Boston Medical Center Corporation
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $130.47 per claim for 99213 (Office/outpatient visit, est. patient, low-mod complexity), which is 3.5× the national median of $37.81.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 169 procedure codes: 99214 at 2.5× median, 99213 at 3.5× median.
Unusually High Spending
This provider's total payments are significantly above the median for their specialty.
High Cost Per Claim
Average payment per claim is much higher than peers billing the same procedures.
Statistical flags are not proof of wrongdoing. Some entities (government agencies, home care programs) may legitimately bill at high rates. Hospitals, government entities, and large care organizations may legitimately bill at higher rates due to patient acuity, overhead costs, or specialized services. Read our methodology.
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:
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.
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.
Unusually High Spending
Unusually High Spending means this provider's total Medicaid payments are significantly above the median for their specialty. This doesn't necessarily indicate fraud — high volume practices and those serving complex populations may legitimately bill more.
High Cost Per Claim
High Cost Per Claim means each individual claim from this provider costs significantly more than what other providers charge for the same services. This could indicate upcoding (billing for more expensive services than provided) or legitimate specialized care.
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
These signals use advanced statistical methods including digit distribution analysis, change-point detection, and market concentration metrics. Learn more.
Risk Assessment
Bills $130.47 per claim for 99213 (Office/outpatient visit, est. patient, low-mod complexity) — 3.5× the national median of $37.81.
Bills $397.49 per claim for 96361 (IV infusion, hydration, each additional hour) — 10.2× the national median of $38.92.
Bills $168.40 per claim for 99283 (Emergency dept visit, moderate complexity) — 4.0× the national median of $42.48.
Billing in the top 1% nationally for 1 procedure code: 59025.
This is a statistical summary, not an accusation. See our methodology.
Compared to General Acute Care Hospital Peers
Total spending distribution among 156 providers in this specialty
This provider's total spending of $768.5M is at the 90th percentile among 156 General Acute Care Hospital providers.
Above 90th percentile for this specialty — higher spending than 140 of 156 peers
Total Paid
$768.5M
$768,481,072
Total Claims
14.5M
Beneficiaries
12.5M
1.2 claims/patient
Avg Cost/Claim
$53
#55 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Boston Medical Center Corporation is a General Acute Care Hospital provider based in Boston, MA. From the 2018–2024 period, this provider received $768.5M in Medicaid payments across 14.5M claims.
Why This Matters
This provider received $768.5M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 96,060 Medicaid beneficiaries for a full year at average per-enrollee costs.
Monthly Spending Trend
Yearly Spending
Procedure Breakdown
Cost per claim compared to national benchmarks
This provider bills for 30 distinct procedure codes. The top code (99214 (Office/outpatient visit, est. patient, mod-high complexity)) accounts for 10% of total spending.
$75.2M
558K claims
$134.63
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$75.2M
558K claims · 9.8%
$57.4M
440K claims
$130.47
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$57.4M
440K claims · 7.5%
$32.1M
81K claims
$397.49
$38.92
IV infusion, hydration, each additional hour
$32.1M
81K claims · 4.2%
$29.4M
149K claims
$196.85
$85.65
Emergency dept visit, high/urgent complexity
$29.4M
149K claims · 3.8%
$28.3M
168K claims
$168.40
$42.48
Emergency dept visit, moderate complexity
$28.3M
168K claims · 3.7%
$28.0M
191K claims
$146.81
$74.09
Office/outpatient visit, high complexity
$28.0M
191K claims · 3.6%
$21.7M
123K claims
$175.63
$69.51
Emergency dept visit, high complexity
$21.7M
123K claims · 2.8%
$17.8M
523K claims
$33.92
$26.41
Hospital outpatient clinic visit
$17.8M
523K claims · 2.3%
$11.1M
96K claims
$115.79
$25.06
Office/outpatient visit, low complexity
$11.1M
96K claims · 1.5%
$10.3M
36K claims
$288.81
$169.17
Respiratory virus detection, 12-25 targets, nucleic acid
$10.3M
36K claims · 1.3%
$10.1M
83K claims
$120.68
$12.93
Office/outpatient visit, minimal complexity
$10.1M
83K claims · 1.3%
$10.0M
83K claims
$121.12
$84.03
Office/outpatient visit, new patient, mod-high complexity
$10.0M
83K claims · 1.3%
$9.8M
2K claims
$4,240.19
$5,391.55
Injection, pembrolizumab, 1 mg
$9.8M
2K claims · 1.3%
$8.9M
78K claims
$114.40
$57.85
Office/outpatient visit, new patient, low-mod complexity
$8.9M
78K claims · 1.2%
$7.7M
197K claims
$39.05
$24.49
Therapeutic exercises, each 15 min
$7.7M
197K claims · 1.0%
$7.6M
31K claims
$240.94
$75.28
Chemotherapy administration, IV infusion, up to 1 hour
$7.6M
31K claims · 1.0%
$7.1M
4K claims · 0.9%
Medicaid certified CCBHC services
$6.9M
29K claims · 0.9%
Emergency dept visit, low complexity
$6.8M
44K claims · 0.9%
Upper GI endoscopy with biopsy
$6.6M
10K claims · 0.9%
Injection, omalizumab, 5 mg
$6.2M
6K claims · 0.8%
CT abdomen and pelvis with contrast
$6.1M
34K claims · 0.8%
$5.8M
70K claims
$83.34
$99.39
Hospital observation service, per hour
$5.8M
70K claims · 0.8%
$5.5M
8K claims
$655.79
$255.17
Colonoscopy with polyp removal, snare technique
$5.5M
8K claims · 0.7%
Colonoscopy, diagnostic
$5.3M
9K claims · 0.7%
$5.3M
86K claims
$61.42
$60.05
COVID-19 test, nucleic acid detection, CDC lab only
$5.3M
86K claims · 0.7%
Fetal non-stress test
$5.3M
18K claims · 0.7%
$5.2M
118K claims
$43.77
$35.43
Drug test, presumptive, by chemistry analyzers
$5.2M
118K claims · 0.7%
$5.2M
28K claims
$186.15
$54.68
Echocardiography, transthoracic, complete, with Doppler
$5.2M
28K claims · 0.7%
$4.8M
3K claims · 0.6%
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