"Is that illegal or unethical?" Mazer asks. "Or is it an administrative use of rules that pushes the envelope but doesn't fall outside the boundaries? That's the question CDPH and other regulators are going to have to answer." He adds that a similar situation may be taking place with respect to the bump in septicemia cases at Prime as well.
It should be pointed out that accusations against Prime surfaced after its labor dispute with United Healthcare Workers-West, which is part of the SEIU, the largest healthcare workers union in the west with more than 150,000 members.
Because of the labor dispute, SEIU-UHW said, it engaged healthcare data experts to dig into federal and state Medicare statistics. They prepared an extensive report ,"Care and Coding of Prime Healthcare Services," released in January. "Not surprisingly, we often find that the same corporate employers who fail to treat their employees with dignity, respect, and fairness are also failing to be responsible corporate citizens in other areas," the report says.
The SEIU-UHW report also notes that five of six hospitals with the highest septicemia rates in the U.S. were operated by Prime Healthcare in 2008, and seven of 12 hospitals with those rates were operated by Prime Healthcare in 2009. Prime Healthcare's septicemia rates were 70% higher and 50% higher, respectively, than the second highest comparable health systems in either of those years, the report states.
But now that the state reports are out, clearly something, as they say, is rotten somewhere. California Watch reported last fall that the Office of Inspector General was asked to look into Prime's coding and billing practices by U.S. Reps. Henry Waxman, D-Los Angeles and Fortney "Pete" Stark, D-Fremont.
Perhaps they may jump in and start examining the bolus of these unusual diagnoses to see if any are wrongly exploiting an opportunity at the taxpayer's expense.