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Hospital to Pay $2.3M to Settle Overcharges to Medicare

December 5, 2018

LEOMINSTER -- UMass Memorial HealthAlliance-Clinton Hospital will pay out $2.3 million in a voluntary settlement with the Office of the Inspector General this week, according to hospital administrators.

An internal audit found the Geriatric Medicine Psychiatry Unit at UMass Memorial Clinton Hospital overcharged Medicare by $1.5 million from Jan. 31, 2011 to Jan. 31, 2017 due to improper documentation practices, said Christopher Hendry, senior director of External Affairs for the health care provider.

“The money was for care that was absolutely adequate and needed,” said Hendry. “We didn’t prescribe care that they didn’t need. The unfortunate part is because we didn’t do the paperwork correctly. It doesn’t matter that it was for care that they needed, you still have to go through the process.”

In addition to repaying this sum, administrators say the Office of the Inspector General fined the hospital $800,000. A press release from the hospital describes this as the “lowest fine possible for this type of event.”

A request for confirmation from the federal office was not returned by deadline Wednesday.

The discovery was part of a comprehensive audit ordered prior to the 2017 merger of UMass Memorial-HealthAlliance Hospital in Leominster and UMass Memorial-Clinton Hospital.

Hospital President and CEO Deborah Weymouth said the Geriatric Medicine Psychiatry Unit serves mostly older patients with mental and physical health needs. The unit had a procedure for filling Medicare claims, but it was incorrect, according to Weymouth.

“They had a process in place to do what they thought was the right rule. As it turns out, it wasn’t to the letter of the way that Medicare wanted it,” she said. “So now we have addressed that and put processes in place so it wouldn’t happen again.”

Hospital administration has instituted automated electronic forms instead of physical paperwork to ensure these claims are filed properly in the future, she said.

Weymouth said administrators believe the documentation error was a mistake with no malicious intent.

“No one benefited,” she said. “No one got to pocket any money.”

When asked if anyone was fired or asked to resign over this discovery, Weymouth wrote hospital policy does not allow the disclosure of personnel information.

The payment will not affect the operations of the hospital, according to Weymouth.

She said while small insurance disputes are settled weekly, this is the first instance in her 4 1/2 years in the position that the hospital has made a payment to the Office of the Inspector General.

“Although highly technical, we can’t overlook this mistake,” Hendry said in the press release. “We addressed the issues and implemented procedures to ensure these actions won’t be repeated. We worked closely with the Office of Inspector General to resolve the matter and we thank them for their cooperation and assistance.”

Follow Elizabeth Dobbins on Twitter @ElizDobbins.

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