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Audit

Audit  Audit of UMass Memorial Health Care Inc.

Our office has conducted a performance audit of certain activities of UMass Memorial Health Care (UMMH) for the period July 1, 2020 through June 30, 2023.

Organization: Office of the State Auditor
Date published: November 4, 2025

Executive Summary

In accordance with Section 12 of Chapter 11 of the Massachusetts General Laws, the Office of the State Auditor has conducted a performance audit of certain activities of UMass Memorial Health Care (UMMH) for the period July 1, 2020 through June 30, 2023.

The purpose of this audit was to determine the following:

  • whether UMMH spent grant funds from the Executive Office of Health and Human Services (EOHHS) in accordance with Chapter 102 of the Acts of 2021 and its Payment Agreement with EOHHS;
  • whether UMMH spent grant funds it received from the Massachusetts Emergency Management Agency in accordance with their associated grant applications; and
  • whether UMMH provided inpatient maternity services to MassHealth members in accordance with MassHealth and Department of Public Health (DPH) regulations, specifically, whether (a) medical records for inpatient maternity services were maintained in accordance with Section 450.205(A) of Title 130 of the Code of Massachusetts Regulations (CMR), (b) inpatient maternity services were provided by registered nurses in accordance with 105 CMR 130.616(F) and best practices established by the Association of Women’s Health, Obstetric and Neonatal Nurses, and (c) births were reported to DPH within 10 days, as required by 105 CMR 305.020.

Below is a summary of our findings, the effects of those findings, and our recommendations, with hyperlinks to each page listed.

  
Finding 1
 		UMMH could not provide accounting records to document how it spent $6.2 million in grants from EOHHS.
EffectOn September 23, 2023, UMMH closed the maternity center located at its HealthAlliance Clinton Hospital’s Leominster Campus, citing a shortage of obstetricians, nurses, and other clinical professionals needed to operate the center. UMMH could have used the $6.2 million of EOHHS grant funding to invest in the clinical workforce it needed to operate and maintain the maternity center, thereby supporting the operation of an existing hospital facility. This would have provided a public benefit related to the expenditure of $6.2 million of taxpayer funding, rather than reimbursing itself for UMMH expenditures incurred in prior years. By not investing this money in its maternity center workforce, UMMH has created a health disparity for its patients, of whom 20% are MassHealth members, because of a lack of access to maternity care in the central Massachusetts region. This is just one example of a loss of a service that may have been prevented if grant funds were used in a different way.
Recommendations
 
  1. UMMH should maintain detailed accounting records and maintain an audit trail to show when state or federal grant revenue is received and what expenses are incurred in association with grant revenue. This is a requirement of the grant agreement executed by UMMH with the Commonwealth.
  2. When accepting taxpayer-funded grants from the Commonwealth, UMMH should use those funds to invest in maintaining operations of essential services. For example, UMMH could have considered allocating those funds to maternity care or other critical healthcare services, rather than spending these taxpayer-funded grants to reimburse itself for UMMH’s prior year expenditures, such as employee bonuses.
  3. UMMH should reassess the need for maternity care in the communities served by HealthAlliance Clinton Hospital and work toward mitigating health disparities caused by a lack of access to maternity care in that region.
Finding 2
 		UMMH could not account for when or if it had reported births occurring in its hospitals to DPH.
EffectAccording to the Centers for Disease Control and Prevention, birth tracking is important because birth outcomes may vary across different geographic regions due to access to care. The birth data that DPH collects from hospitals, such as UMMH hospitals, can be used by stakeholders, such as medical scholars and public health professionals, to understand population trends, identify health disparities, and inform policy decisions. As such, it is important that the data UMMH provides to DPH be complete, accurate, and timely.
Recommendations
 
  1.  UMMH should ensure that it reports all births occurring in its hospitals to DPH within 10 days and maintain documentation to show this.
  2. UMMH should document the birth reconciliation process that it performs annually with DPH and maintain documentation of this process.

In addition to the conclusions we reached regarding our audit objectives, we also identified an issue not specifically addressed by our objectives. For more information, see Other Matters.

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