This story was a profile of a controversial healthcare CEO, Dr. Prem Reddy, and the company he founded, Prime Healthcare Services. Prime is a paradox. On the one hand, it has the noble mission of buying up hospitals that are in so much financial distress that their only other option is closure. Under its leadership, they win quality awards and clean up their balance sheets. But the company’s tactics for turning around these struggling facilities have drawn the ire of unions, insurers, competitors, politicians and even the Department of Justice. Much has written about these controversies, but what sparked this story was a more basic question: what is Dr. Reddy’s secret sauce? Why do his hospitals keep winning awards? Why does he see diamonds in the rough where no one else does? Although this story was a profile of Prime, it also became a story about the challenges of distressed hospitals, the power of insurance companies and the loopholes in billing and coding.