Atlanticare Regional Medical Center
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 68 procedure codes: 99283 at 8.7× median, 99284 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.
Risk Assessment
Bills $371.27 per claim for 99283 (Emergency dept visit, moderate complexity) — 8.7× the national median of $42.48.
Bills $453.59 per claim for 99284 (Emergency dept visit, high complexity) — 6.5× the national median of $69.51.
Bills $377.62 per claim for 99285 (Emergency dept visit, high/urgent complexity) — 4.4× the national median of $85.65.
Billing in the top 1% nationally for 5 procedure codes: 99283, 59025, 76811.
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 $214.9M is at the 50th percentile among 156 General Acute Care Hospital providers.
Total Paid
$214.9M
$214,909,155
Total Claims
2.7M
Beneficiaries
2.1M
1.3 claims/patient
Avg Cost/Claim
$80
#405 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Atlanticare Regional Medical Center is a General Acute Care Hospital provider based in Pomona, NJ. From the 2018–2024 period, this provider received $214.9M in Medicaid payments across 2.7M claims.
Why This Matters
This provider received $214.9M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 26,863 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 (99283 (Emergency dept visit, moderate complexity)) accounts for 23% of total spending.
$48.5M
131K claims
$371.27
$42.48
Emergency dept visit, moderate complexity
$48.5M
131K claims · 22.6%
$45.3M
100K claims
$453.59
$69.51
Emergency dept visit, high complexity
$45.3M
100K claims · 21.1%
$21.7M
57K claims
$377.62
$85.65
Emergency dept visit, high/urgent complexity
$21.7M
57K claims · 10.1%
$14.7M
30K claims
$486.27
$99.39
Hospital observation service, per hour
$14.7M
30K claims · 6.9%
$7.9M
25K claims
$314.76
$148.53
Mental health partial hospitalization, treatment, per hour
$7.9M
25K claims · 3.7%
$6.3M
21K claims
$297.61
$164.22
Ambulance, ALS emergency transport Level 1
$6.3M
21K claims · 2.9%
Emergency dept visit, low complexity
$6.0M
30K claims · 2.8%
$5.3M
6,409 claims
$821.84
$135.70
Intensive outpatient psychiatric services, per diem
$5.3M
6,409 claims · 2.5%
Fetal non-stress test
$3.5M
7,043 claims · 1.6%
CT abdomen and pelvis with contrast
$3.0M
13K claims · 1.4%
Ambulance, BLS emergency transport
$2.8M
14K claims · 1.3%
$2.1M
5,616 claims
$375.71
$106.79
Ultrasound, pregnant uterus, detailed, single fetus
$2.1M
5,616 claims · 1.0%
CT head/brain without contrast
$2.0M
20K claims · 0.9%
Ground mileage, per statute mile
$2.0M
44K claims · 0.9%
$1.8M
3,686 claims
$475.59
$252.36
Ambulance, specialty care transport
$1.8M
3,686 claims · 0.8%
$1.4M
7,890 claims
$182.14
$52.03
Emergency dept visit, minimal complexity
$1.4M
7,890 claims · 0.7%
$1.3M
3,935 claims
$338.36
$75.28
Chemotherapy administration, IV infusion, up to 1 hour
$1.3M
3,935 claims · 0.6%
$1.2M
23K claims
$54.03
$14.92
Therapeutic/prophylactic/diagnostic IV push, each additional substance
$1.2M
23K claims · 0.6%
Upper GI endoscopy with biopsy
$1.2M
680 claims · 0.6%
$1.2M
393K claims
$3.06
$1.68
Orthotic or prosthetic procedure, not otherwise classified
$1.2M
393K claims · 0.6%
$1.2M
2,449 claims
$470.63
$54.68
Echocardiography, transthoracic, complete, with Doppler
$1.2M
2,449 claims · 0.5%
$1.2M
410 claims
$2,807.03
$763.43
Unlisted procedure, dentoalveolar structures
$1.2M
410 claims · 0.5%
$1.0M
7,905 claims
$129.87
$47.65
Ultrasound, pregnant uterus, transvaginal
$1.0M
7,905 claims · 0.5%
$1.0M
5,622 claims
$181.06
$60.19
CT abdomen and pelvis without contrast
$1.0M
5,622 claims · 0.5%
$920K
7,283 claims
$126.31
$39.33
Screening mammography, bilateral, including CAD
$920K
7,283 claims · 0.4%
$907K
9,646 claims
$94.03
$58.16
Ultrasound, pregnant uterus, single fetus, first trimester
$907K
9,646 claims · 0.4%
$830K
6,543 claims · 0.4%
$784K
50K claims
$15.60
$7.50
Electrocardiogram, tracing only, without interpretation
$784K
50K claims · 0.4%
Hemodialysis, one evaluation
$749K
1,501 claims · 0.3%
$708K
3,742 claims
$189.27
$92.96
CT angiography, chest, with contrast
$708K
3,742 claims · 0.3%
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