Judges’ comments: Wow. A tenacious reporter scoured public records and developed a sweeping review of how aggressive Medicare billing practices went undetected in a business-as-usual mode for a California hospital company. This exhausting effort serves as a grand model for news organizations in other states.
Provide names of other journalists involved.
Monica Lam, David Ritsher
List date(s) this work was published or aired.
Various dates throughout 2011.
Provide a brief synopsis of the story or stories, including any significant findings.
Prime Healthcare Services has a reputation for turning around financially troubled hospitals, reporting profits in the tens of millions. But a more troubling trend has emerged, according to this investigation by California Watch. Prime tends to take over hospitals and then dramatically boost the rate of Medicare patients being admitted for care. And the hospitals report that the Medicare patients they see are far sicker than those at neighboring hospitals. Does the chain attract the toughest cases, or are the hospitals exaggerating patient conditions for profit?
- Video: Tapping into Medicare’s gold mine?
- Prime Healthcare reports outsized rates of unusual conditions
- In their own words: Turmoil, turnover among medical coders
- Graphic: More seniors with Medicare admitted after Prime Healthcare takeover
The work was completed by California Watch. Articles were printed in the San Francisco Chronicle, Orange County Register, San Diego Union Tribune, Riverside Press-Enterprise and other papers. A video piece was aired on the PBS News Hour. A shorter version of the same video aired on ABC stations in San Diego and Sacramento.
Explain types of documents, data or Internet resources used. Were FOI or public records act requests required? How did this affect the work?
Stephen K. Doig worked with reporters to analyze state health data, writing 120 SAS programs to sort through 50 million records. Christina Jewett sorted through more than 2,500 pages of court records, visiting nine court houses in four Southern California counties. Reporters used FOIA and PRA to mine various documents that supported the reporting, including transcripts of hearings about possible hospital sales and correspondence between regulators and hospital authorities.
Explain types of human sources used.
Human sources included former company employees who served as whistle blowers and exposed troubling conduct. One source was a patient who was diagnosed with kwashiorkor, a rare form of malnutrition, who didn’t believe she had the ailment, which entitles the hospital to thousands in additional reimbursement. Another was a woman who felt that her grandmother’s admission to a hospital was “bizarre” and profit-motivated. Other sources include physician specialists who questioned high rates of unusual and lucrative medical conditions and experts in medical billing and coding.
Results (if any).
Members of Congress and the California Senate and Assembly called for deeper investigations into fraud. In December, the FBI began interviewing our sources, asking them to confirm what they told California Watch. Federal and state investigations remain under way.
Follow-up (if any). Have you run a correction or clarification on the report or has anyone come forward to challenge its accuracy? If so, please explain.
No correction or clarification has been published.
Advice to other journalists planning a similar story or project.
Don’t fear complexity, just read, interview and examine until complex systems become understandable. Stick with sources who are reluctant to go on the record, because gathering a critical mass of whistle blower types helps people feel the safety of greater numbers. Listen to tipsters at length and ask them how one could prove what they believe to be true. Ask who else you should be talking to.