Tag Archives: california watch

Polk Award recognizes reporting on unusual Medicare claims, reimbursements

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates AHCJ's social media efforts and edits and manages production of association guides, programs and newsletters.

AHCJ member Christina Jewett, a reporter at California Watch, was honored alongside her colleagues, Lance Williams and Steven K. Doig, with the George Polk Award in Medical Reporting for her work on “Decoding Prime,” a yearlong investigative series that exposed how a California-based hospital chain billed Medicare for rare conditions and in turn banked on huge bonus payments.

To do this, the team analyzed more than 51 million hospital admissions records from 2005 through 2010. It also unveiled stories from doctors, nurses and medical coders who were at odds with the chain’s practices.


Reporters uncover Calif. chain’s systematic upcoding

Reporters uncover Calif. chain’s systematic upcoding

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

In a follow-up to their lengthy California Watch investigation into sketchy billing practices at the state’s Prime Healthcare chain, Christina Jewett and Stephen Doig looked at newly released data and found that “Prime Healthcare Services bills Medicare for a variety of unusual ailments – among them a brain disease and a condition causing eyes to bleed – that can generate lucrative payments to the chain.”

For this piece, the reporters reviewed hundreds of pages from five related court cases and talked to a number of former Prime employees who protested the hospital’s billing practices — many of which they say were mandated directly by the company’s owner. Doig and Jewett then returned to the data and found that, as the 14-hospital chain’s leadership pushed providers to bill for a certain lucrative condition, instances of that condition just happened to rise in Prime hospitals.

Jewett and Doig even analyzed medical codes to estimate how much the alleged upcoding could have earned Prime hospitals.

It is not possible to pinpoint how much additional revenue Prime earned when documenting the unusual conditions, because each patient may have numerous diagnoses. But it is clear that conditions reported in outsized rates at Prime hospitals can bring in an additional $3,000 to $7,000, compared with similar but less serious conditions.

Taken together, the report stands out for its deft integration data, court records and interviews into a cohesive investigation.

Report: Calif. hospital chain profited from ER admissions

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

After months of investigation and updates, California Watch reporters Christina Jewett and Stephen K. Doig have unleashed their full report on California hospital chain Prime Healthcare Services and its knack for turning around failing hospitals by apparently pushing for the admission of ER patients who are insured by Medicare or insurance giant Kaiser Permanente, then keeping them in the hospital.

The report includes hyperlink sourcing, a raft of related documents and a great explainer on how they assembled the numbers behind the story. The duo took advantage of court testimony, sources and reams of public records.

The reporters say that evidence points to “an orchestrated campaign of admitting Medicare and Kaiser patients – moving them from the emergency room to a hospital bed – in the interest of changing the fortune of a money-losing hospital.”

State data shows that after the hospital chain took over 11 hospitals beginning in 2005, the percentage of Medicare patients who were admitted from the emergency room to Prime hospital beds increased from about 45 to 63 percent.

That 40 percent increase contrasts with other California hospitals that saw an average 8 percent decline from 2005 to 2009 in Medicare patients moved from the emergency rooms to hospital beds, data shows.

And, as you’ll see throughout the story, the interviews and anecdotes back up the numbers.

Tina Buchanan, the hospital’s former chief nursing officer, testified that [Prime founder and chairman Dr. Prem Reddy] began to require emergency room staff to put a yellow sheet of paper on each patient record that listed their health insurance status.

She said he would go through the “goldenrods,” as the papers were called, and point out the Medicare or Kaiser patients and say, “Make sure you get this one admitted.”

“If it was … an uninsured patient, he would tell them, ‘Get them out of my hospital,’ ” Buchanan testified.

There’s plenty more where that came from, but I will just leave you with this editor’s note, which appears alongside the main story.

It came to our attention late Friday that Prime Healthcare had issued a press release saying it had taken legal action against California Watch. We have not been served and can’t fully comment until we have reviewed any legal filings. In our dealings with Prime over the course of the past several months, the company has yet to present to us a single factual error that has merited correction or clarification. We continue to stand by our reporting.

