Federal Reports

Nutritional marasmus (diagnosis code E41) and unspecified severe protein-calorie malnutrition (diagnosis code E43) are two types of severe malnutrition. Previous OIG audits of severe malnutrition found that hospitals had incorrectly billed Medicare by using severe malnutrition diagnosis codes when they should have used codes for other forms of malnutrition or no malnutrition diagnosis code at all. Diagnosis codes E41 and E43 (severe malnutrition diagnosis codes) are each classified as a type of major complication or comorbidity (MCC). Adding MCCs to a Medicare claim can result in a higher Medicare payment.

The Department complied with IPERA because it met all six compliance requirements. The Department’s improper payment estimate and methodology for the Restart program was generally accurate and complete. However, the Department published improper payments estimates that were unreliable for the Federal Pell Grant (Pell), William D. Ford Federal Direct Loan (Direct Loan), and the Temporary Emergency Impact Aid for Displaced Students (Emergency Impact Aid) programs in its FY 2019 Agency Financial Report (AFR). Specifically, the improper payment estimation methodologies the Department developed and the estimates it produced were not accurate, complete, and statistically valid, as described in Finding 1 and Finding 2.