HHS' inspector general's office has identified another area of possible improper "upcoding" by hospitals, asking HCFA to take a closer look at how hospitals bill Medicare for metabolic disorders such as anorexia and abnormal weight gain.
In a report completed late last month, the inspector general said that discharges billed to Medicare under the code for metabolic disorders nearly doubled from 1993 to 1996 among the 60 hospitals studied.
The report estimated that Medicare overpaid these hospitals $6.7 million in 1996, when discharges for metabolic disorders were actually falling nationwide. The 60 hospitals were referred to HHS' Office of Investigations for further review.
It's the second such report released within a month. The inspector general previously said it's considering an upcoding probe to look at how hospitals bill for blood poisoning, or septicemia (April 19, p. 4).
The federal government's first systematic investigation of hospital upcoding began in 1997 and focuses on how hospitals bill Medicare for pneumonia (Oct. 13, 1997, p. 4). The first hospital to settle a pneumonia upcoding case was Crozer-Keystone Health System in Springfield, Pa., which paid the government nearly $665,000 in 1997.