James Hoyer Prime Hospital Case Takes Major Step Forward

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Karin Berntsen – James Hoyer Client

The whistleblower case filed against Prime Healthcare by James Hoyer client Karin Berntsen has cleared a major hurdle.  The defendant’s Motion to Dismiss the case was denied in its entirety.  Judge Patrick Walsh of the U.S. District Court for the Central District of California wrote:

Based on these allegations, the Court is satisfied that Berntsen has stated an FCA (False Claims Act) claim with sufficient particularity as against all Defendants. Having carefully reviewed the FAC, the Court finds that it includes the who, what, when, where, and how of the alleged fraud.

The San Jose Mercury News wrote about the decision in an article, Controversial hospital chain owner poised to expand empire to Bay Area, about the hospital chain’s rapid expansion.  The article outlined the allegations in Berntsen’s complaint against Prime Healthcare:

Karin Berntsen, who gathered information during meetings with Reddy, alleges in the civil suit that Prime hospitals admit patients when medically unnecessary; “upcode” — that is, falsify patient records and billing codes to increase reimbursement; and, in order to make more money, often refuse to discharge patients or transfer them to another hospital.

The article goes on to further explain the allegations:

Berntsen is a veteran registered nurse, author of a book on patient safety and is currently the director of performance improvement at Alvarado Hospital in San Diego. In her suit, she accuses Reddy, as well as the hospital’s CEO and 14 of Prime’s California hospitals, of bilking the federal government of at least $50 million.

Click here to read the entire article in the San Jose Mercury News.