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Audit (A-03-13-00034)

09-26-2014
Providence Portland Medical Center Incorrectly Billed Medicare Inpatient Claims With Kwashiorkor

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Summary

Providence Portland Medical Center (The Hospital), in Portland, Oregon, did not comply with Medicare requirements for billing Kwashiorkor on any of the 90 claims that we reviewed. The Hospital used diagnosis code 260 for Kwashiorkor but should have used codes for other forms of malnutrition. For 87 of the inpatient claims, removing the diagnosis code resulted in no change in the payment. However, for the remaining three inpatient claims, the errors resulted in overpayments of $13,000. Hospital officials attributed these errors to a lack of clarity in the coding guidelines for malnutrition.

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