California Investigation Finds Prime Healthcare Misdiagnosed 22 Patients With Septicemia

A California state investigation recently found that Prime Healthcare, a California hospital chain under investigation for allegedly overbilling Medicare, inaccurately diagnosed 22 patients with the blood infection septicemia, according to a San Francisco Chronicle report.

Septicemia is a serious and often fatal condition that nets hospitals a high level of reimbursement when treated. According to the report, Prem Reddy, MD, chairman of Prime Healthcare, testified in 2005 that Prime hospitals were reimbursed approximately $9,000 per septicemia case.

The investigation by the California Department of Public Health looked at records from four Prime Healthcare hospitals and found that 22 of 120 patients diagnosed with septicemia showed few to no signs of infection. Inspectors said that seven patients diagnosed with septicemia at a Los Angeles County hospital showed symptoms of urinary tract infections, which are less serious and reimbursed at a much lower rate.

According to the report, HHS is investigating the healthcare system to determine whether it overbilled Medicare for treating septicemia in elderly patients. The probe began in Feb. 2011 after a study of medical records by Service Employees International Union showed that Prime hospitals reported septicemia rates among Medicare beneficiaries at more than three times the national average.

Read the San Francisco Chronicle report on Prime Healthcare and septicemia.

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