IE hospital investigated for Medicare fraud


If a patient were to simultaneously come down with the life-threatening blood infection known as septicemia, there would be real trouble, medical experts say.

Thankfully, these two deadly diagnoses don't converge often – except at Prime Healthcare Services' Chino Valley Medical Center in San Bernardino County.

In the past three years, 7.8 percent of Chino Valley's Medicare patients - 442 people - were reported to have both acute heart failure and septicemia, a California Watch analysis of state records shows.

That's more than 15 times the state rate.

Like acute heart failure, septicemia is classified as a major complication by Medicare. The diagnosis entitles providers to hefty treatment bonuses.

Prime is being investigated by federal authorities for suspected Medicare fraud in connection with its high reported rate of septicemia, records show. The company has denied wrongdoing.

As California Watch reported over the weekend, from 2008 through 2010, Chino Valley Medical Center had the highest rate in the state for acute heart failure among its Medicare patients.

According to state records, the hospital said 35.2 percent of patients aged 65 and older were suffering from this dangerous breakdown in the heart's ability to pump blood. That's six times the state average.

The records, obtained from the state Office of Statewide Health Planning and Development, also showed the confluence of heart failure and septicemia diagnoses at Chino Valley.

A UCLA expert questioned the accuracy of these reported rates, but Prime's attorney, Anthony Glassman, said there was nothing wrong with them.

Septicemia and acute heart failure "commonly coexist in the same patient as septicemia will worsen chronic heart failure," he wrote in a letter in response to California Watch's query.

If it's unusual for a Medicare patient to suffer simultaneously from acute heart failure and sepsis, it's even more unusual for such a patient to go home from the hospital without extensive treatment.

But at Chino Valley, 99 of the 442 patients diagnosed with both acute heart failure and septicemia were discharged to their homes, alive, after hospital stays of two days or less. Chino Valley's rate for quickly discharging patients reported to have the two conditions was more than 50 times higher than the statewide rate.

Heart specialist Dr. Gregg Fonarow, a professor of medicine at UCLA and director of the Ahmanson-UCLA Cardiomyopathy Center, was dubious.

"AHF and septicemia can occur together, but the vast majority of patients with AHF do not have sepsis," he wrote in an e-mail, using the acronym for acute heart failure. "A very short (hospital stay) with discharge to home for septicemia alone or with AHF are very unlikely for patients that meet clinical criteria for these diagnoses."

Prime attorney Glassman did not address questions about patients' length of stay.

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