Rochester General Hospital
Dentist, General Practice
Rochester, New York
NPI: 1255360517
Risk Tier
Elevated
Total Paid
$227.0M
$226,974,802
Total Claims
3.2M
Beneficiaries
2.8M
Avg Cost/Claim
$70.25
Active billing period: 84 months (2018-01 to 2024-12)
Statistical Fraud Flags (1)
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 152 procedure codes: 99213 at 2.2× median, 90834 at 2.4× median.
Advanced Detection Signals
CUSUM Change Point
Billing shifted 8.2x in 2019-09 — 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