Health & Welfare | Daily Report | Decoding Prime

January 9, 2012 | Lance Williams

FBI agents interviewed a former Shasta County hospital patient Friday amid indications of a widening federal inquiry into Medicare billing practices at the Prime Healthcare Services hospital chain.

Darlene Courtois, 64, who was featured in a California Watch report last month about unusual Medicare billings at a Prime hospital in Redding, spent more than an hour with three federal agents, said her daughter, Julie Schmitz.

Schmitz said the agents asked questions about a 2010 hospital stay after which Prime had billed Medicare for treating Courtois for kwashiorkor, a dangerous form of malnutrition that afflicts children during African famines.

The agents also asked questions about an incident last month in which the hospital allegedly publicized Courtois’ medical records – without her permission – in an effort to refute the California Watch story, Schmitz said in a telephone interview.
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Medicare pays hefty bonuses to hospitals for treating complicated medical cases, and a diagnosis of kwashiorkor can boost a hospital’s payout by more than $6,000 per patient, records show.

As California Watch has reported, in the past two years, Prime’s Shasta Regional Medical Center has billed Medicare for more than 1,000 kwashiorkor cases – 70 times the statewide rate.

Among them was Courtois, a retired teacher’s aide who lives in rural Shingletown, west of Mount Lassen.

Courtois told the agents that she was hospitalized in 2010 for kidney failure, not kwashiorkor, her daughter said. She told the agents she received no treatment for kwashiorkor or any other kind of malnutrition during her 2010 hospitalization, by the daughter’s account.

Schmitz said her mother disputed the hospital’s account that she had received diet counseling to treat her for a condition called protein malnutrition.

“No. They didn’t. Nobody has,” said Schmitz, who monitors her mother’s care and who participated in the FBI interview.

In an e-mail in response to a request for comment, a hospital spokesman wrote, “Shasta Regional Medical Center believes it has followed all state and federal laws and regulations. In abundance of caution, Shasta Regional has already notified all the proper agencies.”

In the past 18 months, three California congressmen have asked Medicare to investigate Prime for a suspected form of Medicare fraud called upcoding, in which a provider files false claims via computerized billing codes to reap enhanced reimbursement.

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