Maryland hospital accused of inflating treatment claims
The U.S. Justice Department is suing a Baltimore rehabilitation hospital owned by the University of Maryland Medical System for allegedly inflating its claims for treating a rare form of protein malnutrition more commonly found in famine-racked African nations. In a False Claims Act lawsuit against Kernan Hospital, federal investigators say administrators, doctors and information technology officials conspired to artificially drive up the number of reported cases of Kwashiorkor so the hospital’s case mix would appear more complex and expensive to treat. The lawsuit alleges the hospital told doctors to include the phrase “protein malnutrition” in certain patient files. The hospital’s software then flagged any mention of the phrase so the billing department’s coders would classify the cases as Kwashiorkor. Hospital officials deny the allegations. Mary Lynn Carver, senior vice president for communications at University of Maryland Medical Center, said in an e-mail that the hospital is well known for treating traumatic brain injury patients who often need feeding tubes for protein for prolonged periods of time. As many as 30% of the hospital’s patients arrive with feeding tubes after long stays in acutecare hospitals, she said. Unlike most states, Maryland sets its own Medicare rates. In 2005, the state began allowing providers to include secondary diagnoses in patient records to gauge patient complexity, allowing hospitals with more complex case mixes to be paid more. Investigators say the number Kwashiorkor cases diagnosed by Kernan Hospital spiked, from zero in 2004 to 287 in 2007.