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

Connecticut Children's Medical Center

General Acute Care Hospital, Children·Hartford, CT·NPI: 1134271661SharePrint 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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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

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Bills $1,951.24 per claim for 99285 (Emergency dept visit, high/urgent complexity) — 22.8× the national median of $85.65.

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Bills $235.83 per claim for 99283 (Emergency dept visit, moderate complexity) — 5.5× the national median of $42.48.

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Bills $421.30 per claim for 99284 (Emergency dept visit, high complexity) — 6.1× the national median of $69.51.

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Billing in the top 1% nationally for 4 procedure codes: 99285, 42820, G0379.

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

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

Total Paid

$248.9M

$248,942,412

Total Claims

2.5M

Beneficiaries

1.8M

1.4 claims/patient

Avg Cost/Claim

$101

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

🔍 Analysis

Provider Overview

Connecticut Children's Medical Center is a General Acute Care Hospital, Children provider based in Hartford, CT. From the 2018–2024 period, this provider received $248.9M in Medicaid payments across 2.5M claims.

Why This Matters

This provider received $248.9M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 31,117 Medicaid beneficiaries for a full year at average per-enrollee costs.

↑ 28% growthsince first billing year

Monthly Spending Trend

Yearly Spending

2018
$30.8M
+12%
2019
$34.4M
-18%
2020
$28.4M
+29%
2021
$36.5M
+9%
2022
$39.7M
-0%
2023
$39.5M
+0%
2024
$39.5M

Procedure Breakdown

Cost per claim compared to national benchmarks

This provider bills for 30 distinct procedure codes. The top code (99285 (Emergency dept visit, high/urgent complexity)) accounts for 17% of total spending.

99285Top 1%

Emergency dept visit, high/urgent complexity

$42.8M

22K claims · 17.2%

Your Cost: $1,951.24/claim|Median: $85.65
22.8× median
99283Top 5%

Emergency dept visit, moderate complexity

$23.7M

101K claims · 9.5%

Your Cost: $235.83/claim|Median: $42.48
5.5× median
99284Top 5%

Emergency dept visit, high complexity

$22.1M

53K claims · 8.9%

Your Cost: $421.30/claim|Median: $69.51
6.1× median
J1745Normal range

Injection, infliximab, excludes biosimilar, 10 mg

$15.1M

8K claims · 6.1%

Your Cost: $1,998.14/claim|Median: $1,587.53
1.3× median
42820Top 1%

Tonsillectomy and adenoidectomy, under age 12

$14.5M

3K claims · 5.8%

Your Cost: $5,093.81/claim|Median: $331.68
15.4× median
99282Top 25%

Emergency dept visit, low complexity

$11.4M

84K claims · 4.6%

Your Cost: $135.78/claim|Median: $37.72
3.6× median
97110Top 10%

Therapeutic exercises, each 15 min

$6.9M

93K claims · 2.8%

Your Cost: $74.14/claim|Median: $24.49
3.0× median
J3380Normal range

$6.9M

2K claims · 2.8%

Your Cost: $4,330.05/claim|Median: $4,027.41
1.1× median
95810Top 5%

Polysomnography, sleep study, 6+ hours

$5.4M

6K claims · 2.2%

Your Cost: $965.67/claim|Median: $233.73
4.1× median
G0379Top 1%

Direct admission to hospital observation

$4.5M

2K claims · 1.8%

Your Cost: $2,155.84/claim|Median: $48.25
44.7× median
92507Top 10%

Speech/hearing/language treatment

$4.3M

47K claims · 1.7%

Your Cost: $91.82/claim|Median: $49.45
1.9× median
97530Normal range

Therapeutic activities, each 15 min

$4.2M

84K claims · 1.7%

Your Cost: $49.74/claim|Median: $33.11
1.5× median
42830Top 5%

$4.0M

1K claims · 1.6%

Your Cost: $2,697.48/claim|Median: $341.04
7.9× median
69436Top 25%

Tympanostomy, general anesthesia

$3.5M

4K claims · 1.4%

Your Cost: $894.30/claim|Median: $205.50
4.3× median
96413Top 5%

Chemotherapy administration, IV infusion, up to 1 hour

$3.0M

10K claims · 1.2%

Your Cost: $311.48/claim|Median: $75.28
4.1× median
93303Top 5%

Echocardiography, transthoracic, limited

$2.9M

6K claims · 1.2%

Your Cost: $455.12/claim|Median: $112.83
4.0× median
93306Top 5%

Echocardiography, transthoracic, complete, with Doppler

$2.8M

6K claims · 1.1%

Your Cost: $484.48/claim|Median: $54.68
8.9× median
95782Top 25%

$2.8M

3K claims · 1.1%

Your Cost: $998.41/claim|Median: $216.35
4.6× median
43239Top 10%

Upper GI endoscopy with biopsy

$2.8M

4K claims · 1.1%

Your Cost: $626.08/claim|Median: $151.68
4.1× median
87636Normal range

Respiratory virus detection, 6-11 targets, nucleic acid

$2.4M

19K claims · 1.0%

Your Cost: $123.48/claim|Median: $97.61
1.3× median
44970Top 10%

$2.2M

443 claims · 0.9%

Your Cost: $4,958.93/claim|Median: $1,699.18
2.9× median
96365Top 10%

IV infusion, therapeutic/prophylactic/diagnostic, initial, up to 1 hour

$2.2M

12K claims · 0.9%

Your Cost: $178.33/claim|Median: $54.77
3.3× median
93304Top 5%

$1.9M

4K claims · 0.8%

Your Cost: $506.10/claim|Median: $54.29
9.3× median
92587Top 1%

$1.9M

7K claims · 0.8%

Your Cost: $271.10/claim|Median: $19.24
14.1× median
76705Top 5%

Ultrasound, abdominal, limited

$1.9M

15K claims · 0.8%

Your Cost: $129.28/claim|Median: $23.81
5.4× median
G0330Normal range

$1.9M

1K claims · 0.8%

Your Cost: $1,397.26/claim|Median: $1,205.70
1.2× median
G0463Top 5%

Hospital outpatient clinic visit

$1.7M

15K claims · 0.7%

Your Cost: $116.29/claim|Median: $26.41
4.4× median
96374Top 5%

Therapeutic/prophylactic/diagnostic IV push, single substance

$1.7M

12K claims · 0.7%

Your Cost: $142.87/claim|Median: $21.76
6.6× median
71046Top 5%

Chest X-ray, 2 views

$1.7M

24K claims · 0.7%

Your Cost: $69.38/claim|Median: $8.92
7.8× median
92523Top 10%

Evaluation of speech sound production with language comprehension

$1.7M

7K claims · 0.7%

Your Cost: $237.49/claim|Median: $110.87
2.1× median

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