Statistical flags indicate unusual patterns — not proof of fraud or wrongdoing. Read our methodology

Arthur G James Cancer Hospital and Research Institute

Special Hospital·Columbus, OH·NPI: 1124127683SharePrint Report
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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:

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Billing Swing

Billing Swing means this provider's total billing changed dramatically from one year to the next — increasing or decreasing by more than 200% with over $1M in absolute change. This could indicate a change in practice scope, a billing scheme ramping up, or legitimate growth.

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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

Change PointBilling shifted 48.2x in 2022-12

These signals use advanced statistical methods including digit distribution analysis, change-point detection, and market concentration metrics. Learn more.

Risk Assessment

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Bills $1,587.02 per claim for 77386 (Intensity modulated radiation treatment delivery, complex) — 6.1× the national median of $260.56.

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Bills $12,407.71 per claim for J9299 (Nivolumab (Opdivo) injection, 1 mg) — 3.5× the national median of $3,562.28.

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Bills $4,672.55 per claim for J2506 — 4.7× the national median of $997.36.

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Billing in the top 1% nationally for 7 procedure codes: J9271, 77386, J9299.

This is a statistical summary, not an accusation. See our methodology.

Active Billing Period:2018-01→2024-12(84 months)

Total Paid

$140.7M

$140,711,422

Total Claims

795K

Beneficiaries

505K

1.6 claims/patient

Avg Cost/Claim

$177

#785 of 618K providers by total spending(top 0.1%)

🔍 Analysis

Provider Overview

Arthur G James Cancer Hospital and Research Institute is a Special Hospital provider based in Columbus, OH. From the 2018–2024 period, this provider received $140.7M in Medicaid payments across 795K claims.

Why This Matters

This provider received $140.7M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 17,588 Medicaid beneficiaries for a full year at average per-enrollee costs.

↑ 4168% growthsince first billing year

Monthly Spending Trend

Yearly Spending

2018
$1.3M
+20%
2019
$1.6M
-31%
2020
$1.1M
+15%
2021
$1.3M
+31%
2022
$1.7M
+4428%
2023
$76.5M
-25%
2024
$57.2M

Procedure Breakdown

Cost per claim compared to national benchmarks

This provider bills for 30 distinct procedure codes. The top code (J9271 (Injection, pembrolizumab, 1 mg)) accounts for 19% of total spending.

J9271Top 1%

Injection, pembrolizumab, 1 mg

$27.3M

2K claims · 19.4%

Your Cost: $14,687.41/claim|Median: $5,391.55
2.7× median
77386Top 1%

Intensity modulated radiation treatment delivery, complex

$15.5M

10K claims · 11.0%

Your Cost: $1,587.02/claim|Median: $260.56
6.1× median
J9299Top 1%

Nivolumab (Opdivo) injection, 1 mg

$9.1M

731 claims · 6.4%

Your Cost: $12,407.71/claim|Median: $3,562.28
3.5× median
J2506Top 5%

$5.6M

1K claims · 4.0%

Your Cost: $4,672.55/claim|Median: $997.36
4.7× median
96413Top 5%

Chemotherapy administration, IV infusion, up to 1 hour

$4.5M

17K claims · 3.2%

Your Cost: $260.38/claim|Median: $75.28
3.5× median
J9358Normal range

$4.0M

741 claims · 2.8%

Your Cost: $5,393.08/claim|Median: $3,408.30
1.6× median
J9306Top 5%

$3.7M

448 claims · 2.7%

Your Cost: $8,352.38/claim|Median: $3,571.19
2.3× median
J9144Top 10%

$3.6M

483 claims · 2.6%

Your Cost: $7,547.89/claim|Median: $3,253.39
2.3× median
77301Top 1%

$3.2M

748 claims · 2.2%

Your Cost: $4,225.12/claim|Median: $546.64
7.7× median
78815Top 5%

PET imaging for limited area

$2.8M

2K claims · 2.0%

Your Cost: $1,437.96/claim|Median: $325.10
4.4× median
J9355Normal range

$2.4M

841 claims · 1.7%

Your Cost: $2,868.24/claim|Median: $1,942.13
1.5× median
71260Top 5%

CT chest with contrast

$2.0M

5K claims · 1.4%

Your Cost: $410.89/claim|Median: $48.36
8.5× median
74177Top 5%

CT abdomen and pelvis with contrast

$2.0M

4K claims · 1.4%

Your Cost: $480.76/claim|Median: $65.76
7.3× median
80053Top 5%

Comprehensive metabolic panel

$1.9M

34K claims · 1.4%

Your Cost: $57.24/claim|Median: $7.24
7.9× median
77334Top 1%

$1.8M

1K claims · 1.3%

Your Cost: $1,234.27/claim|Median: $99.06
12.5× median
99211Top 10%

Office/outpatient visit, minimal complexity

$1.8M

37K claims · 1.3%

Your Cost: $48.06/claim|Median: $12.93
3.7× median
85025Top 5%

Complete blood count (CBC) with differential, automated

$1.7M

61K claims · 1.2%

Your Cost: $28.66/claim|Median: $4.71
6.1× median
77300Top 1%

$1.7M

1K claims · 1.2%

Your Cost: $1,422.75/claim|Median: $87.77
16.2× median
70553Top 10%

MRI brain without contrast, then with contrast

$1.7M

3K claims · 1.2%

Your Cost: $590.28/claim|Median: $133.68
4.4× median
G0378Top 10%

Hospital observation service, per hour

$1.6M

2K claims · 1.1%

Your Cost: $848.04/claim|Median: $99.39
8.5× median
99212Top 25%

Office/outpatient visit, low complexity

$1.4M

27K claims · 1.0%

Your Cost: $52.62/claim|Median: $25.06
2.1× median
77336Top 5%

$1.4M

3K claims · 1.0%

Your Cost: $445.99/claim|Median: $55.04
8.1× median
J9202Top 5%

$1.3M

1K claims · 0.9%

Your Cost: $1,058.65/claim|Median: $483.75
2.2× median
77412Top 5%

$1.2M

2K claims · 0.9%

Your Cost: $574.09/claim|Median: $111.69
5.1× median
96417Top 5%

$1.2M

5K claims · 0.8%

Your Cost: $254.52/claim|Median: $37.60
6.8× median
96415Top 25%

$1.1M

4K claims · 0.7%

Your Cost: $273.88/claim|Median: $43.68
6.3× median
76642Top 1%

$1.0M

3K claims · 0.7%

Your Cost: $306.36/claim|Median: $32.06
9.6× median
77373Top 10%

$924K

556 claims · 0.7%

Your Cost: $1,662.47/claim|Median: $914.99
1.8× median
J0185Top 5%

$920K

2K claims · 0.7%

Your Cost: $512.87/claim|Median: $125.72
4.1× median
J9035Top 5%

Injection, bevacizumab, 10 mg

$799K

511 claims · 0.6%

Your Cost: $1,564.41/claim|Median: $43.71
35.8× median

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