Wake Forest University Health Sciences
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 11 procedure codes: 90472 at 2.8× median, 99417 at 6.5× 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 $226.07 per claim for 99417 — 6.5× the national median of $34.90.
Billing in the top 1% nationally for 1 procedure code: 99417.
This is a statistical summary, not an accusation. See our methodology.
Compared to Clinic/Center, Multi-Specialty Peers
Total spending distribution among 12 providers in this specialty
This provider's total spending of $188.0M is at the 75th percentile among 12 Clinic/Center, Multi-Specialty providers.
Total Paid
$188.0M
$187,983,112
Total Claims
7.3M
Beneficiaries
5.0M
1.5 claims/patient
Avg Cost/Claim
$26
#498 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Wake Forest University Health Sciences is a Clinic/Center, Multi-Specialty provider based in Winston Salem, NC. From the 2018–2024 period, this provider received $188.0M in Medicaid payments across 7.3M claims.
Why This Matters
This provider received $188.0M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 23,497 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 (99199 (Unlisted special service, procedure, or report)) accounts for 13% of total spending.
$23.8M
3.5M claims
$6.84
$5.39
Unlisted special service, procedure, or report
$23.8M
3.5M claims · 12.7%
$23.7M
505K claims
$46.92
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$23.7M
505K claims · 12.6%
$23.7M
386K claims
$61.31
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$23.7M
386K claims · 12.6%
$17.2M
152K claims
$113.44
$85.65
Emergency dept visit, high/urgent complexity
$17.2M
152K claims · 9.1%
$16.7M
191K claims
$87.46
$69.51
Emergency dept visit, high complexity
$16.7M
191K claims · 8.9%
$5.0M
61K claims
$82.47
$74.09
Office/outpatient visit, high complexity
$5.0M
61K claims · 2.7%
$4.9M
111K claims
$43.70
$23.99
Subsequent hospital care, per day, moderate complexity
$4.9M
111K claims · 2.6%
$4.2M
88K claims
$47.42
$42.48
Emergency dept visit, moderate complexity
$4.2M
88K claims · 2.2%
$4.1M
64K claims
$64.31
$57.85
Office/outpatient visit, new patient, low-mod complexity
$4.1M
64K claims · 2.2%
$3.4M
40K claims
$86.02
$69.35
Preventive medicine, established patient, infant (under 1)
$3.4M
40K claims · 1.8%
$3.4M
37K claims
$91.18
$75.18
Preventive medicine, established patient, age 1-4
$3.4M
37K claims · 1.8%
$2.7M
43K claims
$63.76
$35.30
Subsequent hospital care, per day, high complexity
$2.7M
43K claims · 1.5%
$2.4M
19K claims
$128.03
$121.58
Office or other outpatient consultation, moderate complexity
$2.4M
19K claims · 1.3%
$2.4M
27K claims
$89.29
$74.82
Preventive medicine, established patient, age 5-11
$2.4M
27K claims · 1.3%
$2.3M
123K claims
$18.50
$9.80
Immunization administration, 1 vaccine, percutaneous/ID/SC/IM
$2.3M
123K claims · 1.2%
$2.1M
63K claims
$33.58
$11.79
Immunization administration, each additional vaccine
$2.1M
63K claims · 1.1%
$2.1M
22K claims
$93.96
$84.03
Office/outpatient visit, new patient, mod-high complexity
$2.1M
22K claims · 1.1%
$1.5M
33K claims
$47.42
$54.68
Echocardiography, transthoracic, complete, with Doppler
$1.5M
33K claims · 0.8%
$1.5M
16K claims
$96.65
$103.70
Subsequent intensive care, 2,501-5,000 grams
$1.5M
16K claims · 0.8%
$1.4M
5K claims
$270.07
$307.98
Subsequent pediatric critical care, per day, age 2-5
$1.4M
5K claims · 0.7%
$1.4M
14K claims
$96.34
$80.15
Preventive medicine, established patient, age 12-17
$1.4M
14K claims · 0.7%
$1.4M
31K claims
$44.44
$35.80
Surgical pathology, gross and microscopic examination
$1.4M
31K claims · 0.7%
$1.3M
8K claims
$168.04
$283.78
Anesthesia, neuraxial labor analgesia/delivery
$1.3M
8K claims · 0.7%
$1.3M
22K claims
$57.75
$37.22
Hospital discharge day management, 30 minutes or less
$1.3M
22K claims · 0.7%
$1.3M
31K claims
$39.91
$58.55
Ultrasound, pregnant uterus, follow-up
$1.3M
31K claims · 0.7%
$1.3M
6K claims · 0.7%
$1.2M
23K claims
$53.01
$65.76
CT abdomen and pelvis with contrast
$1.2M
23K claims · 0.7%
$1.1M
9K claims
$119.32
$67.32
Initial hospital care, per day, high complexity
$1.1M
9K claims · 0.6%
$1.1M
15K claims
$75.52
$62.48
Initial hospital or birthing center care, newborn, per day
$1.1M
15K claims · 0.6%
$984K
3K claims
$294.31
$293.45
Subsequent intensive care, very low birth weight infant
$984K
3K claims · 0.5%
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