Prolific antipsychotic prescribers have industry ties

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

California Watch’s Christina Jewett compares a list of that state’s top antipsychotic prescribers reimbursed by state Medicaid (obtained through Sen. Charles Grassley, R-Iowa) to ProPublica’s database of educational and speaking fees pharmaceutical companies have paid to doctors.

Not surprisingly, she finds matches. Of the top 10 prescribers, Jewett writes, “Three of them accepted $20,000 or more in educational or speaking fees from the company that makes the drug they prescribe to Medi-Cal patients.” Of those, the most remarkable are a duo who share an office near San Diego:

Samuel Etchie prescribed Seroquel more than 1,000 times in 2009 at a cost of $449,000 to the state, according to Medi-Cal records collected by the ProPublica news organization and provided to California Watch. The drug’s maker paid him $25,350 this year to speak to health professionals.

Etchie did not return two calls to his office.

John Allen, who shares an office with Etchie, was among the state’s top prescribers of Zyprexa, also an antipsychotic drug. Allen dispensed 418 prescriptions at a cost to the state of $346,569. This year and last, the drug’s maker, Eli Lilly and Co., paid him about $27,000 to educate other medical professionals.

The icing on the cake? A quote from Allen:

“I think it’s unfortunate that there’s an implication in articles that we’re robots for drug companies,” Allen said. “We have to have our own experience with medications and find out what works best. We’re not 5-year-olds in front of TV watching cereal and toy commercials.”

California law re-seals some child abuse autopsies

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

On the California Watch blog, Ryan Gabrielson reports that the state has partially reversed a SB 39, the 2008 ruling that made public the autopsy reports of all children who died from abuse.

The measure, nearly unopposed in the state Assembly and Senate, empowers the parent (biological, legal, or by marriage) of a child who died as a result of a crime to have the autopsy report sealed.

The San Diego County District Attorney’s Office initiated the legislation. But unlike many similar exemptions to the state public records law, the child autopsy bill is not driven by law enforcement concern about undermining criminal investigation.

Instead, Gabrielson writes, the law was passed so that families aren’t “victimized a second time” by media coverage of the autopsy reports. Gabrielson seems to find this logic curious, as “the opening section of SB 39 two years ago specifically discussed information dissemination as critical to advancing public safety.”

Gabrielson also notes that the new law comes less than a month after The Los Angeles Times reported that L.A. County failed to make dozens of child abuse deaths public.

Full coverage of the legislation, from The Reporters Committee for Freedom of the Press, can be found here.


Project offers guide on access to autopsy records

Data: Calif. for-profits order more C-sections

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

Writing for California Watch, Nathanael Johnson leads with the numbers on his story about for-profit hospitals and C-sections. Appropriately for a story based on a hand-built database, classic health anecdotes don’t even surface until after the 20th paragraph. Instead, readers are immediately hit with this:

A database compiled from state birthing records revealed that, all factors considered, women are at least 17 percent more likely to have a cesarean section at a for-profit hospital than at one that operates as a non-profit. A surgical birth can bring in twice the revenue of a vaginal delivery.

It’s a powerful and nuanced – if not unexpected – finding. Johnson digs deep in the numbers, and hits on a litany of confounding factors and caveats. In the end, some of his most surprising findings were that patients at for-profit hospitals in poorer areas of Los Angeles were the most likely to receive C-sections, and that variation in these surgeries can be attributed to everything from cultural differences, patient preferences and even a desire to avoid malpractice suits.

How Johnson put it all together

For health journalists, the most exciting part of the entire package is likely Johnson’s detailed “how I did it” sidebar. He talks about how he chose which data to pursue, how he created the database behind the story, and even which specific Excel functions he used to find meaning within the numbers. Of particular interest are the sections in which he lists the sources he used to help him understand what he was seeing within the numbers, and to guide him toward his subsequent conclusions.