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Payments for Patients Diagnosed with Malnutrition

Kwashiorkor is a form of severe protein malnutrition that generally affects children living in tropical and subtropical parts of the world during periods of famine or insufficient food supply. It is typically not found in the United States. A diagnosis of kwashiorkor on a claim substantially increases the hospitals' reimbursement from Medicare. Prior OIG reviews have identified inappropriate payments to hospitals for claims with a kwashiorkor diagnosis. We will review Medicare payments made to hospitals for claims that include a diagnosis of kwashiorkor to determine whether the diagnosis is adequately supported by documentation in the medical record. We will roll up the results of our audits of Medicare hospital payments for kwashiorkor to provide Centers for Medicare & Medicaid Services with cumulative results and make recommendations for any appropriate changes to the program.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
Completed (partial) Centers for Medicare & Medicaid Services Payments for Patients Diagnosed with Malnutrition Office of Audit Services A-03-14-00010; W-00-17-35538; various reviews 2018