Kwashiorkor in Northern California Means Fraud
|Kwashiorkor in Niger|
Before you answer that, let me explain what Kwashiorkor is. It is a severe form of protein malnutrition...starving to death actually. It is the type of starvation you see in African children. It is so severe that the patient needs special nutritional support including special re-feeding with vitamins and it occurs mainly in children ages 1-4. Adults can starve to death, but they do not develop classic Kwashiorkor.
Medicare pays hospitals a flat rate based on diagnosis codes for patients. Patients with more severe coded illnesses get paid at a much higher rate. Shasta Regional Medical Center, located in Redding, Shasta County, California is under the microscope for billing Medicare (our tax dollars at work) for 1,030 cases of Kwashiorkor to the tune of $11,463 for each diagnosis. This medical center is a 246 bed facility in a town of about 90,000 people. The entire county is less than 200,000 population. The median home price in 2010 was $245,000 and the average household income is $62,222. Hardly the demographics for Kwashiorkor.
|Patient described as kwashiorkor|
A former medical coder at another Prime Healthcare Hospital told California Watch that she was pressured to write up patients for kwashiorkor if they had low albumin levels and were diagnosed for ordinary malnutrition. Low albumin is very common in hospitalized patients and it can accompany a number of medical illnesses. Coding these as kwashiorkor is fraud, plain and simple.
Most hospitals across the Country are doing their best to take care of patients and function with the byzantine regulations of Medicare and hundreds of insurance companies. The majority of hospitals lose money on Medicare patients. Flagrant abuse in billing, such as is suspected at Shasta Regional Medical Center, gets no sympathy from me. I hope the CEO ends up in stripes and that all of the Prime Healthcare Hospitals are closely investigated.