Vibra Hospital Incorrectly Billed Medicare Inpatient Claims With Kwashiorkor

Vibra Hospital (the Hospital), in Amarillo, Texas, did not comply with Medicare requirements for billing Kwashiorkor on any of the 92 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 five of the inpatient claims, substituting a more appropriate diagnosis code produced no change in the payment amount. For the remaining 87 inpatient claims, the errors resulted in overpayments of $584,000. Hospital officials attributed this to errors made by a former owner of the Hospital and to a lack of clarity in the coding guidelines.