Maimonides Medical Center
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 154 procedure codes: 99214 at 2.7× median, 99213 at 3.8× median.
Explosive Growth
Billing increased over 500% year-over-year — far beyond normal growth patterns.
Billing grew 1067% from 2018 to 2019.
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.
Explosive Growth
Explosive Growth means this provider's billing increased by more than 500% year-over-year. While rapid expansion can be legitimate, this pattern has been observed in fraud schemes that ramp up billing quickly before detection.
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 $144.56 per claim for 99213 (Office/outpatient visit, est. patient, low-mod complexity) — 3.8× the national median of $37.81.
Bills $224.26 per claim for 99283 (Emergency dept visit, moderate complexity) — 5.3× the national median of $42.48.
Bills $227.02 per claim for 90834 (Psychotherapy, 45 minutes) — 3.6× the national median of $63.65.
Billing above the 90th percentile for 19 procedure codes simultaneously.
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 $260.8M is at the 50th percentile among 156 General Acute Care Hospital providers.
Total Paid
$260.8M
$260,808,086
Total Claims
3.4M
Beneficiaries
3.0M
1.1 claims/patient
Avg Cost/Claim
$77
#315 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Maimonides Medical Center is a General Acute Care Hospital provider based in Brooklyn, NY. From the 2018–2024 period, this provider received $260.8M in Medicaid payments across 3.4M claims.
Why This Matters
This provider received $260.8M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 32,601 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 9% of total spending.
$24.8M
174K claims
$142.55
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$24.8M
174K claims · 9.5%
$21.8M
150K claims
$144.56
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$21.8M
150K claims · 8.3%
$16.6M
74K claims
$224.26
$42.48
Emergency dept visit, moderate complexity
$16.6M
74K claims · 6.4%
Injection, pembrolizumab, 1 mg
$12.6M
1K claims · 4.8%
$10.5M
55K claims
$193.17
$69.51
Emergency dept visit, high complexity
$10.5M
55K claims · 4.0%
Psychotherapy, 45 minutes
$10.3M
46K claims · 4.0%
$7.0M
43K claims
$163.95
$85.65
Emergency dept visit, high/urgent complexity
$7.0M
43K claims · 2.7%
Psychotherapy, 30 minutes
$7.0M
40K claims · 2.7%
$4.8M
27K claims
$180.62
$74.09
Office/outpatient visit, high complexity
$4.8M
27K claims · 1.9%
Emergency dept visit, low complexity
$3.7M
16K claims · 1.4%
$3.5M
126K claims
$27.90
$1.57
Collection of venous blood by venipuncture
$3.5M
126K claims · 1.3%
$3.0M
14K claims
$207.91
$38.92
IV infusion, hydration, each additional hour
$3.0M
14K claims · 1.1%
$3.0M
29K claims
$103.12
$25.06
Office/outpatient visit, low complexity
$3.0M
29K claims · 1.1%
$2.8M
17K claims
$162.87
$54.68
Echocardiography, transthoracic, complete, with Doppler
$2.8M
17K claims · 1.1%
$2.7M
15K claims
$175.99
$84.03
Office/outpatient visit, new patient, mod-high complexity
$2.7M
15K claims · 1.0%
Basic metabolic panel
$2.5M
79K claims · 0.9%
$2.4M
4K claims
$656.80
$99.39
Hospital observation service, per hour
$2.4M
4K claims · 0.9%
$2.3M
908 claims · 0.9%
$2.3M
1K claims · 0.9%
$2.3M
18K claims
$124.86
$69.35
Preventive medicine, established patient, infant (under 1)
$2.3M
18K claims · 0.9%
CT abdomen and pelvis with contrast
$2.2M
12K claims · 0.9%
Hospital outpatient clinic visit
$2.2M
25K claims · 0.8%
$2.1M
7K claims · 0.8%
Group psychotherapy
$2.0M
19K claims · 0.8%
Injection, denosumab, one milligram
$1.9M
1K claims · 0.7%
$1.9M
7K claims · 0.7%
$1.8M
11K claims
$169.36
$57.85
Office/outpatient visit, new patient, low-mod complexity
$1.8M
11K claims · 0.7%
$1.8M
661 claims · 0.7%
Fetal non-stress test
$1.7M
9K claims · 0.7%
$1.7M
13K claims
$127.94
$75.28
Chemotherapy administration, IV infusion, up to 1 hour
$1.7M
13K claims · 0.7%
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