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

Scottish Rite Children's Medical Center

Pediatrics Pediatric Hematology-Oncology·Atlanta, GA·NPI: 1184779332SharePrint 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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Cost Outlier

Cost Outlier means this provider charges significantly more per claim than other providers billing the same procedure codes. This could indicate upcoding, inflated charges, or specialized services that justify higher costs.

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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 $813.01 per claim for 99285 (Emergency dept visit, high/urgent complexity) — 9.5× the national median of $85.65.

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Bills $419.05 per claim for 99284 (Emergency dept visit, high complexity) — 6.0× the national median of $69.51.

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Bills $231.78 per claim for 99283 (Emergency dept visit, moderate complexity) — 5.5× the national median of $42.48.

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Billing in the top 1% nationally for 13 procedure codes: 99285, 70551, 70553.

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

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

Total Paid

$493.4M

$493,376,372

Total Claims

3.6M

Beneficiaries

3.0M

1.2 claims/patient

Avg Cost/Claim

$139

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

🔍 Analysis

Provider Overview

Scottish Rite Children's Medical Center is a Pediatrics Pediatric Hematology-Oncology provider based in Atlanta, GA. From the 2018–2024 period, this provider received $493.4M in Medicaid payments across 3.6M claims.

Why This Matters

This provider received $493.4M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 61,672 Medicaid beneficiaries for a full year at average per-enrollee costs.

↑ 29% growthsince first billing year

Monthly Spending Trend

Yearly Spending

2018
$55.4M
+9%
2019
$60.5M
-12%
2020
$53.5M
+41%
2021
$75.3M
+19%
2022
$89.4M
-2%
2023
$88.0M
-19%
2024
$71.3M

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 18% of total spending.

99285Top 1%

Emergency dept visit, high/urgent complexity

$88.1M

108K claims · 17.9%

Your Cost: $813.01/claim|Median: $85.65
9.5× median
99284Top 5%

Emergency dept visit, high complexity

$56.4M

134K claims · 11.4%

Your Cost: $419.05/claim|Median: $69.51
6.0× median
99283Top 5%

Emergency dept visit, moderate complexity

$50.6M

218K claims · 10.2%

Your Cost: $231.78/claim|Median: $42.48
5.5× median
97110Top 5%

Therapeutic exercises, each 15 min

$14.2M

123K claims · 2.9%

Your Cost: $115.54/claim|Median: $24.49
4.7× median
70551Top 1%

MRI brain without contrast

$13.3M

13K claims · 2.7%

Your Cost: $996.53/claim|Median: $85.39
11.7× median
70553Top 1%

MRI brain without contrast, then with contrast

$12.3M

7K claims · 2.5%

Your Cost: $1,821.30/claim|Median: $133.68
13.6× median
95810Top 1%

Polysomnography, sleep study, 6+ hours

$11.0M

6K claims · 2.2%

Your Cost: $1,736.77/claim|Median: $233.73
7.4× median
44970Top 25%

$10.0M

2K claims · 2.0%

Your Cost: $4,122.26/claim|Median: $1,699.18
2.4× median
95782Top 5%

$9.8M

6K claims · 2.0%

Your Cost: $1,742.20/claim|Median: $216.35
8.1× median
97150Top 5%

Therapeutic procedure, group (2+ patients)

$7.5M

77K claims · 1.5%

Your Cost: $97.37/claim|Median: $12.12
8.0× median
G0378Top 25%

Hospital observation service, per hour

$6.6M

19K claims · 1.3%

Your Cost: $355.04/claim|Median: $99.39
3.6× median
42820Normal range

Tonsillectomy and adenoidectomy, under age 12

$5.8M

5K claims · 1.2%

Your Cost: $1,174.99/claim|Median: $331.68
3.5× median
76770Top 1%

Ultrasound, retroperitoneal, complete

$5.1M

15K claims · 1.0%

Your Cost: $342.77/claim|Median: $37.35
9.2× median
70450Top 5%

CT head/brain without contrast

$5.1M

14K claims · 1.0%

Your Cost: $376.24/claim|Median: $45.53
8.3× median
95812Top 10%

$5.0M

11K claims · 1.0%

Your Cost: $464.42/claim|Median: $104.99
4.4× median
43239Top 1%

Upper GI endoscopy with biopsy

$4.9M

4K claims · 1.0%

Your Cost: $1,173.15/claim|Median: $151.68
7.7× median
D9420Top 1%

$4.8M

4K claims · 1.0%

Your Cost: $1,349.59/claim|Median: $81.82
16.5× median
70543Top 5%

$4.1M

2K claims · 0.8%

Your Cost: $2,007.72/claim|Median: $247.27
8.1× median
73721Top 1%

MRI joint of lower extremity without contrast

$3.9M

3K claims · 0.8%

Your Cost: $1,281.67/claim|Median: $127.34
10.1× median
69436Top 25%

Tympanostomy, general anesthesia

$3.8M

7K claims · 0.8%

Your Cost: $541.64/claim|Median: $205.50
2.6× median
72197Top 1%

$3.7M

2K claims · 0.8%

Your Cost: $2,017.12/claim|Median: $201.67
10.0× median
97161Top 5%

Physical therapy evaluation, low complexity

$3.3M

19K claims · 0.7%

Your Cost: $171.70/claim|Median: $47.89
3.6× median
71046Top 5%

Chest X-ray, 2 views

$3.3M

41K claims · 0.7%

Your Cost: $80.39/claim|Median: $8.92
9.0× median
99291Top 1%

Critical care, first 30-74 minutes

$3.3M

3K claims · 0.7%

Your Cost: $1,249.36/claim|Median: $101.24
12.3× median
74183Top 1%

$3.0M

2K claims · 0.6%

Your Cost: $1,810.40/claim|Median: $151.91
11.9× median
97530Top 5%

Therapeutic activities, each 15 min

$2.9M

28K claims · 0.6%

Your Cost: $102.16/claim|Median: $33.11
3.1× median
74177Top 5%

CT abdomen and pelvis with contrast

$2.7M

3K claims · 0.6%

Your Cost: $855.58/claim|Median: $65.76
13.0× median
74230Top 1%

$2.7M

5K claims · 0.5%

Your Cost: $524.22/claim|Median: $19.67
26.6× median
99213Top 5%

Office/outpatient visit, est. patient, low-mod complexity

$2.7M

28K claims · 0.5%

Your Cost: $96.43/claim|Median: $37.81
2.5× median
76700Top 1%

Ultrasound, abdominal, complete

$2.7M

7K claims · 0.5%

Your Cost: $379.33/claim|Median: $50.69
7.5× median

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