Dive Brief:
- A healthcare union has accused hospital chain Prime Healthcare of overbilling Medicare by $93 million, which the chain allegedly did by keeping patients overnight as inpatients when they could have been on observation status.
- An analysis of Prime Healthcare Medicare claims found that Prime hospitals keep patients in the ED for inpatient stays at a far higher rate than the national average, the SEIU-UHW contends. While 35% to 40% of patients are admitted from the ED at other hospitals, between 50% to 60% of ED patients are kept as inpatients at Prime hospitals, the union says.
- For these reasons, among others, the union insists Prime should not be permitted to purchase Los Altos, CA-based Daughters of Charity Health System. Daughters of Charity is currently in discussions with Prime, but Attorney General Kamala Harris must approve the sale first, along with the Vatican.
Dive Insight:
It's hard to tell how much impact the SEIU-UHW's research and entrenched opposition will have on the progress of the deal.
On the one hand, the union represents 1.1 million healthcare workers, and its new allegations, if based strictly on Medicare claims data, certainly deserve scrutiny. There are also other questions that have been raised about Prime's conduct, including those contained in a whistleblower lawsuit filed in January by a former Prime executive. The lawsuit alleges that Prime fraudulently billed Medicare tens of millions of dollars for needless overnight stays.
That being said, the Catholic health system is in terrible financial shape and has said that its business isn't currently viable. If it went out of business, needy patients would lose safety net hospitals in several communities, and thousands of healthcare workers would be out of a job.
It looks like the politics of this deal are only going to get more intense before authorities decide what to to do.