UMass Memorial cited for $1.65M of Medicare overpayments

UMass Memorial Health Center's Memorial Campus

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A federal audit found errors in more than two-thirds of UMass Memorial Medical Center’s (UMMMC) sampled Medicare claims from 2010 and 2011, resulting in nearly $1.65 million in overpayments to the health care system.

A report released last week by the Office of the Inspector General found that UMMMC made errors on 158 of 232 inpatient and outpatient claims reviewed, 125 of which stemmed from incorrectly billing services as inpatient when they should’ve been outpatient.

Eight of the 21 identified outpatient errors stemmed from UMMMC failing to reporting instances where it received full credit for the replacement of a medical device.

The health care system has agreed to refund the overpayments and said it set aside reserves in the fiscal year ending in September 2013 for that purpose. Therefore, UMMMC spokesman Rob Brogna said the results of the review won’t affect the system’s 2014 financial performance.

UMMMC officials agreed with most of the report’s findings but disputed a few claims involving discharge codes.

Brogna said in a statement that the health care system plans to increase staff in key risk areas, enhance staff education, update policies and procedures to reduce the risk of errors, and strengthen existing internal controls.

UMMMC reported an operating loss of $55 million in October, and has made plans to reduce or eliminate 353 positions since then.