Both hospitals used diagnosis code 260 for Kwashiorkor but should have used either a code for another form of malnutrition or no malnutrition code at all, according to the OIG.
Methodist Hospital received $440,496 in overpayments from Medicare, while Baptist Medical Center received $477,334 in overpayments.
The estimation for Methodist Hospital was based on the results of a sample of 124 claims reviewed by the OIG. The estimation for Baptist Medical Center was based on the results of a sample of 102 claims reviewed by the OIG plus four additional claims reviewed by the hospital.
The OIG recommended that the hospitals refund their respective estimated overpayments to the Medicare program and strengthen controls to ensure full billing requirement compliance.
Baptist Medical Center concurred that all 102 reviewed claims were incorrectly billed with a diagnosis code for Kwashiorkor, while Methodist Hospital concurred that all 124 claims reviewed by the OIG were incorrectly billed with a diagnosis code for Kwashiorkor.
