In the latest controversy between Ontario, Calif.-based Prime Healthcare Services and SEIU-United Healthcare Workers West, the union has accused the for-profit hospital operator of overbilling Medicare by $93 million. However, Prime Healthcare says the accusations are based on fabricated data.
According to SEIU-UHW research, Prime Healthcare unnecessarily admitted 18,000 emergency department patients for overnight stays when those patients should have been put into observation care, which is much less costly. The union says Prime Healthcare was paid an average of $5,000 more per person for each of the admitted patients than it would have been if the patients were placed in observation.
"Every time we think we've heard every example of Prime Healthcare jacking up its billing at the expense of taxpayers, we seem to find one more," said Dave Regan, president of SEIU-UHW.
Concerning the Medicare overbilling accusations, Fred Ortega, a Prime Healthcare spokesperson says, "These latest allegations are part of a tired, self-serving corporate campaign the SEIU-UHW is waging against Prime Healthcare and are based on the union's own fabricated data. In fact, the findings are inconsistent with reviews conducted by nationally accredited Medicare auditing agencies and do not recognize the objective criteria used to determine the need for inpatient admission."
The battle between the union and Prime Healthcare has been going on for months. In August, SEIU-UHW protested after news surfaced that Prime Healthcare and Daughters of Charity Health System — a six-hospital network based in Los Altos Hill, Calif. — were in merger talks. Later that month, Prime Healthcare filed a federal lawsuit against several employee unions, including SEIU-UHW, alleging the unions had used extortionist tactics to prevent it from purchasing DCHS.
In October, DCHS agreed to sell its six hospitals to Prime Healthcare. Immediately after the sale announcement was made, SEIU-UHW proclaimed it would fight to stop the deal. Later that month, the union filed a lawsuit against DCHS alleging the system evaded federal pension law by improperly classifying its pension as a "church plan," and further alleged the future of 9,000 employees and retirees was at risk because Prime Healthcare had not agreed to operate the pension plan as one protected by the Employee Retirement Income Security Act.
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