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Audit (A-03-14-00003)

10-10-2014
Overlook Medical Center Incorrectly Billed Medicare Inpatient Claims With Kwashiorkor

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Summary

Overlook Medical Center (The Hospital), in Summit, New Jersey, did not comply with Medicare requirements for billing Kwashiorkor on any of the 55 claims that we reviewed. The Hospital used diagnosis code 260 for Kwashiorkor but should have used codes for other forms of malnutrition. For 36 of the inpatient claims, correcting the diagnosis code resulted in no change in the payment. However, for the remaining 19 inpatient claims, the errors resulted in overpayments of $85,000. Hospital officials attributed these errors to a lack of clarity in the coding guidelines and issues with the medical coding software program used to code the diagnoses.

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