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Prime Healthcare charged for alleged false claims

Whistleblower worked at Alvarado

The federal government today (May 25) charged Prime Healthcare Services with fraud for billing for medically unnecessary in-patient short-stay admissions that should have been classified on an outpatient/observation status. The suit was filed in federal court in Los Angeles.

Prime was allegedly able to get bloated reimbursements from Medicare and other government health programs, says the suit.

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San Diego's Alvarado Hospital is one of the 11 facilities in the Prime chain charged with such activities. The suit charges that Dr. Prem Reddy, founder of Prime, gave instructions that led to the activity.

The whistleblower in the suit is Karin Berntsen, who was director of case management at Alvarado.

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The federal government today (May 25) charged Prime Healthcare Services with fraud for billing for medically unnecessary in-patient short-stay admissions that should have been classified on an outpatient/observation status. The suit was filed in federal court in Los Angeles.

Prime was allegedly able to get bloated reimbursements from Medicare and other government health programs, says the suit.

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San Diego's Alvarado Hospital is one of the 11 facilities in the Prime chain charged with such activities. The suit charges that Dr. Prem Reddy, founder of Prime, gave instructions that led to the activity.

The whistleblower in the suit is Karin Berntsen, who was director of case management at Alvarado.

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Comments

And people wonder why health care costs keep rising. There is so much fraud and waste in health care.

May 26, 2016

AlexClarke: True. Where in our society is there NOT fraud and waste -- and also cozy relationships with politicians and regulators? Best, Don Bauder

May 26, 2016

Well, Don, I thought long and hard and I came up with . . . nothing. It would appear that where humans are involved there is waste, fraud and abuse. There is hope (I hope).

May 26, 2016

AlexClarke: Where humans are involved, there is greed and often fraud. Best, Don Bauder

May 27, 2016

The rules for Medicare are far too intricate for anyone on the outside to understand, typical of things issued by government bureaucracies. But good ol' Alvarado Hospital has had a history of things that were very wrong. Back in its Tenet Healthcare days, it got into hot water on multiple occasions. It was never well run, and also had its scandals in regard to poor patient care. I'd suggest that all San Diegans avoid using that hospital except in the case of extreme emergency.

May 26, 2016

Visduh: You are quite right that Alvarado has gotten into hot water several times. In this case, Alvarado is one of eleven hospitals accused of overcharging. The whistleblower launched the suit, and the federal government joined in.

I had two quadruple heart bypass surgeries at Alvarado (1981 and 1990) and had satisfactory relationships. Best, Don Bauder

May 26, 2016

from all that I've read and heard bout this place past 47 years, I agree :P stay aWAY - very FAR aWAY from Alvarado Hospital GLAD you had good experience there Don

May 26, 2016

Shotgun Shela: Some health experts believe that for-profit hospitals generally are a problem, because they only provide services that are profitable. That leaves a big financial obligation to the non-profit hospitals, which have to provide unprofitable services. Best, Don Bauder

May 26, 2016

Respect and admiration to Ms Berntsen, the reported "whistleblower," a silly descriptor for a serious individual. Blowing a whistle is fun, but being the one who has the moral strength to truly do their job is not. She is the antithetical hero to the sneaky, albeit alleged, villain who uses their job to unfair advantage. Rules don't work without people like Ms Berntsen. Hooray for her.

May 26, 2016

rehftmann: I agree with you 100 percent. Whistleblowers are great helps to government prosecutors. The whistleblowers can be great help to investigative reporters, too. We have to be careful, though, not to take the word of the whistleblower who might have an ax to grind, or is dishonest. On balance, whistleblowers are most often the losers. They become pariahs within their organizations, and wind up getting fired. Best, Don Bauder

May 26, 2016
  1. Nonprofits can still pay their employees well. There's something sleazy about profiting from the misfortunes of others.

  2. True societies have traditionally shared risks and responsibilities. The culture that the USA has become increasingly preys on its weakest members.

  3. Citizenship is a responsibility of all of us, not any "government." We hired/elected them, and we got what we asked for.

  4. Slogans are no substitute for action.

  5. Those with the means in any society have the responsibility to do more to compensate for those who struggle for mere survival. Those with the most means have to do more. Noblesse oblige.

Without these characteristics, societies degenerate into downward spirals of self-destruction.

May 26, 2016

Flapper: Perceptive points. I especially like #5. Yes, those with the means have a responsibility to help those without. In our society, it's the reverse. The upper 1 percent and upper one-tenth of 1 percent continue to rake in moolah, cheat on their taxes, fleece the little people, and pay money to politicians who are contemptuous of the needs of the weak and indigent, as well as the middle class. Best, Don Bauder

May 27, 2016

The progression is from the specific to the principle (not the general, which is a different concept). A society is a cooperating group; a culture is a set of rules or laws (that displace social mores), generally hierarchical, that impose obligations downward more than upward, and "competition" is no longer based on a "race" to the best, it becomes increasingly a race to trip up ones "opponents." Trump this?

May 27, 2016

Flapper: Sometimes competition results in a race to the bottom. Best, Don Bauder

May 28, 2016

If you could flake spear points and arrowheads better than the rest in your group, that became your job, and you would get as good or better than you got. Reciprocity was a given; you tried to give more than you got, not less. Such a system of voluntary reciprocity bonded the social (cooperative) group together. If you constantly tried to get the "best deal," your status in the group suffered.

Now we worship the chumps and cooperative societies are considered suckers.

May 28, 2016

Flapper: Today, such standards would be considered communistic. Best, Don Bauder

May 28, 2016

Not when I grew up. We did this sort of thing all the time, and were rabid Red-baiters. And some of that was during McCarthy.

May 28, 2016

Flapper: What worries me is the possible return of the McCarthy era. I was in high school during that frightening time. Best, Don Bauder

May 29, 2016
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