FOR RELEASE October 27, 2016
Contact: Elizabeth Nikels 909-235-4305 enikels@primehealthcare.com
American Hospital Association and California Hospital Association challenge Department of Justice’s prosecution of False Claims Act cases against hospitals (October 27, 2016 – Ontario, CA) - Amicus briefs filed by the American Hospital Association (AHA) and the California Hospital Association (CHA) in the False Claims action involving Prime Healthcare Services, Inc. state the government’s regulation of hospital admissions inappropriately challenges the clinical decisions of physicians and is unjust to patients, hospitals and physicians. The briefs by the two largest hospital associations in the country call for reform of the federal government’s enforcement of the Medicare regulation determining whether patients require inpatient admission or observation care. “This case represents the latest in a series of attempts by auditors and government attorneys to retrospectively review medical judgments and clinical predictions that physicians make every day against a necessarily ambiguous standard that the Medicare agency itself has struggled unsuccessfully to refine and clarify,” states the AHA amicus brief. The AHA and CHA briefs raise considerable doubt as to the validity and veracity of the government’s actions against hospitals on retrospective governmental review of complex medical decisions. The “second guessing” of physicians’ medical judgment by auditors and government entities negatively affects patient care and puts patients at risk, the briefs argue. The AHA represents more than 5,000 hospitals, health care systems, and other health care organizations. The CHA represents more than 400 hospitals, health systems members and more than 94 percent of the patient beds in California. As the AHA states in its brief, “The AHA has an interest in Medicare patients—in ensuring that the elderly and infirm among us have access to the benefits to which they are entitled so they receive the care they need. In this context, this case is significant for hospitals, physicians, and patients, beyond the issues of False Claims Act (FCA) jurisprudence.” In its complaint filed last May, the United States Department of Justice alleged that Medicare patients could have been treated under observation status rather than as inpatients. However, Prime Healthcare stated that physicians, not hospitals, determine medical necessity for admission using their independent medical judgment in the best interests of patients. Prime Healthcare | 3300 East Guasti Rd | Ontario, CA. 91761 Primehealthcare.com | Tel: (909) 235-4400