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Branson, Missouri, Hospital Ensnared In Kwashiorkor Crackdown

This story was updated at 5:14 p.m. to include comments from a spokeswoman for Cox Medical Center.

Cox Medical Center in Branson, Missouri, is the latest hospital to come under scrutiny for billing Medicare for a rare form of malnutrition usually seen in third-world countries.

In a report released Wednesday, the Department of Health and Human Services’ Office of Inspector General (OIG) said not one of the hospital’s 59 claims for the treatment of Kwashiorkor that the OIG reviewed was legitimate.

From 2010 to 2013, the 165-bed acute care hospital received $1.15 million in Medicare payments for using the diagnosis code for the disease, a severe form of protein deficiency typically found in children in tropical and subtropical countries and characterized by a distended belly. Cases in the United States are extremely rare.

Since last year, Medicare officials have been cracking down on what they see as a questionable rise in the diagnosis of Kwashiorkor, which pays more than other malnutrition diagnoses. In 2010 and 2011, the federal health care program paid $711 million for Kwashiorkor claims, according to the OIG, prompting it to launch a series of hospital audits.

Over a three-month period last year, the OIG found that not one of 466 audited claims billed as Kwashiorkor at five hospitals was legitimate. The hospitals said the errors were due to medical coding software programs or to unclear guidelines for malnutrition cases.

Cox, too, attributed its errors to problems with the software it used to code the diagnoses.

Melinda Honey, a spokeswoman for the hospital, said that Cox had cooperated with the OIG in identifying and reviewing cases with the diagnosis code for Kwashiorkor. 

"The issue regarding the Kwashiorkor diagnosis code was caused in part by the encoding system we were using at the time," she said in an email. "Cox Branson was presented the finding of the review and as a result, is prepared to make all necessary refunds to Medicare. All staff have been educated and changes have been made to the coding systems to help resolve this issue."

Specifically, the hospital has agreed to refund $122,951 in overpayments to Medicare. The OIG’s audit looked $541,961 in payments, but it said that for 21 of the 59 claims it reviewed, changing the diagnosis code would have made no difference in what Medicare paid.

Dan Margolies, editor of the Heartland Health Monitor team, is based at KCUR.

Dan Margolies has been a reporter for the Kansas City Business Journal, The Kansas City Star, and KCUR Public Radio. He retired as a reporter in December 2022 after a 37-year journalism career.
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