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Audit (A-03-14-00006)

09-09-2014
Mother Frances Hospital Incorrectly Billed Medicare Inpatient Claims With Kwashiorkor

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Summary

Mother Frances Hospital (the Hospital), in Tyler, Texas, did not comply with Medicare requirements for billing Kwashiorkor on any of the 160 claims that we reviewed, resulting in overpayments totaling $780,000. The Hospital used diagnosis code 260 for Kwashiorkor but should have billed either other forms of malnutrition or no malnutrition at all. Hospital officials attributed these errors to misinterpretation of the coding guidelines, issues with the medical coding software program used to code the diagnoses, and incorrect guidance from a third party consultant.

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