Childrens Hospital of Philadelphia
General Acute Care Hospital Children
Philadelphia, Pennsylvania
NPI: 1215921457
Risk Tier
Critical
Total Paid
$286.9M
$286,882,030
Total Claims
1.7M
Beneficiaries
1.4M
Avg Cost/Claim
$171.08
Active billing period: 84 months (2018-01 to 2024-12)
Statistical Fraud Flags (4)
Billing Swing
Experienced over 200% change in year-over-year billing with >$1M absolute change.
Billing changed from $24.4M (2020) to $83.3M (2021) — a 242% swing with $58.9M absolute change.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 350 procedure codes: 99283 at 14.1× median, 99284 at 8.5× median.
High Cost Per Claim
Average payment per claim is much higher than peers billing the same procedures.
High Claims Per Patient
Filing an unusually high number of claims per beneficiary compared to peers.
Advanced Detection Signals
CUSUM Change Point
Billing shifted 4.6x in 2020-09 — a statistically significant structural change in billing behavior was detected.
Disclaimer: Statistical flags indicate unusual billing patterns — they are not proof of fraud or wrongdoing. Some entities (government agencies, home care programs, hospitals) may legitimately bill at higher rates due to patient acuity, overhead costs, or specialized services. This report is generated from public HHS data and statistical analysis only. No clinical or investigative review has been performed.
Generated by OpenMedicaid | openmedicaid.org | Data: HHS 2018-2024