Rise in kwashiorkor claims spurs HHS audit

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. Recent audits at two U.S. hospitals found that not one of 217 claims for the treatment of the condition in Medicare patients was proven legitimate.

All told, Medicare paid more than $700 million in 2010 and 2011 for patients diagnosed with kwashiorkor, which triggered a national review of claims for the condition.

Some experts say kwashiorkor may be documented in adult patients with traumatic brain injury who receive protein through a feeding tube over prolonged periods.

Last month, HHS' inspector general's office released audit results finding that medical records from two hospitals that each billed Medicare for more than 100 cases of kwashiorkor between 2010 and 2011 did not justify any of the diagnoses. Both hospitals blamed computer errors for the inaccurate billings. The auditors found that although kwashiorkor wasn't documented, most of the patients had secondary diagnoses that would have justified the same level of payments.

Mercy Medical Center in Des Moines, Iowa, which is owned by Catholic Health Initiatives, agreed to reimburse the government $89,000 for overpayments for its cases. It since has implemented a patch in its electronic billing system.

Christus St. Vincent Regional Medical Center in Santa Fe, N.M., owned by Christus Health, agreed to pay back $147,000. In 2010, the hospital used faulty software that resulted in incorrect diagnoses, according to a letter from the hospital's CEO in response to the investigation. The flaw has since been fixed, and the hospital has not seen another kwashiorkor case as of September, 2013.

Prime Healthcare Services, a for-profit hospital chain based in Ontario, Calif., has acknowledged being subpoenaed by federal investigators for information about its malnutrition cases, following an investigative report by California Watch that raised questions about Prime's high billing rates for kwashiorkor. Prime officials said the company was being targeted by federal investigators because of false allegations lodged against it by the Service Employees International Union, which represents some Prime employees.

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