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Medicare Compliance Review of UMass Memorial Medical Center for Calendar Years 2010 and 2011

UMass Memorial Medical Center (UMMC) (operating in Worcester, Massachusetts) complied with Medicare billing requirements for 74 of the 232 inpatient and outpatient claims we reviewed. However, UMMC did not fully comply with Medicare billing requirements for the remaining 158 claims, resulting in overpayments of approximately $1.6 million for calendar years 2010 and 2011. Overpayments occurred primarily because UMMC did not have adequate controls to prevent the incorrect billing of Medicare claims within the selected risk areas that contained errors.