Rising Scrutiny of Kwashiorkor Claims Places Hospitals at Risk of FCA Lawsuits

Billing for a severe protein deficiency called kwashiorkor is a new area receiving immense scrutiny from HHS' Office of the Inspector General this year.

Kwashiorkor is a form of severe protein malnutrition that mostly affects children in famine-stricken areas and developing countries, which makes it an uncommon diagnosis in the U.S. The mismatch in populations of those who suffer from kwashiorkor and those who receive Medicare has resulted in increased scrutiny from the OIG concerning bills for this diagnosis.

Since February, seven hospitals have been flagged by the OIG for inappropriate kwashiorkor billing. The combined overpayments for those seven cases total $811,480.

Fraudulent billing for kwashiorkor first gained attention in 2009 when two hospitals in California reported extremely high rates of this specific type of malnutrition. That year, Redding, Calif.-based Shasta Regional Medical Center reported 16 percent of its Medicare patients 65 and older suffered from kwashiorkor, which was 70 times the state average of .2 percent. Victorville, Calif.-based Desert Valley Hospital reported 9 percent of its Medicare patients suffered from kwashiorkor, or about 39 times the state average.

More recently, an OIG audit revealed Dearborn, Mich.-based Oakwood Hospital, the 553-bed flagship of Oakwood Healthcare, had incorrectly billed for kwashiorkor resulting in $47,860 in Medicare overpayments. 

Due to the OIG's peaked interest in kwashiorkor, hospitals can anticipate rising government scrutiny of kwashiorkor billing and potential whistle-blower claims under the False Claims Act in the near future.

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