Morning Briefing
Summaries of health policy coverage from major news organizations
Justice Department Joins Lawsuit Accusing Calif. Hospital Chain Of Improper Medicare Billing
The Wall Street Journal: DOJ Joining Lawsuit Against Prime Healthcare Services Alleging Medicare Fraud
The Justice Department said it is joining a lawsuit against Prime Healthcare Services and its chief executive that alleges Prime hospitals improperly admitted patients for care and submitted false claims to Medicare. The lawsuit was first brought in 2011. On Wednesday a federal judge granted a Justice Department request to join the case. Troy Schell, general counsel for the Ontario, Calif.-based Prime Healthcare Services, said in a statement the company’s officials believe it will be exonerated. (Evans, 5/25)
Los Angeles Times: Justice Department Accuses Ontario-Based Hospital Chain Of Cheating Medicare System
The U.S. Justice Department has joined a whistle-blower case against Prime Healthcare Services, adding significant weight to allegations of widespread Medicare overbilling at 14 of the company’s hospitals in California. A Los Angeles magistrate judge granted the agency’s request to intervene in the case Tuesday, one day after the government declared in a court filing that its investigation of the Ontario- hospital operator has “yielded sufficient evidence” that the facilities “submitted or caused the submission of claims to Medicare for unnecessary inpatient stays.” (Sisson, 5/25)
Meanwhile in Missouri, hospitals are trying to draw attention to what they see as a problem in Medicare policy —
Kaiser Health News: Missouri Hospitals Seek To Focus Readmission Penalties On Patient Poverty
Christian Hospital says its costly difference of opinion with Medicare hinges on how to count the large number of poor people that the St. Louis hospital treats. Medicare penalizes hospitals that readmit too many patients within 30 days of discharge, and Christian expects to lose almost $600,000 in reimbursements this year, hospital officials said. Christian is one of 14 hospitals in the BJC HealthCare System. Steven Lipstein, chief executive of BJC, which includes Barnes-Jewish hospital in St. Louis, said Medicare doesn’t play fair because its formula for setting penalties does not factor in patients with socioeconomic disadvantages -- low-income, poor health habits and chronic illnesses for instance -- that contribute to repeated hospitalizations. (Gillespie, 5/26)
