Round Number Billing: When Every Claim Ends in Zeros
Legitimate medical billing rarely produces perfectly round numbers. Costs involve complex fee schedules, modifiers, and insurance calculations. When a provider submits dozens of claims at exact round dollar amounts — $500.00, $1,000.00, $2,500.00 — it suggests the amounts may be fabricated rather than derived from actual services.
68K
Round-number claims
$128.1M
Round-number spending
5K
Most by one provider
100
Flagged providers
Why Round Numbers Are Suspicious
Medical billing amounts are determined by fee schedules, procedure modifiers, geographic adjustments, and insurance negotiation. The result is almost never a round number. A typical claim might be $347.82 or $1,213.47 — not $500.00 or $2,000.00.
$347.82
Normal: Fee schedule + modifier + geographic adjustment = odd number.
$500.00
Suspicious: Exact round amounts suggest the number was chosen, not calculated.
$2,500.00
Red flag: Multiple large round claims from one provider signals fabrication.
The Heaviest Round-Number Billers
NPI: 1205822236
5K
round claims
$8.0M
round spending
52
distinct amounts
6.2%
of total round $
NPI: 1548343510
2K
round claims
$2.0M
round spending
31
distinct amounts
1.6%
of total round $
NPI: 1407806391
2K
round claims
$4.6M
round spending
39
distinct amounts
3.6%
of total round $
NPI: 1104145549
2K
round claims
$5.2M
round spending
28
distinct amounts
4.0%
of total round $
NPI: 1336196401
2K
round claims
$7.7M
round spending
51
distinct amounts
6.0%
of total round $
We scanned all 227 million billing records for providers who repeatedly submit claims at exact round dollar amounts. Out of more than 617,000 providers, we identified 100 with exceptionally heavy round-number billing — providers with 50 or more round-dollar claims across multiple distinct amounts.
The Top Round Biller: 5K Claims
The most prolific round-number biller submitted 5K claims at exact round dollar amounts across 52 different round amounts, totaling $8.0M in round-number spending alone. That many round claims from a single provider is extraordinarily unlikely to occur naturally.
Together, these 100 providers submitted 68K round-number claims totaling $128.1M. The provider with the most variety billed across 52 different round amounts — suggesting systematic use of fabricated figures rather than an occasional coincidence.
When round billing is legitimate
Some services have legitimately round rates — especially flat-rate contracts, per-diem payments, and capitated arrangements. A group home might bill exactly $200/day per resident. A transportation provider might charge a flat $50 per trip. This analysis is a signal for further investigation, not proof of fraud. The providers flagged here show an unusually high concentration of round-number claims that warrants closer scrutiny.
Top 30 Round-Number Billers
| # | Provider | Round Patterns | Round Claims | Round Spending |
|---|---|---|---|---|
| 1 | Yale University NPI: 1205822236 | 52 | 5K | $8.0M |
| 2 | Permanente Medical Group Inc NPI: 1548343510 | 31 | 2K | $2.0M |
| 3 | NPI: 1407806391 NPI: 1407806391 | 39 | 2K | $4.6M |
| 4 | NPI: 1104145549 NPI: 1104145549 | 28 | 2K | $5.2M |
| 5 | NPI: 1336196401 NPI: 1336196401 | 51 | 2K | $7.7M |
| 6 | City Medical Of Upper East Side Pllc NPI: 1730491945 | 19 | 1K | $4.3M |
| 7 | NPI: 1063461481 NPI: 1063461481 | 42 | 1K | $3.6M |
| 8 | NPI: 1043242555 NPI: 1043242555 | 26 | 1K | $1.3M |
| 9 | NPI: 1982889598 NPI: 1982889598 | 44 | 1K | $3.1M |
| 10 | NPI: 1467408013 NPI: 1467408013 | 33 | 1K | $4.6M |
| 11 | NPI: 1356634737 NPI: 1356634737 | 24 | 1K | $2.2M |
| 12 | NPI: 1972563138 NPI: 1972563138 | 21 | 1K | $1.5M |
| 13 | NPI: 1013042480 NPI: 1013042480 | 10 | 1K | $371K |
| 14 | NPI: 1114955010 NPI: 1114955010 | 23 | 1K | $1.3M |
| 15 | Seattle-king County Dept Of Public Health NPI: 1104983543 | 13 | 1K | $688K |
| 16 | The William W Backus Hospital NPI: 1467517235 | 27 | 1K | $1.7M |
| 17 | NPI: 1528237385 NPI: 1528237385 | 32 | 995 | $2.2M |
| 18 | Bridgeport Hospital NPI: 1992910152 | 18 | 963 | $1.6M |
| 19 | NPI: 1407888928 NPI: 1407888928 | 21 | 952 | $767K |
| 20 | NPI: 1497235030 NPI: 1497235030 | 31 | 918 | $1.1M |
| 21 | NPI: 1184099251 NPI: 1184099251 | 32 | 882 | $1.2M |
| 22 | Mid Atlantic Pemanente Medical Group NPI: 1811062763 | 32 | 836 | $1.4M |
| 23 | NPI: 1083910962 NPI: 1083910962 | 25 | 825 | $1.4M |
| 24 | NPI: 1205995388 NPI: 1205995388 | 12 | 825 | $424K |
| 25 | NPI: 1225060742 NPI: 1225060742 | 19 | 822 | $597K |
| 26 | NPI: 1568618304 NPI: 1568618304 | 25 | 821 | $818K |
| 27 | NPI: 1669825162 NPI: 1669825162 | 16 | 815 | $995K |
| 28 | NPI: 1962944967 NPI: 1962944967 | 29 | 812 | $955K |
| 29 | NPI: 1184786527 NPI: 1184786527 | 27 | 806 | $1.3M |
| 30 | NPI: 1902278906 NPI: 1902278906 | 41 | 806 | $2.0M |
Key Takeaways
- ▸100 providers show heavy round-number billing patterns across 68K claims totaling $128.1M.
- ▸The top provider submitted 5K round-number claims across 52 distinct round amounts.
- ▸Legitimate medical billing involves fee schedules, modifiers, and insurance calculations that almost never produce round numbers. High concentrations of round claims suggest amounts were chosen, not calculated.
- ▸Some services (flat-rate contracts, per-diem payments, transportation) have legitimately round rates. This is a signal for investigation, not proof of fraud.
Source: HHS T-MSIS Other Services File (2018–2024) · 227M records