OIG investigates Aetna in its latest round of audits

by Brian Murphy

Few diagnoses seem to be under the microscope so intensely as severe malnutrition. A year ago, the Office of Inspector General (OIG) released the report “Hospitals Overbilled Medicare $1 Billion by Incorrectly Assigning Severe Malnutrition Diagnosis Codes to Inpatient Hospital Claims.” (What a headline!) In it, the OIG describes an audit of about 225,000 claims, representing $3.4 billion in Medicare payments, within the discharge date of fiscal year 2016-2017. These claims contained a severe malnutrition diagnosis code which was the only MCC. The audit consisted of a random sample of 200 claims with payments totaling $2.9 million. A subcontractor for the OIG performed both medical and coding reviews to determine whether the services were medically necessary and properly coded.