Umass Memorial Medical Center, Inc.
General Acute Care Hospital
Worcester, Massachusetts
NPI: 1831151455
Risk Tier
Elevated
Total Paid
$491.0M
$491,010,299
Total Claims
9.7M
Beneficiaries
8.2M
Avg Cost/Claim
$50.49
Active billing period: 84 months (2018-01 to 2024-12)
Statistical Fraud Flags (1)
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.
Advanced Detection Signals
Billing Velocity
5262.5 claims per working day — may exceed physically possible volume for a single provider.
Disclaimer: Statistical flags indicate unusual billing patterns — they are not proof of fraud or wrongdoing. Some entities (government agencies, home care programs, hospitals) may legitimately bill at higher rates due to patient acuity, overhead costs, or specialized services. This report is generated from public HHS data and statistical analysis only. No clinical or investigative review has been performed.
Generated by OpenMedicaid | openmedicaid.org | Data: HHS 2018-2024