California Watch has consistently stood behind its reporting on Prime Healthcare Services’ aggressive Medicare billing practices.
And we continue to do so – even as our reporters have come under attack from the editor of the Redding Record Searchlight for our story about a local Prime hospital that claimed in Medicare billings that it was treating an outbreak of a nutritional disorder seen in developing countries called kwashiorkor.
In a column Sunday, the editor wrote that he decided not to publish California Watch’s Dec. 16, 2011, report after meeting with Prime officials to review the confidential medical records of a patient who was interviewed for the story. The state health department recently fined Prime $95,000 for violating patient confidentiality laws by publicizing the patient’s records.
In his column, the editor accused California Watch, a project of the Center for Investigative Reporting, of ignoring “contradicting facts” and failing to correct errors in our report. But the column cited no errors, and the “contradicting facts” that he accused us of ignoring actually were addressed at length in the story.
Because the Record Searchlight continues to feel the need to justify its decision not to publish an important local story by criticizing California Watch, we felt the need to respond in more detail regarding the handling of this story.
Here are the facts:
Kwashiorkor is a nutritional disorder that experts say typically afflicts children during famines in developing countries. In 2009 and 2010, Prime’s Shasta Regional Medical Center billed Medicare for treating more than 1,000 cases of the ailment, a California Watch analysis shows. That’s more than 70 times the statewide rate for general hospitals.
Among the patients was the 64-year-old woman who was the subject of the Dec. 16 story. Records obtained via a Freedom of Information Act request show that Prime billed Medicare for treating the patient for kwashiorkor and received an additional payment of $6,700.
In an interview, the patient, who we identified in our story as an on-the-record source, said she had never heard of kwashiorkor and was hospitalized and treated for kidney failure, not malnutrition. The patient was described as “well nourished” in her admitting documents and described herself as overweight.
The patient requested her hospital records from Prime and allowed California Watch to review them.
The records supported her account. On the eve of publication, Prime said it had additional documents – records that the patient said she had not been provided. Prime did not provide these records to California Watch, though it showed them to the Record Searchlight.
The company maintained that these records showed that the patient had been diagnosed with protein malnutrition and had received a nutritional consultation. That justified a billing for kwashiorkor, Prime contended. Our story quoted Prime spokesman Edward Barrera on these points. We also published his letter on our website.
But the story also noted that the patient denied receiving a nutritional consultation and insisted she had never been told she was malnourished. In addition, the story quoted experts who described kwashiorkor as a dangerous condition that requires urgent intervention to save the patient’s life.
Since publishing our story we have learned additional details about the patient’s case that underscore the concerns our story raised regarding the accuracy of her diagnosis and of the billing Prime submitted to Medicare.
For example, results from the patient’s blood chemistry panel conflicted with a malnutrition diagnosis or could be explained by the fact that she happens to be diabetic. Both the American Hospital Association and Medicare itself have said that hospitals should not equate malnutrition with kwashiorkor on Medicare billings – even in cases in which a malnutrition diagnosis is justified.
Our reporters spent a year on our investigation of Prime. California Watch’s site provides additional information about Prime’s billing practices and about how we reported the story.
We continue to stand by our work.
Mark Katches is the editorial director of the Center for Investigative Reporting.