Health Information Management

News: OIG Kwashiorkor scrutiny continues

CDI Strategies, May 12, 2016

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The Office of the Inspector General (OIG) continues to target fraudulent Kwashiorkor claims. This time, the agency found Cornerstone Hospital of Bossier City, Louisiana, was overpaid $321,971 for inpatient claims. OIG audited 73 of the 189 claims with Kwashiorkor submitted by the 62-bed long-term acute-care hospital, which is part of Cornerstone Healthcare Group, from 2010 to 2014. None of them complied with Medicare billing rules for Kwashiorkor, the OIG said.

Cornerstone Hospital agreed that none of the patients were correctly coded for Kwashiorkor, though hospital officials believe that in all cases the medical record documentation supported some level of protein malnutrition.  
 
Kwashiorkor, a rare form of severe protein malnutrition typically found in third-world, famine-struck countries, 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.
 
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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