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UMass Medical Center Settles False and Fraudulent Medicare Claims Case

On June 16, 2017, UMass Memorial Medical Center, Inc. (UMass), entered into a $441,047.36 settlement agreement with OIG. The settlement agreement resolves allegations that UMass submitted claims for "new patient" evaluation and management outpatient clinic visits using Healthcare Common Procedure Coding System (HCPCS) codes 99203-99205 when the patients at issue were actually "established patients" and, thus, UMass should have submitted those claims using the lower-paying HCPCS codes 99213-99215. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Andrea Treese Berlin and Geoffrey Hymans, collaborated to achieve this settlement.

Action Details

  • Date:June 16, 2017
  • Enforcement Types:
    • CMP and Affirmative Exclusions