The U.S. Department of Justice intervened in a lawsuit recently against the operator of Glendora Community Hospital, alleging improper activity.
The lawsuit against Prime Healthcare Services Inc, the operator’s 14 California hospitals and its founder and CEO Prem Reddy alleges emergency departments at Prime’s facilities improperly admitted patients to the hospitals and submitted false government healthcare claims.
In the lawsuit, United States ex rel. Berntsen v. Prime Healthcare Services, et al, Prime’s founder Prem Reddy is accused of pressuring Prime’s emergency department physicians and hospital administrators to raise patient admission rates, regardless if the admissions were medically necessary. Reddy is also accused of exerting pressure on ER doctors to admit patients who could have been placed in observation, treated as outpatients, or discharged, according to the DOJ in a written statement.
The hospitals also allegedly filed false claims to federal healthcare programs such as Medicare as a result of the unnecessary admissions.
“The Department of Justice is committed to ensuring that health care providers do not inappropriately seek to profit at the expense of federal health care programs,” said Principal Deputy Assistant Attorney General Benjamin C. Mizer, head of the Justice Department’s Civil Division. “Schemes such as this one can contribute significantly to the rising cost of health care delivery and create needless patient risk.”
The lawsuit was filed in the U.S. District Court in Los Angeles by Karin Bernsten, a former employee at one of Prime’s hospitals where the improper patient admissions took place.
“Charging for medically unnecessary services, as alleged in this case, raises costs in government health programs and remorselessly passes that bill along to taxpayers,” said Special Agent in Charge Christian Schrank of the U.S. Department of Health and Human Services Office of Inspector General. “Our investigation into the allegations in this case, along with our law enforcement partners, led to the government’s decision to intervene.”
Glendora Community Hospital is a 128-bed facility and was announced as a non-profit facility in January of 2016.