Mary­land hos­pi­tal ac­cused of in­flat­ing treat­ment claims

Modern Healthcare - - LATE NEWS -

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.

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