Vanderbilt University Medical Center
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 27 procedure codes: 99291 at 2.0× median, 99233 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 5 procedure codes simultaneously.
This is a statistical summary, not an accusation. See our methodology.
Total Paid
$189.4M
$189,387,730
Total Claims
3.4M
Beneficiaries
2.7M
1.3 claims/patient
Avg Cost/Claim
$56
#492 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Vanderbilt University Medical Center is a Transplant Surgery provider based in Nashville, TN. From the 2018–2024 period, this provider received $189.4M in Medicaid payments across 3.4M claims.
Why This Matters
This provider received $189.4M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 23,673 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 10% of total spending.
$18.8M
264K claims
$71.00
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$18.8M
264K claims · 9.9%
$15.0M
288K claims
$51.94
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$15.0M
288K claims · 7.9%
$9.6M
25K claims
$384.41
$307.98
Subsequent pediatric critical care, per day, age 2-5
$9.6M
25K claims · 5.1%
$9.6M
28K claims
$343.42
$293.45
Subsequent intensive care, very low birth weight infant
$9.6M
28K claims · 5.0%
$9.2M
69K claims
$132.00
$84.03
Office/outpatient visit, new patient, mod-high complexity
$9.2M
69K claims · 4.8%
$9.0M
97K claims
$92.31
$69.51
Emergency dept visit, high complexity
$9.0M
97K claims · 4.7%
$8.7M
68K claims
$128.07
$85.65
Emergency dept visit, high/urgent complexity
$8.7M
68K claims · 4.6%
$7.9M
134K claims
$59.08
$42.48
Emergency dept visit, moderate complexity
$7.9M
134K claims · 4.2%
$6.3M
67K claims
$93.86
$74.09
Office/outpatient visit, high complexity
$6.3M
67K claims · 3.3%
$4.5M
94K claims
$47.61
$23.99
Subsequent hospital care, per day, moderate complexity
$4.5M
94K claims · 2.4%
$4.0M
48K claims
$83.18
$57.85
Office/outpatient visit, new patient, low-mod complexity
$4.0M
48K claims · 2.1%
$3.8M
50K claims
$76.11
$75.18
Preventive medicine, established patient, age 1-4
$3.8M
50K claims · 2.0%
Critical care, first 30-74 minutes
$3.6M
18K claims · 1.9%
$3.6M
35K claims
$104.58
$112.83
Echocardiography, transthoracic, limited
$3.6M
35K claims · 1.9%
$3.5M
54K claims
$65.02
$69.35
Preventive medicine, established patient, infant (under 1)
$3.5M
54K claims · 1.9%
$3.0M
40K claims
$76.17
$35.30
Subsequent hospital care, per day, high complexity
$3.0M
40K claims · 1.6%
$3.0M
4K claims
$805.03
$283.78
Anesthesia, neuraxial labor analgesia/delivery
$3.0M
4K claims · 1.6%
$2.7M
35K claims
$76.17
$74.82
Preventive medicine, established patient, age 5-11
$2.7M
35K claims · 1.4%
$2.5M
35K claims
$72.93
$54.68
Echocardiography, transthoracic, complete, with Doppler
$2.5M
35K claims · 1.3%
$2.3M
21K claims
$112.04
$103.70
Subsequent intensive care, 2,501-5,000 grams
$2.3M
21K claims · 1.2%
$2.3M
26K claims
$88.10
$35.80
Surgical pathology, gross and microscopic examination
$2.3M
26K claims · 1.2%
$1.9M
38K claims
$49.69
$58.55
Ultrasound, pregnant uterus, follow-up
$1.9M
38K claims · 1.0%
$1.8M
6K claims
$292.50
$331.68
Tonsillectomy and adenoidectomy, under age 12
$1.8M
6K claims · 0.9%
$1.7M
11K claims
$153.92
$121.58
Office or other outpatient consultation, moderate complexity
$1.7M
11K claims · 0.9%
$1.6M
10K claims
$154.54
$111.09
Office/outpatient visit, new patient, high complexity
$1.6M
10K claims · 0.9%
$1.6M
26K claims
$61.24
$65.76
CT abdomen and pelvis with contrast
$1.6M
26K claims · 0.8%
Chest X-ray, single view
$1.5M
196K claims · 0.8%
$1.4M
71K claims
$20.32
$9.10
Developmental screening, per standardized instrument
$1.4M
71K claims · 0.8%
$1.4M
23K claims
$62.52
$37.22
Hospital discharge day management, 30 minutes or less
$1.4M
23K claims · 0.8%
$1.4M
48K claims · 0.7%
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