New Research From SEIU-UHW Shows Prime Healthcare Overbilled Medicare Estimated $93 Million for 18,000 Unnecessary Hospital Admissions
Two Lawsuits Against Company Also Allege Needless Admissions
OAKLAND, Calif., Nov. 19, 2014 /PRNewswire-USNewswire/ -- New research from SEIU-United Healthcare Workers West (SEIU-UHW) shows Prime Healthcare overbilled Medicare $93 million by unnecessarily admitting to their hospitals 18,000 emergency room patients for overnight stays instead of putting them into much less costly observation care.
The research finds that by admitting the patients, Prime was paid an average of $5,000 more per person than if those patients had been kept for observation and released. Two pending lawsuits filed against Prime Healthcare by a former executive and group of doctors also allege this practice of unnecessary admissions.
"Every time we think we've heard every example of Prime Healthcare jacking up its billings at the expense of taxpayers, we seem to find one more," said Dave Regan, president of SEIU-UHW.
Prime is currently trying to purchase Daughters of Charity Health System, a move that has drawn strong condemnation from elected leaders, community organizations, unions and others because, among other issues, concerns about Prime's billing practices and admission policies. The new research on emergency room admissions raises new issues as California Attorney General Kamala Harris decides whether to approve the sale.
According to Medicare claims filed by Prime Healthcare, the company has a history of steering emergency room patients to overnight stays at considerably higher rates than the national average. Whereas between 50 percent and 60 percent of emergency room patients at Prime hospitals are kept overnight, only 35 percent to 40 percent are admitted at other hospitals across the country.
Based on the disparity in those admission figures and various individual health conditions, SEIU-UHW concluded Prime has unnecessarily admitted nearly 4,000 emergency room patients for overnight stays in 2012 alone and 18,000 over the previous six years. This system of admitting emergency room patients into hospital beds has netted Prime Healthcare an estimated $93 million from Medicare during that period. The overbilling figure is determined by using a national study, which reported Medicare pays an average $5,000 more to treat a patient for an overnight stay versus an outpatient or observation stay.
In addition, a whistleblower lawsuit filed in January 2014 by a former Prime Healthcare executive at Alvarado Hospital in San Diego alleges the company fraudulently billed Medicare tens of millions of dollars for unnecessarily holding patients for overnight stays. Separately, in March 2013, a group of doctors at Prime-owned Chino Valley Medical Center in Chino, Calif. filed a lawsuit against the facility for needlessly admitting patients from the emergency room into hospital beds.
Daughters of Charity announced Oct. 10 that it chose Prime Healthcare as the lead bidder for the safety-net hospital system and would negotiate with Prime exclusively.
Daughters of Charity owns Seton Medical Center, Daly City; Seton Coastside, Moss Beach; O'Connor Hospital, San Jose; Saint Louise Regional Hospital, Gilroy; St. Vincent Medical Center, Los Angeles; and St. Francis Medical Center, Lynwood.
SEIU-United Healthcare Workers West (SEIU-UHW) is the largest hospital and healthcare union in the western United States with more than 150,000 members. We unite every type of healthcare worker with a mission to achieve high-quality healthcare for all. SEIU-UHW is part of the two million-member Service Employees International Union (SEIU), the nation's fastest-growing union. Learn more at www.seiu-uhw.org.
CONTACT: Sean Wherley
(323) 893-6831
[email protected]
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SOURCE SEIU United Healthcare Workers-West
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