Health Information Management

News: Maryland facility faces $8 million fraud charges for Kwashiorkor billing

CDI Strategies, October 27, 2011

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The Department of Health and Human Services and the Department of Defense accused Baltimore-based Kernan Hospital, a part of the University of Maryland Medical System, of inappropriately billing “protein malnutrition” as “kwashiorkor”—a $1.6 million potential error that could ultimately cost the facility up to $8 million in fraud charges, The Baltimore Sun reported. Government penalties associated with filing false claims can amount to triple the amount of each false claim filed.

“The term ‘kwashiorkor’ was first used in 1933 by Dr. Cicely Williams to describe severe protein deficiency with some degree of preserved caloric (carbohydrate) intake among children in Africa,” writes Richard D. Pinson, MD, FACP, CCS, principal of HCQ Consulting in the October edition of CDI Journal. “The most striking and characteristic finding is severe edema associated with malnutrition. Kwashiorkor was never meant to apply to adults, and such severe protein deficiency alone is an extremely rare condition in America.”
Kernan Hospital allegedly programmed its electronic records system to recognize the words “protein malnutrition” as “kwashiorkor” and its administration reportedly pressured clinicians to write protein malnutrition in patients’ charts, The Baltimore Sun states. Cases including kwashiorkor as a secondary diagnosis reportedly rose from none in 2004 to 287 in 2007.
AHA’s Coding Clinic for ICD-9-CM, third quarter 2009 states that coders should not report ICD-9-CM code 260 when the provider does not specifically document kwashiorkor. (See the January 20, 2011 Q&A published in CDI Strategies.)
Coding Clinic also states:
“Kwashiorkor … is extremely rare in the United States. The National Center for Health Statistics (NCHS) is considering a proposal to revise the index entries under mild and moderate protein malnutrition in order to provide clearer direction ...”
Editor’s Note: For additional information regarding documentation requirements and coding guidelines related to malnutrition visit the ACDIS website and type “malnutrition” into the site search bar.

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