Upcoding trend? Hospital pays $800K over inflated malnutrition claims

Baltimore's Good Samaritan Hospital will pay about $800,000 to settle claims that it submitted inflated rates of patients suffering from malnutrition to Medicare and Medicaid for four years, reported The Baltimore Sun.

According to federal officials, from January 2005 to December 2008, the hospital added malnutrition as a secondary diagnosis when patients were not diagnosed or treated for that condition, according to the U.S. Department of Justice.

Moreover, the hospital allegedly asked leading questions to get physicians to report that patients were malnourished--which made patients appear to be in worse condition and led to increased reimbursement rates, the Justice Department noted.

Although the MedStar Health System hospital denied any wrongdoing, it decided to settle to avoid the continuing litigation costs, according to the Sun.

The industry has been rife with allegations of hospitals upcoding patient diagnoses to boost Medicare and Medicaid reimbursements. Last fall, the U.S. Department of Health & Human Services and the Department of Defense sued Kernan Hospital in Baltimore for $8.1 million for inflating the number of claims for a severe form of malnutrition called kwashiorkor.

Earlier that year, California-based Prime Healthcare was accused of falsely billing Medicare for treating a large number of kwashiorkor patients. State and federal authorities are investigating the health system for possible Medicare fraud related to unusually high rates of septicemia among its older patients.

Good Samaritan's settlement money was recovered under the federal False Claims Act, which has led to $2.4 billion in recoveries in civil healthcare fraud cases last year.

For more information:
- read the Baltimore Sun article
- here's the DoJ statement

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