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Promise Hospital of Ascension Incorrectly Billed Medicare Inpatient Claims With Kwashiorkor

Promise Hospital of Ascension (The Hospital), in Gonzales, Louisiana, did not comply with Medicare requirements for billing Kwashiorkor on any of the 62 claims that we reviewed. The Hospital used diagnosis code 260 for Kwashiorkor but should have billed for other forms of malnutrition or no malnutrition at all. For four of the inpatient claims, substituting a more appropriate diagnosis code produced no change in the diagnosis-related group or payment amount. However, for the remaining 58 inpatient claims, the errors resulted in overpayments of $465,000. The Hospital believes that all claims that we identified were appropriately submitted for payment.

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Office of Inspector General, U.S. Department of Health and Human Services | 330 Independence Avenue, SW, Washington, DC 20201