North Shore-lij Medical PC
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 107 procedure codes: 99214 at 2.1× median, 99213 at 2.2× 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
Billing above the 90th percentile for 14 procedure codes simultaneously.
This is a statistical summary, not an accusation. See our methodology.
Total Paid
$387.7M
$387,661,176
Total Claims
5.3M
Beneficiaries
4.9M
1.1 claims/patient
Avg Cost/Claim
$73
#166 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
North Shore-lij Medical PC is a Urology provider based in Great Neck, NY. From the 2018–2024 period, this provider received $387.7M in Medicaid payments across 5.3M claims.
Why This Matters
This provider received $387.7M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 48,457 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 (99214 (Office/outpatient visit, est. patient, mod-high complexity)) accounts for 16% of total spending.
$60.8M
545K claims
$111.68
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$60.8M
545K claims · 15.7%
$51.0M
415K claims
$122.88
$69.51
Emergency dept visit, high complexity
$51.0M
415K claims · 13.2%
$44.5M
256K claims
$173.82
$85.65
Emergency dept visit, high/urgent complexity
$44.5M
256K claims · 11.5%
$37.0M
448K claims
$82.69
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$37.0M
448K claims · 9.5%
$15.3M
88K claims
$173.33
$84.03
Office/outpatient visit, new patient, mod-high complexity
$15.3M
88K claims · 3.9%
$10.0M
150K claims
$66.74
$42.48
Emergency dept visit, moderate complexity
$10.0M
150K claims · 2.6%
$8.5M
54K claims
$157.66
$74.09
Office/outpatient visit, high complexity
$8.5M
54K claims · 2.2%
$8.4M
74K claims
$113.99
$58.55
Ultrasound, pregnant uterus, follow-up
$8.4M
74K claims · 2.2%
$8.1M
68K claims
$119.17
$57.85
Office/outpatient visit, new patient, low-mod complexity
$8.1M
68K claims · 2.1%
$7.9M
91K claims
$87.18
$65.76
CT abdomen and pelvis with contrast
$7.9M
91K claims · 2.0%
$6.1M
53K claims
$114.38
$54.68
Echocardiography, transthoracic, complete, with Doppler
$6.1M
53K claims · 1.6%
$6.1M
92K claims
$65.92
$23.99
Subsequent hospital care, per day, moderate complexity
$6.1M
92K claims · 1.6%
$5.4M
58K claims
$92.03
$35.30
Subsequent hospital care, per day, high complexity
$5.4M
58K claims · 1.4%
$3.9M
46K claims
$84.98
$35.80
Surgical pathology, gross and microscopic examination
$3.9M
46K claims · 1.0%
$3.7M
25K claims
$150.55
$67.32
Initial hospital care, per day, high complexity
$3.7M
25K claims · 1.0%
Nasal endoscopy, diagnostic
$3.6M
16K claims · 0.9%
CT head/brain without contrast
$3.5M
95K claims · 0.9%
$3.5M
18K claims
$198.77
$112.83
Echocardiography, transthoracic, limited
$3.5M
18K claims · 0.9%
$3.1M
16K claims
$190.39
$106.79
Ultrasound, pregnant uterus, detailed, single fetus
$3.1M
16K claims · 0.8%
$3.0M
37K claims
$81.04
$49.45
Fetal biophysical profile with non-stress test
$3.0M
37K claims · 0.8%
Chest X-ray, single view
$2.7M
308K claims · 0.7%
$2.6M
323K claims
$8.19
$5.60
Electrocardiogram, interpretation and report only
$2.6M
323K claims · 0.7%
Critical care, first 30-74 minutes
$2.5M
11K claims · 0.6%
$2.4M
22K claims · 0.6%
$2.3M
748 claims
$3,121.58
$1,482.45
Routine obstetric care, vaginal delivery, including postpartum
$2.3M
748 claims · 0.6%
$2.3M
874 claims
$2,649.82
$1,587.53
Injection, infliximab, excludes biosimilar, 10 mg
$2.3M
874 claims · 0.6%
$2.2M
39K claims
$56.34
$69.35
Preventive medicine, established patient, infant (under 1)
$2.2M
39K claims · 0.6%
$2.2M
14K claims
$154.22
$108.91
Psychiatric diagnostic evaluation with medical services
$2.2M
14K claims · 0.6%
$2.2M
11K claims
$204.57
$111.09
Office/outpatient visit, new patient, high complexity
$2.2M
11K claims · 0.6%
Ultrasound, transvaginal
$2.2M
23K claims · 0.6%