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Review of Tufts Medical Center Claims That Included Medical Device Replacements

Tufts Medical Center (Tufts) (operating in Boston, Massachusetts) complied with Medicare billing requirements for 4 of the 18 inpatient and outpatient claims we reviewed. However, Tufts did not fully comply with Medicare billing requirements for the remaining 14 claims, resulting in overpayments of at least $118,000 for calendar years 2011 through 2014. These errors occurred primarily because Tufts staff (1) had inadequate education on inpatient level-of-care criteria and lacked documentation necessary to determine the appropriate level of service and (2) lacked the level of oversight and the coordination between departments to correctly report the device credits it received for warranted or recalled medical devices.