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Paradise Valley Hospital Suing Kaiser Over Unpaid ER Bills

National City’s Paradise Valley Hospital said Feb. 11 that it has filed a lawsuit against Kaiser Permanente for failing to pay emergency room bills for its HMO members.

Seven other hospitals, all owned by Victorville-based Prime Healthcare Services Inc., also filed suit in four of the state’s counties and are seeking $25 million, according to Prime Healthcare’s news release.

The hospital management company claimed that Kaiser made excessive demands for medical records, stated that care may not have been medically necessary, and demanded patients transferred back to Kaiser facilities without regard to safety.

Spokesman Jim Anderson said that Kaiser’s coordination of care policy ensures that patients who are stable be moved to Kaiser hospitals.

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He also called it an unusual and exceptional situation. In the past year, Kaiser awarded $1.2 billion in ER and related claims for HMO and PPO care across the state, according to Anderson.

“Most of the time, the system works,” he said.

Prime Healthcare operates nine acute-care hospitals in Southern California. Paradise Valley Hospital is a 301-bed facility serving the South Bay.

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Child Obesity Activist Named A Top Communicator:

Cheryl Moder was awarded a health care communicator award for her advocacy work with a public-private partnership fighting childhood obesity.

Moder is director of the San Diego County Childhood Obesity Initiative, a partner of the Coalition on Children & Weight San Diego.

The award was presented by Health Care Communicators of San Diego, a membership organization that represents individuals in the health care, medical and biotechnology industries. It was announced Feb. 7.

“Focusing on health care communications helps people in other industries understand the importance of the issue,” said Moder, a two-time president of Health Care Communicators.

The initiative was created to combat higher-than-normal childhood obesity rates in the county. The organization works for the long and short terms, on things such as increasing the number of walkable communities and improving access to affordable and healthy foods.

The plan also provides a venue for seven fields , government, health care, education, child care, community- and faith-based organizations, media and business , to share best practices when it comes to dealing with childhood obesity.

It is working with more than 50 organizations, ranging from local hospitals and clinics to the offices of county and city officials and regional restaurants.

The initiative employs Moder and one other staff member. The offices are located at the Community Health Improvement Partners’ headquarters on Ruffin Road.

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Rady Joins Nonprofit To Form Down Syndrome Clinic:

Rady Children’s Hospital San Diego has partnered with DS Action, a local nonprofit organization, to create a clinic that will offer specialized services twice a month for children with Down syndrome.

The Frost Street facility is the only pediatric Down syndrome center in Southern California, according to Carlos Delgado, hospital spokesman. Services will be available to patients from Mexico.

Social workers, pediatric clinical geneticists, developmental specialists, physical therapists and dentists will be available at the clinics, which are held the second and third Tuesday mornings of every month.

Hospital staff is treating eight patients at each clinic, which started Jan. 15, with payment coming from insurance providers or Medi-Cal, the state health care plan for the poor and the elderly.

During the next three years, the team at DS Action is planning to raise $250,000 to sustain the center and maintain its presence at Rady, according to Sharla Hank, the nonprofit’s vice president.

DS Action was founded in 2006 by a group of parents, grandparents and business and medical professionals; it is affiliated with the National Down Syndrome Society.

Down syndrome occurs in one out of every 733 live births, and more than 350,000 people in the United States have this genetic condition, according to the society.


Send health care news to Jaimy Lee at

jlee@sdbj.com

. She may also be reached at (858) 277-6359, ext. 3107.

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