Umass Memorial Medical Center, Inc.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 142 procedure codes: 99214 at 2.5× median, 99212 at 5.7× median.
Statistical flags are not proof of wrongdoing. Some entities (government agencies, home care programs) may legitimately bill at high rates. Hospitals, government entities, and large care organizations may legitimately bill at higher rates due to patient acuity, overhead costs, or specialized services. Read our methodology.
Red Flags Explained
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Each flag represents a statistical test that identified unusual billing patterns. Here's what each flag on this provider means in plain English:
Rate Outlier
Rate Outlier means this provider charges above the 90th percentile for multiple different procedure codes simultaneously. While one high-cost code could reflect specialization, consistently high rates across many codes may indicate systematic overbilling.
These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.
Advanced Detection Signals
Additional statistical tests from advanced fraud detection methods
These signals use advanced statistical methods including digit distribution analysis, change-point detection, and market concentration metrics. Learn more.
Risk Assessment
Bills $141.79 per claim for 99212 (Office/outpatient visit, low complexity) — 5.7× the national median of $25.06.
Bills $366.43 per claim for 96361 (IV infusion, hydration, each additional hour) — 9.4× the national median of $38.92.
Bills $126.80 per claim for 99213 (Office/outpatient visit, est. patient, low-mod complexity) — 3.4× the national median of $37.81.
Billing in the top 1% nationally for 1 procedure code: 96110.
This is a statistical summary, not an accusation. See our methodology.
Compared to General Acute Care Hospital Peers
Total spending distribution among 156 providers in this specialty
This provider's total spending of $491.0M is at the 90th percentile among 156 General Acute Care Hospital providers.
Above 90th percentile for this specialty — higher spending than 140 of 156 peers
Total Paid
$491.0M
$491,010,299
Total Claims
9.7M
Beneficiaries
8.2M
1.2 claims/patient
Avg Cost/Claim
$50
#127 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Umass Memorial Medical Center, Inc. is a General Acute Care Hospital provider based in Worcester, MA. From the 2018–2024 period, this provider received $491.0M in Medicaid payments across 9.7M claims.
Why This Matters
This provider received $491.0M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 61,376 Medicaid beneficiaries for a full year at average per-enrollee costs.
Monthly Spending Trend
Yearly Spending
Procedure Breakdown
Cost per claim compared to national benchmarks
This provider bills for 30 distinct procedure codes. The top code (99214 (Office/outpatient visit, est. patient, mod-high complexity)) accounts for 13% of total spending.
$61.7M
460K claims
$134.19
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$61.7M
460K claims · 12.6%
$29.2M
206K claims
$141.79
$25.06
Office/outpatient visit, low complexity
$29.2M
206K claims · 6.0%
$26.0M
140K claims
$185.74
$85.65
Emergency dept visit, high/urgent complexity
$26.0M
140K claims · 5.3%
$23.0M
63K claims
$366.43
$38.92
IV infusion, hydration, each additional hour
$23.0M
63K claims · 4.7%
$18.5M
146K claims
$126.80
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$18.5M
146K claims · 3.8%
$14.8M
93K claims
$159.53
$42.48
Emergency dept visit, moderate complexity
$14.8M
93K claims · 3.0%
$14.7M
91K claims
$161.38
$69.51
Emergency dept visit, high complexity
$14.7M
91K claims · 3.0%
Ambulance, BLS emergency transport
$12.8M
59K claims · 2.6%
$10.4M
386K claims
$27.07
$26.41
Hospital outpatient clinic visit
$10.4M
386K claims · 2.1%
$9.5M
67K claims
$141.06
$12.93
Office/outpatient visit, minimal complexity
$9.5M
67K claims · 1.9%
$8.6M
27K claims
$315.81
$75.28
Chemotherapy administration, IV infusion, up to 1 hour
$8.6M
27K claims · 1.8%
$8.5M
1K claims
$8,276.67
$17,264.74
Ocrelizumab (Ocrevus) injection, 1 mg
$8.5M
1K claims · 1.7%
$7.3M
35K claims
$208.63
$164.22
Ambulance, ALS emergency transport Level 1
$7.3M
35K claims · 1.5%
$6.5M
54K claims
$120.38
$100.62
Respiratory virus detection, 3-5 targets, nucleic acid
$6.5M
54K claims · 1.3%
$6.1M
4K claims
$1,394.15
$1,587.53
Injection, infliximab, excludes biosimilar, 10 mg
$6.1M
4K claims · 1.2%
$5.6M
11K claims · 1.1%
$5.1M
78K claims
$65.51
$60.05
COVID-19 test, nucleic acid detection, CDC lab only
$5.1M
78K claims · 1.0%
$4.9M
29K claims
$169.95
$9.10
Developmental screening, per standardized instrument
$4.9M
29K claims · 1.0%
$4.6M
33K claims
$140.27
$65.76
CT abdomen and pelvis with contrast
$4.6M
33K claims · 0.9%
Upper GI endoscopy with biopsy
$4.6M
7K claims · 0.9%
$4.3M
36K claims
$118.33
$99.39
Hospital observation service, per hour
$4.3M
36K claims · 0.9%
$4.3M
26K claims
$164.35
$54.77
IV infusion, therapeutic/prophylactic/diagnostic, initial, up to 1 hour
$4.3M
26K claims · 0.9%
Emergency dept visit, low complexity
$3.9M
25K claims · 0.8%
$3.6M
7K claims
$522.05
$501.33
Crisis intervention mental health services, per diem
$3.6M
7K claims · 0.7%
$3.6M
5K claims
$751.18
$255.17
Colonoscopy with polyp removal, snare technique
$3.6M
5K claims · 0.7%
$3.5M
16K claims
$226.88
$260.56
Intensity modulated radiation treatment delivery, complex
$3.5M
16K claims · 0.7%
$3.3M
11K claims
$295.25
$40.12
IV infusion, therapeutic/prophylactic/diagnostic, each additional hour
$3.3M
11K claims · 0.7%
$3.2M
27K claims
$119.27
$61.57
IV infusion, hydration, initial, 31 minutes to 1 hour
$3.2M
27K claims · 0.7%
Colonoscopy with biopsy
$3.1M
5K claims · 0.6%
CT head/brain without contrast
$3.0M
23K claims · 0.6%
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