Update: The Systemic Nature of Medicare Fraud

On January 9, I posted “The Systemic Nature of Medicare Fraud,” —“the kind of Medicare fraud that makes your skin crawl.” On January 10, I received an email from Dr. Ted Mazer, Chief of Staff at Alvarado Hospital Medical Center. He strongly objected to this sentence: “Its Alvarado Hospital Medical Center in San Diego already appears to be under investigation.” And then we had an illuminating exchange of emails.

California Watch published a series of articles that investigated Medicare fraud at the hospital chain, Prime Healthcare Services, and I used some of the examples. Here is the paragraph from the California Watch article on which I based the offending sentence:

Last month, California Watch reported that FBI agents had contacted two former employees of Prime’s Alvarado Hospital Medical Center in San Diego to discuss billing practices. In an earlier interview with California Watch, the employees said that at a 2010 meeting, Reddy had urged physicians to document a disorder called autonomic nerve disorder in cases when patients fainted. Reporting the disorder would boost the hospital’s payout, by their account.

Here is my paragraph with the offending sentence, highlighted for clarity:

So a special industry has sprouted up around Medicare. California Watch, which claims to have analyzed more than 50 million Medicare patient records that it obtained through the Freedom of Information Act, identified thousands of instances where Prime Healthcare Services billed Medicare for the treatment of rare conditions. Its Alvarado Hospital Medical Center in San Diego already appears to be under investigation. At its Chino Valley Medical Center in San Bernardino County, a whopping 35.2% of the Medicare patients were treated for acute heart failure, six times the average rate. The hospital chain meanwhile claims its billing statements are accurate.

And here is the beginning of Dr. Mazer’s initial email: 

As the new Chief of Staff at Alvarado Hospital in San Diego, and a long time Alvarado staff surgeon, I will not take issue with your Jan. 10 article on Medicare fraud, noting that we all look forward to an actual conclusion from any reported investigations into billing practices at Prime hospitals, regardless of the findings, so as to resolve the ongoing media trial of very complex issues in medical coding and billing. The same holds true for the most recent issue of possible privacy violations which we as physicians hold dear.However, I do take strong exception to your statement in the article regarding Alvarado Hospital which has been owned by Prime for just over a year. You state: “Its Alvarado Hospital Medical Center in San Diego already appears to be under investigation.” I challenge you on this as there is no investigation of Alvarado by any entity to my knowledge….

To my knowledge. That, ultimately, is the point. I do NOT have any knowledge of an investigation either. What I do have is a series of articles by California Watch. And one of the paragraphs describes some events that I interpreted to mean that Alvarado Hospital might be under investigation—though the events could have been unrelated to an investigation of Alvarado Hospital. Because I didn’t have actual knowledge of an investigation, I used “appears to be” rather than “is.”

Yet, for the reader, there may be no difference between “appears to be” and “is.” The reader might simply retain “under investigation” and take that as a fact. I should have stuck closer to the wording California Watch used, and not imply something that wasn’t stated in the text and that I had no knowledge of. So I have removed the sentence from the original post. And I appreciate Dr. Mazer’s bringing this issue to my attention.

Enjoy reading WOLF STREET and want to support it? You can donate. I appreciate it immensely. Click on the beer and iced-tea mug to find out how:

Would you like to be notified via email when WOLF STREET publishes a new article? Sign up here.