Medicare officials have noticed a suspicious jump in the diagnosis of kwashiorkor, a rare form of malnutrition generally seen in children in poor countries during famines. Not one of 217 claims for the treatment of the condition in Medicare patients was proven legitimate in recent audits of two U.S. hospitals.
All told, the federal healthcare program paid more than $700 million in 2010 and 2011 for patients diagnosed with kwashiorkor—an amount so high that it has triggered a national review of claims for the condition. Kwashiorkor typically affects children, and Medicare is primarily limited to adults 65 and older.
One of the most visible signs of kwashiorkor is a distended belly in children afflicted with the condition. Though it has traditionally been known in tropical and subtropical climates in remote sections of Africa, some experts say it may be documented in traumatic brain-injury patients who receive protein through a feeding tube over prolonged periods of time.
As a diagnosis, kwashiorkor pays far more than other forms of malnutrition, and the U.S. Justice Department has accused one Maryland hospital of installing electronic health-record systems that specifically prompted clinicians and coders to classify almost any protein-deficiency case as kwashiorkor. That False Claims Act case was dismissed by a judge in 2011.