Montefiore Medical Center
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 143 procedure codes: 99214 at 2.0× median, 99213 at 2.0× 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 $1,629.30 per claim for 01967 (Anesthesia, neuraxial labor analgesia/delivery) — 5.7× the national median of $283.78.
Billing in the top 1% nationally for 1 procedure code: 01967.
This is a statistical summary, not an accusation. See our methodology.
Compared to Anesthesiology Peers
Total spending distribution among 13 providers in this specialty
This provider's total spending of $398.4M is at the 99th percentile among 13 Anesthesiology providers.
Above 99th percentile for this specialty — higher spending than 12 of 13 peers
Total Paid
$398.4M
$398,402,839
Total Claims
6.4M
Beneficiaries
5.8M
1.1 claims/patient
Avg Cost/Claim
$63
#160 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Montefiore Medical Center is a Anesthesiology provider based in Bronx, NY. From the 2018–2024 period, this provider received $398.4M in Medicaid payments across 6.4M claims.
Why This Matters
This provider received $398.4M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 49,800 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 15% of total spending.
$61.5M
586K claims
$105.01
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$61.5M
586K claims · 15.4%
$60.3M
788K claims
$76.42
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$60.3M
788K claims · 15.1%
$24.7M
197K claims
$125.28
$69.51
Emergency dept visit, high complexity
$24.7M
197K claims · 6.2%
$15.8M
105K claims
$151.13
$84.03
Office/outpatient visit, new patient, mod-high complexity
$15.8M
105K claims · 4.0%
$11.1M
154K claims
$71.91
$42.48
Emergency dept visit, moderate complexity
$11.1M
154K claims · 2.8%
$11.0M
64K claims
$172.49
$85.65
Emergency dept visit, high/urgent complexity
$11.0M
64K claims · 2.8%
$10.4M
6K claims
$1,629.30
$283.78
Anesthesia, neuraxial labor analgesia/delivery
$10.4M
6K claims · 2.6%
$10.4M
99K claims
$104.53
$57.85
Office/outpatient visit, new patient, low-mod complexity
$10.4M
99K claims · 2.6%
$8.5M
65K claims
$131.47
$74.09
Office/outpatient visit, high complexity
$8.5M
65K claims · 2.1%
$7.1M
72K claims
$98.18
$35.30
Subsequent hospital care, per day, high complexity
$7.1M
72K claims · 1.8%
$6.1M
75K claims
$81.36
$35.80
Surgical pathology, gross and microscopic examination
$6.1M
75K claims · 1.5%
$5.8M
72K claims
$81.14
$75.18
Preventive medicine, established patient, age 1-4
$5.8M
72K claims · 1.5%
$5.4M
79K claims
$68.36
$23.99
Subsequent hospital care, per day, moderate complexity
$5.4M
79K claims · 1.4%
$5.4M
62K claims
$86.38
$74.82
Preventive medicine, established patient, age 5-11
$5.4M
62K claims · 1.3%
$5.0M
62K claims
$81.15
$54.68
Echocardiography, transthoracic, complete, with Doppler
$5.0M
62K claims · 1.3%
Critical care, first 30-74 minutes
$4.4M
19K claims · 1.1%
$4.1M
33K claims
$125.25
$58.55
Ultrasound, pregnant uterus, follow-up
$4.1M
33K claims · 1.0%
$3.9M
58K claims
$67.66
$39.33
Screening mammography, bilateral, including CAD
$3.9M
58K claims · 1.0%
$3.9M
42K claims
$92.55
$65.76
CT abdomen and pelvis with contrast
$3.9M
42K claims · 1.0%
$3.5M
22K claims
$160.35
$67.32
Initial hospital care, per day, high complexity
$3.5M
22K claims · 0.9%
$3.5M
120K claims
$29.10
$17.85
Immunization administration, first vaccine/toxoid, with counseling
$3.5M
120K claims · 0.9%
$3.5M
55K claims
$63.30
$69.35
Preventive medicine, established patient, infant (under 1)
$3.5M
55K claims · 0.9%
$3.3M
32K claims
$105.07
$80.15
Preventive medicine, established patient, age 12-17
$3.3M
32K claims · 0.8%
$3.3M
332K claims
$9.91
$3.67
Brief emotional/behavioral assessment, per standardized instrument
$3.3M
332K claims · 0.8%
$3.2M
15K claims
$217.34
$106.79
Ultrasound, pregnant uterus, detailed, single fetus
$3.2M
15K claims · 0.8%
$2.6M
84K claims
$31.62
$24.49
Therapeutic exercises, each 15 min
$2.6M
84K claims · 0.7%
$2.6M
50K claims
$51.91
$25.06
Office/outpatient visit, low complexity
$2.6M
50K claims · 0.7%
$2.5M
30K claims
$85.65
$47.65
Ultrasound, pregnant uterus, transvaginal
$2.5M
30K claims · 0.6%
$2.5M
43K claims
$57.99
$29.03
Arthrocentesis, aspiration/injection, major joint
$2.5M
43K claims · 0.6%
Ultrasound, transvaginal
$2.3M
23K claims · 0.6%
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