Health Information Management

News: OIG fines another facility for inappropriate Kwashiorkor claims

CDI Strategies, April 24, 2014

Want to receive articles like this one in your inbox? Subscribe to CDI Strategies!

Oakwood Hospital and Medical Center (the Hospital), in Dearborn, Mich., is the latest facility to fall under the sights of the Office of the Inspector General (OIG) for inappropriately assigning diagnosis code 260 for Kwashiorkor.

In February Christus Saint Vincent Regional Medical Center, in Santa Fe, and Des Moines-based Mercy Health Network were both investigated, resulting in $150,000 and $90,000 in overbilling respectively.

In 2011, University of Maryland Medical System faced up to $8 million in fraud charges for inappropriate use of the code as did several California hospitals associated with Prime Healthcare.

Kwashiorkor is a form of severe protein malnutrition which typically afflicts children in so-called “third-world” countries during famine and is particularly rare in the United States. However, during calendar years 2010 and 2011 Medicare paid more than $700 million for Kwashiorkor-related claims.  

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. 

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 ...”

For additional information, consider reading the following ACDIS/HCPro articles on the subject:


Want to receive articles like this one in your inbox? Subscribe to CDI Strategies!

    Briefings on APCs
  • Briefings on APCs

    Worried about the complexities of the new rules under OPPS and APCs? Briefings on APCs helps you understand the new rules...

  • HIM Briefings

    Guiding Health Information Management professionals through the continuously changing field of medical records and toward a...

  • Briefings on Coding Compliance Strategies

    Submitting improper Medicare documentation can lead to denial of fees, payback, fines, and increased diligence from payers...

  • Briefings on HIPAA

    How can you minimize the impact of HIPAA? Subscribe to Briefings on HIPAA, your health information management resource for...

  • APCs Insider

    This HTML-based e-mail newsletter provides weekly tips and advice on the new ambulatory payment classifications regulations...

Most Popular