The Hospital of Central Connecticut Incorrectly Billed Medicare Inpatient Claims With Kwashiorkor

The Hospital of Central Connecticut (the Hospital), with locations in Southington and New Britain, Connecticut, did not comply with Medicare requirements for billing Kwashiorkor on any of the 30 claims that we reviewed. The Hospital used diagnosis code 260 for Kwashiorkor but should have used codes for other forms of malnutrition or no malnutrition code at all. For three of the inpatient claims, substituting a more appropriate diagnosis code produced no change in the payment amount. However, for the remaining 27 inpatient claims, the errors resulted in overpayments of $114,000. Hospital officials attributed these errors to a lack of clarity in the diagnosis coding guidelines.