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Polk Award recognizes reporting on unusual Medicare claims, reimbursements

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

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

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

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.”

Calif. hospitals slow to prep for quakes

California Watch health reporter Christina Jewett has found that despite an earthquake readiness push that’s a decade and a half old, few at-risk California hospitals have even had their potential collapse risk calculated, and even fewer have done anything about it.


Photo by martinluff via Flickr

It seems to come down to the inherent difficult in enforcing regulations like these. A strict interpretation would call for the wholesale closure of noncompliant hospitals, a move that would create a public health issue every bit as severe as the one it’s trying to solve.

In the mean time, smaller quakes cracked floors and walls in at least one at-risk hospital in 2008, and some of the hospitals with the highest assessed risk are taking slow, expensive steps toward correcting it. The deadlines have already been extended repeatedly, though Gov. Schwarzenegger appears to be taking a hard line stand on pushing them back any farther. Hospitals now have until 2013 or 2015 to comply, depending. Hospitals that can prove financial hardship (regardless of assessed risk) have until 2020.