A California chain of 14 hospitals has some explaining to do after results of state inspections released this week found three facilities had miscoded patient diagnoses and a fourth failed to adequately monitor central venous catheters for infections.
The documents follow accusations in February that the hospital system has been coding an astonishingly large number of patients with a rare wasting syndrome called kwashiorkor, a serious form of malnutrition that generates thousands of dollars more in federal reimbursement. The chain also faces allegations filed by a labor union with which it is in dispute that the entire system is coding large numbers of patients with septicemia they don't actually have.
After unannounced inspections, licensing officials said in their reports that Prime Healthcare Services' San Dimas Community Hospital had inaccurately coded principal diagnoses of 17 of 29 patients in 2008 and 2009 whose charts were randomly reviewed.
The state concluded that a diagnosis of septicemia, sepsis, or septic shock could be supported by only 7 of the 29 records, and the diagnosis was "marginal" for another 19 because of the absence of positive blood culture and criteria for systemic inflammatory response syndrome. For the remaining three patients, a diagnosis other than septicemia, sepsis or septic shock was found, the report said.
Coding problems were also found at Prime's West Anaheim Medical Center and Chino Valley Medical Center.
A fourth, Desert Valley Hospital in Victorville, failed to adequately monitor central venous catheter insertions for bloodstream infections.
Prior accusations against Prime have provoked influential state and federal lawmakers to call for investigations of the facilities' billing and safety practices and for health officials to hold up any Prime facility license reviews.