According to the OIG, Cornerstone Hospital billed Medicare for kwashiorkor, a form of severe protein malnutrition that mostly affects children in famine-stricken areas and developing countries. Kwashiorkor is not common in the U.S., but Medicare still provides reimbursement for its treatment.
The OIG said 73 claims submitted by Cornerstone Hospital used the code for kwashiorkor when a different malnutrition code should have been used. This resulted in overpayments of $321,971. Hospital officials believe all claims identified by the OIG were appropriately submitted for payment.
Based on its findings and a review of the hospital’s comments, the OIG recommended Cornerstone Hospital refund the Medicare program $321,971 and strengthen its controls to ensure full compliance with Medicare billing requirements.
The OIG’s audit covered 73 inpatient claims that the hospital submitted from Jan. 1, 2010, through Dec. 31, 2014.
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