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California lawmakers call for investigation of Prime Healthcare

Prime Healthcare Services for California is reportedly facing allegations from California state lawmakers concerning allegations over a number of controversial medical billing practices.

State lawmakers announced Friday that they will hold a hearing led by the Senate Health Committee, which will investigate suspected overbilling of patients and suspected refusals to transfer out-of-network patients. The potential motives behind these actions could be to increase Prime Healthcare hospital revenues, at the cost of patient care and money, a practice lawmakers suggest could be illegal.

California State Senator Ed Hernandez, chairman of the Senate Health Committee, called the hearing on Friday in Los Angeles after learning of these suspected actions by Prime Healthcare.

“I have no problem with an entity turning a profit, but not at the expense of the consumer to the point it drives up healthcare costs,” Mr. Hernandez said.

The hearing focused primarily on the hospital’s requirement to transfer out-of-network patients once they become stabilized to receive necessary care in other appropriate facilities. By limiting the number of out-of-network patients from being transferred interferes with the quality of their care.  Hospitals and medical facilities have an obligation to the patient to ensure the best possible care.  While facility revenue is an issue, their revenue concerns should not hinder the care of their patients.

In addition, billing practices of Prime Healthcare were under fire.  Prime Healthcare is accused of overbilling medical charges to employers and government-run health programs.  The hearing highlighted the upcoming changes to Medi-Cal’s reimbursement system and how the state is preparing to handle the influx of millions of new patients, many of whom will be covered by 2014.

According to Prime Healthcare, it is unaware of any federal or state inquiries.  Prime Healthcare believes its practices comply with all state laws and regulations.

These allegations against Prime Healthcare were stimulated by conclusions from a 2010 study that found that 64 percent of Prime Healthcare patients stay in their hospitals for up to two days, compared to 36 percent of patients admitted to out-of-network hospitals. In addition, hospital billing staff and nurses have been interviewed to learn more about the hospitals’ practices.

In the past, Prime Healthcare was investigated for possibly submitting fraudulent bills to Medicare and Medi-Cal.  When these issues were brought to light, officials from Medicare and Medi-Cal looked into allegations of Prime Healthcare “upcoding” patient bills.

Prime Healthcare owns 14 hospitals in California Texas, and Pennsylvania. In addition, there are three other California hospitals that are related to nonprofit foundations.

After these allegations against Prime Healthcare were filed, Lex Reddy, the president and CEO, of Prime Healthcare resigned, after 11 years for personal reasons.  Prem Reddy, the company’s chairman, has taken over as the interim CEO. This new leadership may lead to management changes within Prime Healthcare, the required changes to rebuild confidence in the patients.

Michael Sarrao, vice president and general counsel at Prime Healthcare, said the investigation is simply politics, adding that he expects the company will be vindicated.

The investigation comes nearly a year after Mr. Hernandez, a Democrat, proposed a measure to hold state hospitals more accountable. The California Democrat was the chief sponsor of legislation that closed a loophole in state law concerning hospital licensing.

During that debate, Mr. Hernandez pointed to a series of actions by Prime Healthcare. Prime Healthcare bought Alvarado Hospital from Plymouth Health Investments in November of 2010. Since the named license-holder for the hospital, Alvarado Hospital LLC, was unchanged in the sale, Prime was not required to apply for a new license. This despite being under investigation by the Dept. of Public Health for problems reported at other hospitals Prime operates, according to Mr. Hernandez.

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HEALTH

CDC: Raw milk connected to diary-related disease outbreaks in U.S.

According to the Centers for Disease Control and Prevention (CDC), most diary-related diseases come from consumption of raw, or unpasteurized, milk or milk-products. States that allowed the sale of raw milk were found to have more than double the number of dairy-related disease outbreaks, compared to states that prohibit the sale of raw milk. Shockingly, the rate of incidents linked to raw milk and raw milk-products is nearly 150 times greater than incidents linked to pasteurized milk.

In this study, researchers examined diary-product disease outbreaks nationally over the past 13 years (1993-2006). In the survey, there were 121 outbreaks linked to dairy products. Of these reported outbreaks, about 60 percent of the outbreaks were linked to raw milk, and 39 percent of outbreaks were linked to pasteurized milk.

Raw milk products led to 4,413 reported illnesses, 239 reported hospitalizations, and three reported linked-deaths. Most of the severe illnesses disproportionally affected people under the age of 20-years-old, especially young children.

The dairy-related outbreaks occurred in 30 states, and 75 percent of the raw milk outbreaks occurred in 21 states where it was legal to sell raw milk products at the time.

In the U.S., there are 20 states where it is illegal to sell raw milk. However, about one percent of milk and milk-products consumed are made from raw milk.

Some people prefer to consume raw milk because they believe raw milk offered health benefits that pasteurized milk does not. Unfortunately, even under cleanliest conditions, collecting milk introduces bacteria, and when this raw milk is stored, these bacteria can could to grow.

Pasteurization is the process of heating milk to kill bacteria that are present. This makes the milk safer for people to consume. This process typically involved heating the milk to 161 degrees F for 15 seconds.

The most recent milk related outbreak was responsible for making 77 people in four states sick. Campylobacteria was found to be the cause, originating from milk produced by Family Cow dairy in Chambersburg, Pennsylvania.

This study was published in the journal emerging Infectious Disease.

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NSA chief worries about Anonymous attack on U.S. power grid

General Keith Alexander, director of the National Security Agency, is concerned about the threat posed  to the U.S. power grid by the computer hacking group known as Anonymous.

The Wall Street Journal reports that Mr. Alexander has held meetings at the White House recently explaining his assessment of Anonymous.

The NSA has not publicly commented on the matter though.

Anonymous is a group of highly skilled computer hackers, known for having committed cyber attacks on some of the most high profile companies in the U.S. recently. They are known for wearing the Guy Fawkes mask, popularized by the 2005 film “V for Vendetta.”

Their cyber attacks primarily have been aimed at either embarrassing companies or simply trying to make a point of the damage that their hacking abilities can pose.

According to the Anonymous Twitter account and blog though, they are not planning any of the attacks reported by the Journal Tuesday.

“Anonymous attracted the attention of the National Security Agency,” wrote the hackers on their blog site Tuesday. “In private meetings at the White House, NSA director General Keith Alexander warned that in a year or two the group could attack the energy grid and shut off power for millions. Ridiculous! Why should Anonymous shut off power grid? Makes no sense! They just want to make you feel afraid.”

The Anonymous group have also been vocal about their opposition to the SOPA and PIPA bills that are currently up for consideration in both chambers of Congress.

No representatives from the White House or the NSA have publicly commented on Anonymous specifically. However, Mr. Alexander recently did comment on the growing abilities of hackers that are able to access, damage and even shut down high profile computer networks in the U.S.