The HHS Office of Inspector General found Christus Saint Vincent Regional Medical Center in Santa Fe, N.M., did not comply with Medicare requirements for billing kwashiorkor from 2010 through 2012.
Kwashiorkor is a form of severe protein malnutrition that generally affects children who live in tropical and subtropical environments during periods of famine or inadequate food supply. Cases of kwashiorkor the United States are rare, but the Medicare program still provides coverage for the condition.
For calendar years 2010 and 2011, Medicare paid $711 million to hospitals for claims including the code for kwashiorkor. In light of this amount, the OIG is reviewing hospitals with claims that included the kwashiorkor diagnosis code.
The OIG reviewed 115 claims from Christus Saint Vincent, a 195-bed nonprofit teaching hospital that received $3.12 million for Medicare claims that included a code for kwashiorkor from calendar years 2010 through 2012.
The report says the hospital used diagnosis code 260 for kwashiorkor, but should have used codes for other forms of malnutrition. For 86 of the inpatient claims, correcting the diagnosis code resulted in no change in the diagnosis-related group payment. However, for the remaining 29 inpatient claims, the errors resulted in overpayments of $147,000.
Hospital officials attributed these errors to the medical coding software program used to code the diagnoses, according to the OIG.
The OIG recommended the hospital refund Medicare $147,262 for the incorrectly coded claims and strengthen its controls to ensure full Medicare billing compliance.
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