Prime Healthcare Services

Prime Healthcare Services is an American private healthcare company. It was established in 2001, by chairman Prem Reddy, and operates 45 hospitals in 14 states. It is affiliated with the nonprofit Prime Healthcare Foundation.

Prime Healthcare Services
TypePrivate
IndustryHealth care
Founded2001 (2001)
Ontario, California, U.S.
HeadquartersOntario, California, U.S.
Area served
Northern and Southern California, Kansas, Nevada, Pennsylvania, Rhode Island and Texas
Key people
Prem Reddy, MD, FACC, FCCP
Founder and Chairman
ProductsHealth care services
Subsidiaries(see list)
Websiteprimehealthcare.com

History

In 2007, the Los Angeles Times ran a news story that alleged that the policies of Prime HealthCare Services, Inc., resulted in higher-than-average profits for the possible cost of patient care: "When Reddy's company, Prime Healthcare Services Inc., takes over a hospital, it typically cancels insurance contracts, allowing the hospital to collect steeply higher reimbursements. It has suspended services — such as chemotherapy treatments, mental health care and birthing centers — that patients need but aren't lucrative.... On four occasions since 2002, inspectors have found that Prime Healthcare facilities failed to meet minimum federal safety standards, placing their Medicare funding at risk."[1]

In 2008 the State of California and Kaiser Permanente each sued Prime Healthcare over its balance billing practices and Kaiser obtained an injunction preventing Prime from continuing the practice; Prime had cancelled agreements with insurance companies when it acquired hospitals, leaving patients in an out-of-network situation resulting in higher costs, and has been aggressively pursuing patients including sending unpaid costs to collection agencies.[2] This was the first of several suits between Prime and Kaiser. In June 2010 Kaiser sued Prime Healthcare for "trapping patients" and contended that Prime Healthcare needlessly admitted emergency department patients, rather than transfer them to Kaiser facilities and then sending their insurance companies highly inflated bills.[3] Prime counter-sued Kaiser and the Service Employees International Union, claiming that Kaiser owed it $100 million in unpaid medical claims and that Kaiser and the union conspired to keep Prime out of the market;[4] that suit was dismissed in 2012,[5] and Prime appealed all the way to the US Supreme Court, which declined to hear the case in 2016.[6] In 2015 both sides agreed on dropping their respective lawsuits and resolve them through confidential and binding arbitration.[4]

In 2010 Prime Healthcare came under investigation by the US Department of Health and Human Services and the California Department of Justice about concerns over a reported spike in sepsis. The investigation centers around whether the spike in sepsis represents a large public health issue or multimillion-dollar Medicare fraud. Six Prime hospitals ranked in the 99th percentile of U.S. hospitals for sepsis and five were in the 95th percentile.[7] In 2011 Prime Healthcare Service had high rates of kwashiorkor among its elderly patients. At Shasta Regional Medical Center, Prime reported 16.1% of its Medicare patients suffered from kwashiorkor, but California's average for Medicare patients is 0.2%.[8] In 2011 California Watch reported that Prime Healthcare had a practice of transferring high numbers of patients from its emergency department to its hospital beds, specifically with patients on Medicare. Some families describe being trapped by doctors at Prime facilities and were unable to see their own doctor at another facility. Former Prime employees have described an orchestrated campaign of admitting Medicare and Kaiser patients, moving them from the emergency department to a hospital bed, in the interest of changing the fortune of a money-losing hospital.[9] In September 2011, California Attorney General Kamala Harris rejected the approval for the sale of the Victor Valley Global Medical Center in Victorville, California, and stated that the sale would not be in the public interest.[10]

In 2012, two executives at Prime Healthcare Services disclosed a patient's chart to multiple media outlets without the patient's express written consent. The release was in response to a California Watch article on Prime Healthcare Services billing practices at Shasta Regional Medical Center, which included claims by a Darlene Courtois about her treatment by Shasta. In this incident, Randall Hempling, the hospital CEO, and Dr. Marcia McCampbell, its chief medical officer, showed up at the offices of the Redding Record Searchlight and successfully convinced the paper's editor not to publish an article, echoing the California Watch claims by reference to Courtois' actual medical records.[11]

In 2012, eight of Prime Healthcare Services' hospitals were named among the "100 Top Hospitals" in the nation by Thomson Reuters.[12] In 2013, Prime Healthcare Services was named as one of the "Top 15 Health Systems" in the country by Truven Health Analytics.[13]

In 2014, Garden City Hospital was sold to Prime Healthcare Services in a deal valued at $76 million. As of that point, Prime Healthcare operated 27 hospitals.[14] The full listing of hospitals and their acquisition year is listed below.

