$8.1M federal upcoding suit dismissed

Kernan Hospital in Baltimore is no longer facing charges of manipulating patient data to receive more federal reimbursements, after a federal judge last week dismissed the $8.1 million lawsuit, reported The Baltimore Sun.

According to the lawsuit filed last year, the U.S. Department of Health & Human Services and Department of Defense claimed the hospital system upcoded patients for a severe form of malnutrition called kwashiorkor to receive higher payments from Medicare and Medicaid.

However, U.S. District Judge Richard D. Bennett's ruling said the feds didn't demonstrate that fraudulent diagnoses were submitted to the government for reimbursement, noted the Associated Press.

According to the University of Maryland Medical System, which owns Kernan, there wasn't a rise in kwashiorkor cases, reported the Sun. The issue stemmed from changes in reimbursement that gave secondary diagnosis coding greater weight, the system said.

Because the judge's ruling did not focus on the legitimacy of the malnutrition diagnoses, the U.S. attorney's office is mulling over whether to appeal or file an amended complaint, according to the AP.

Baltimore is no stranger to accusations of upcoded patient diagnoses. Earlier this year, Good Samaritan Hospital agreed to pay about $800,000 to settle claims that it submitted inflated rates of patients suffering from malnutrition to Medicare and Medicaid for four years.

To learn more:
- read the Sun article
- here's the AP article

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