October 17, 2018
Fourteen hospitals caught in ‘up-coding’ scam
ONTARIO – (INT) – Ontario-based Prime Healthcare Services, Inc.; Prime Healthcare Foundation, Inc.; Prime Healthcare Management, Inc.; and Prime’s Founder and chief executive officer, Dr. Prem Reddy, have agreed to pay the United States $65 million to settle allegations that 14 Prime hospitals in California knowingly submitted false claims to Medicare by admitting patients who required only less costly, outpatient care.

The practice is known as ‘up-coding’.

Among the Inland Empire hospital defendants are Desert Valley Hospital and Chino Valley Medical Center. Montclair Hospital Medical Center is among four other hospital defendants owned by Prime Healthcare Foundation that are also parties to the settlement agreement

The settlement resolves allegations that, from 2006 through 2013, Prime engaged in a deliberate, corporate-driven scheme to increase inpatient admissions of Medicare beneficiaries who originally presented to the Emergency Departments at the 14 Prime hospitals in California. The government claimed that the inpatient admission of these beneficiaries was not medically necessary.
Story Date: August 11, 2018
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