PHILADELPHIA,PA- Prime Healthcare Services Inc. and Dr. Prem Reddy, the California hospital management company’s founder and CEO based in Ontario,CA, have agreed to pay the US $1.25 million to settle allegations that two of its hospitals in the Philadelphia region knowingly submitted false claims to Medicare, according to media reports. Prime Healthcare has 45 acute-case hospitals in 14 states.
The government alleged Roxborough Memorial Hospital in Philadelphia and Lower Bucks Hospital in Bristol admitted Medicare patients to the hospital for overnight stays who required only less costly, outpatient care and billed Medicare for more expensive patient diagnoses than the patients had — a practice known as upcoding.
Prime operates 45 hospitals in 14 states. It acquired Roxborough Memorial Hospital in February 2012 and Lower Bucks Hospital in October of the same year. The alleged improper admissions, according to the U.S. Attorney’s Office in Philadelphia, occurred from the time the medical centers were acquired through September 2103. under Prime’s management, the hospitals allegedly admitted emergency room Medicare patients for “costly and medically unnecessary” one- and two-day overnight hospital stays, instead of treating the patients in less costly outpatient service or keeping them under observation. The upcoding incidents allegedly occurred from time the hospitals were acquired through December 2014. Prime and Reddy paid the US $65 million dollars in August 2018 to settle similar Medicare fraud allegations involving 14 Prime hospitals in California.
In August 2018, Prime, Roxborough Memorial and Lower Bucks hospitals, and Reddy entered into a Corporate Integrity Agreement with the Department of Health and Human Services Office of Inspector General requiring the company to engage in “significant” compliance efforts over the next five years. Under the agreement, Prime is required to retain an independent review organization to review the accuracy of its claims for services provided to Medicare beneficiaries. The settlement resolves a whistleblower lawsuit filed under the False Claims Act in the U.S. District Court for the Eastern District of Pennsylvania by an employee and former employee of Roxborough Memorial. The case was investigated by the Office of the Inspector General of the U.S. Department of Health and Human Services and the U.S. Attorney’s Office for the Eastern District of Pennsylvania.
Prime operates 45 hospitals in 14 states. It acquired Roxborough Memorial Hospital in February 2012 and Lower Bucks Hospital in October of the same year. The alleged improper admissions, according to the U.S. Attorney’s Office in Philadelphia, occurred from the time the medical centers were acquired through September 2103. under Prime’s management, the hospitals allegedly admitted emergency room Medicare patients for “costly and medically unnecessary” one- and two-day overnight hospital stays, instead of treating the patients in less costly outpatient service or keeping them under observation. The upcoding incidents allegedly occurred from time the hospitals were acquired through December 2014. Prime and Reddy paid the US $65 million dollars in August 2018 to settle similar Medicare fraud allegations involving 14 Prime hospitals in California.
In August 2018, Prime, Roxborough Memorial and Lower Bucks hospitals, and Reddy entered into a Corporate Integrity Agreement with the Department of Health and Human Services Office of Inspector General requiring the company to engage in “significant” compliance efforts over the next five years. Under the agreement, Prime is required to retain an independent review organization to review the accuracy of its claims for services provided to Medicare beneficiaries. The settlement resolves a whistleblower lawsuit filed under the False Claims Act in the U.S. District Court for the Eastern District of Pennsylvania by an employee and former employee of Roxborough Memorial. The case was investigated by the Office of the Inspector General of the U.S. Department of Health and Human Services and the U.S. Attorney’s Office for the Eastern District of Pennsylvania.
RSS Feed