In May 2016 US Department of Justice joined a qui tam case against Prime Health Care and its chief executive concerning Medicare fraud.[15] The case was settled in August 2018 for $65 million, resolving the "allegations that 14 Prime hospitals in California knowingly submitted false claims to Medicare by admitting patients who required only less costly, outpatient care and by billing for more expensive patient diagnoses than the patients had (a practice known as “up-coding”)."[16]

In 2016, Becker's Hospital Review listed four Prime Healthcare hospitals in a list of 49 hospitals with the lowest rate of serious complications.[17]

Operations

Prime operates 45 acute care hospitals in 14 states,[18] serving communities in San Bernardino, San Diego, Los Angeles, Inglewood, Orange County and Shasta County in California, Alabama, Florida, Georgia, Indiana, Michigan, Missouri, Nevada, New Jersey, Ohio, Pennsylvania, Kansas, Rhode Island and Texas. The hospital network has over 42,000 employees and physicians and more than 7,700 patient beds.[19]

Prime Healthcare Foundation

The Prime Healthcare Foundation is an affiliated 501(c)(3).[20]

References
  1. Daniel Costello, Hospital group rejects system and cashes in, July 8, 2007
  2. Costello, Daniel (2 July 2008). "Hospital operator is sued by state". Los Angeles Times.
  3. Pfeifer, Stuart (February 1, 2015). "Hospital chain Prime Healthcare faces a fight to grow – LA Times". Los Angeles Times.
  4. Schencker, Lisa (February 10, 2015). "Kaiser, Prime drop long-running court battles; Kaiser isn't backing Prime hospital purchase". Modern Healthcare.
  5. "Prime Healthcare's Antitrust Lawsuit Against Kaiser, SEIU Dismissed". Beckers Hospital Review. September 18, 2012.
  6. Beard, Kathryn (June 30, 2016). "After denying cert in health law cases, SCOTUS ends term". Wolters Kluwer Legal & Regulatory U.S.
  7. William, Lance; Christina Jewett (October 11, 2010). "Hospital chain's high infection rate leads to fraudulent billing concerns". California Watch.
  8. Williams, Lance; Christina Jewett; Stephen K. Doig (February 19, 2011). "Hospital chain, already under scrutiny, reports high malnutrition rates". California Watch.
  9. Jewett, Christina; Doig, Stephen K. (July 23, 2011). "Chain profits by admitting ER patients". California Watch. Archived from the original on November 6, 2011.
  10. "Attorney general denies sale to controversial hospital chain | California Watch". californiawatch.org. Retrieved 2014-07-30.
  11. "Her case shows why healthcare privacy laws exist - Los Angeles Times". articles.latimes.com. Retrieved 2014-07-30.
  12. "Prime Healthcare Services Hospitals Named Among 100 Top Hospitals in the Nation". www.hbhospital.org. Retrieved 2017-11-14.
  13. "Press Releases | News and Events | Truven Health Analytics". thomsonreuters.com. Retrieved 2014-07-30.
  14. "Garden City Hospital sells to California-based Prime Healthcare Services | Crain's Detroit Business". crainsdetroit.com. Retrieved 2014-07-30.
  15. Sisson, Paul (May 25, 2016). "Justice Department accuses Ontario-based hospital chain of cheating Medicare system". Los Angeles Times.
  16. "Prime Healthcare Services and CEO to Pay $65 Million to Settle False Claims Act Allegations". 2018-08-03. Retrieved 2018-08-09.
  17. Barnet, Shannon. "49 hospitals with the lowest serious complication rates". www.beckershospitalreview.com. Retrieved 2016-06-17.
  18. Dryda, Laura (2019-09-12). "100 of the largest hospitals and health systems in America". BeckershospitalReview.com. Retrieved 2019-12-31.
  19. "Factsheet | Prime Healthcare Services | About Us | Southern & Northern California". primehealthcare.com. Retrieved 2014-07-30.
  20. Jan 29, Posted on; 2018. "Health System". Prime Healthcare Services. Retrieved 2019-06-09.CS1 maint: numeric names: authors list (link)
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