OIG tags shuttered Louisiana hospital for incorrect billing


HHS' Office of Inspector General found Promise Hospital, a now-closed 54-bed transitional care hospital in Gonzales, La., submitted erroneous bills to Medicare for treatment of a rare malnutrition condition.

According to the OIG, Promise 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 62 inpatient claims submitted by Promise Hospital used the code for kwashiorkor when a different malnutrition code or no malnutrition code should have been used. This resulted in overpayments of $465,079. The hospital believes that 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 the hospital refund the Medicare program $465,079 and strengthen its controls to ensure full compliance with Medicare billing requirements.

The OIG's audit covered 62 inpatient claims that the hospital submitted from Jan. 1., 2010, through Dec. 31, 2013. The hospital closed before the start of the OIG's audit work.

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