Audits from the Office of the Inspector General (OIG) found two hospitals failed to comply with Medicare billing requirements for Kwashiorkor, a form of severe protein malnutrition. The condition typically covers children suffering from famine or insufficient food supply.
Methodist Hospital, a 1,585-bed acute care hospital in San Antonio, Texas, received $9,466,320 in Medicare payments for the Kwashiorkor diagnosis code from 2010 to 2013. However, OIG said the hospital did not comply with Medicare billing requirements for any of the 124 claims it reviewed, which resulted in overpayments of $440,496.
Methodist Hospital agreed with the OIG’s report and attributed the errors to a medical software program and lack of clarity in coding guidelines. The hospital said the coding software has been updated and coders and physicians have been trained to understand the appropriate codes.
Baptist Hospital, a 1,422-bed acute care hospital in San Antonio, Texas, received $7,689,31 in Medicare payments for the Kwashiorkor diagnosis code from 2010 to 2013. However, IOG said the hospital did not comply with Medicare billing requirements for any of the 102 claims it reviewed, which resulted in overpayments of $458,677.
Officials at Baptist Hospital conducted their own review and found $18,657 in overpayments for four additional Kwashiorkor claims that were incorrectly coded. They attributed the errors to lack of knowledge of the coding guidelines and potential confusion from ICD-9 books.
Both hospitals indicated they would refund the overpayments.
Executive Editor
Tim Casey joined TriMed Media Group in 2015 as Executive Editor. For the previous four years, he worked as an editor and writer for HMP Communications, primarily focused on covering managed care issues and reporting from medical and health care conferences. He was also a staff reporter at the Sacramento Bee for more than four years covering professional, college and high school sports. He earned his undergraduate degree in psychology from the University of Notre Dame and his MBA degree from Georgetown University.