A hospital owned by Ontario, Calif.-based Prime Healthcare is facing accusations from investigative news outlet California Watch that it diagnosed patients with acute heart failure to reap more generous Medicare payments.
California Watch alleges that from 2008-2010, Chino (Calif.) Valley Medical Center claimed more than 35 percent of its Medicare patients suffered from acute heart failure — six times the state average, according to the report. California Watch says the spike in heart failure diagnoses is linked to a change in Medicare rules that authorized bonus payments to hospitals treating patients with major complications.
The news outlet reportedly analyzed the hospital’s billing data and found zero acute heart failure cases in 2006, before Medicare enacted its bonus payment rule. From 2008-2010, after the new reimbursement method was enacted, the hospital allegedly treated 1,971 Medicare patients for acute heart failure, according to the report.
A Prime attorney cited in the report said California Watch’s analysis is “faulty, unfair and biased.” He also said the heart failure diagnoses were accurate and made by treating physicians and not the hospital itself, according to the report.
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