Health Information Management

News: OIG continues Kwashiorkor targets

CDI Strategies, February 11, 2016

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Even though Promise Hospital of Ascension, a 54-bed transitional care hospital located in Gonzales, Louisiana, closed before the Office of the Inspector General (OIG) began auditing it for fraudulent Kwashiorkor claims, the agency found errors resulting in more than $450,000 in overpayments. In the end, the OIG found that 58 of the 64 claims it reviewed should have been billed as other forms of malnutrition or not malnutrition at all, the OIG says.

For its part, Promise says it followed ICD-9-CM coding conventions in “good faith and reasonable interpretation” for unspecified protein malnutrition.
Kwashiorkor has long been a target for the OIG, consistently mentioned in the agencies annual Work Plan. Its 2016 Work Plan includes a number of items pertinent for CDI professionals including ongoing investigations into MS-DRG assignment associated with mechanical ventilation and kwashiorkor claims. Medicare paid more than $700 million for kwashiorkor claims during calendar years 2010 and 2011 alone. The OIG’s review of Promise covered claims within calendar years 2010-2013 based on CMS’s National Claims History data.
Kwashiorkor, a rare form of severe protein malnutrition which typically only occurs in third-world, famine-struck countries. CDI professionals seeking clarifications for malnutrition need to understand how documentation for various malnutrition types track to different code sets to guard against inappropriate assignment for Kwashiorkor .
Type the term in the ACDIS search engine to read up on nearly a dozen cases of OIG take backs.

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