OIG tags Louisiana hospital for incorrect billing

HHS' Office of the Inspector General found Cornerstone Hospital of Southwest Louisiana, a 30-bed long-term acute care hospital in Sulphur, submitted erroneous bills to Medicare for treatment of a rare malnutrition condition.

According to the OIG, Cornerstone 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 52 inpatient claims submitted by Cornerstone used the code for kwashiorkor when a different malnutrition code should have been used. This resulted in overpayments of $343,365 from 52 claims the hospital submitted between Jan. 1, 2010, and Dec. 31, 2013.

Based on its findings and a review of the hospital's comments, the OIG recommended the hospital refund the Medicare program $343,365 and strengthen its controls to ensure full compliance with Medicare billing requirements.

Hospital officials believe all claims identified by the OIG were appropriately submitted for payment.

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