connection with a supposed FBI investigation into coding practices by Prime hospitals, that does not equate to an investigation of our hospital," he said.

San Diego Congressman Bob Filner requested a federal investigation of Prime in October after reading the California Watch coverage.

Filner did not return requests for comment on the status of the investigation. 

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