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

Robert Wood Johnson University Hospital, INC

General Acute Care Hospital·New Brunswick, NJ·NPI: 1346243375SharePrint Report
View on Risk Watchlist →

Red Flags Explained

▼

Each flag represents a statistical test that identified unusual billing patterns. Here's what each flag on this provider means in plain English:

•

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

•

Bills $915.29 per claim for G0378 (Hospital observation service, per hour) — 9.2× the national median of $99.39.

•

Bills $399.05 per claim for 99285 (Emergency dept visit, high/urgent complexity) — 4.7× the national median of $85.65.

•

Bills $381.57 per claim for 99284 (Emergency dept visit, high complexity) — 5.5× the national median of $69.51.

•

Billing in the top 1% nationally for 2 procedure codes: 43239, 77334.

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

P25MedianP75P90

This provider's total spending of $198.3M is at the 50th percentile among 156 General Acute Care Hospital providers.

Active Billing Period:2018-01→2024-12(84 months)
Sharp billing drop in final month

Total Paid

$198.3M

$198,255,360

Total Claims

2.7M

Beneficiaries

2.1M

1.3 claims/patient

Avg Cost/Claim

$73

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

🔍 Analysis

Provider Overview

Robert Wood Johnson University Hospital, INC is a General Acute Care Hospital provider based in New Brunswick, NJ. From the 2018–2024 period, this provider received $198.3M in Medicaid payments across 2.7M claims.

Why This Matters

This provider received $198.3M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 24,781 Medicaid beneficiaries for a full year at average per-enrollee costs.

↑ 31% growthsince first billing year

Monthly Spending Trend

Yearly Spending

2018
$24.4M
+3%
2019
$25.2M
-19%
2020
$20.5M
+47%
2021
$30.2M
+4%
2022
$31.2M
+12%
2023
$35.0M
-9%
2024
$31.8M

Procedure Breakdown

Cost per claim compared to national benchmarks

This provider bills for 30 distinct procedure codes. The top code (G0378 (Hospital observation service, per hour)) accounts for 13% of total spending.

G0378Top 10%

Hospital observation service, per hour

$25.3M

28K claims · 12.8%

Your Cost: $915.29/claim|Median: $99.39
9.2× median
99285Top 5%

Emergency dept visit, high/urgent complexity

$15.2M

38K claims · 7.7%

Your Cost: $399.05/claim|Median: $85.65
4.7× median
99284Top 5%

Emergency dept visit, high complexity

$14.9M

39K claims · 7.5%

Your Cost: $381.57/claim|Median: $69.51
5.5× median
99283Top 5%

Emergency dept visit, moderate complexity

$14.4M

57K claims · 7.2%

Your Cost: $250.18/claim|Median: $42.48
5.9× median
96413Top 5%

Chemotherapy administration, IV infusion, up to 1 hour

$8.5M

22K claims · 4.3%

Your Cost: $377.91/claim|Median: $75.28
5.0× median
OP250Top 5%

$7.8M

178K claims · 3.9%

Your Cost: $43.85/claim|Median: $1.68
26.1× median
J1745Top 10%

Injection, infliximab, excludes biosimilar, 10 mg

$7.0M

2K claims · 3.5%

Your Cost: $3,987.44/claim|Median: $1,587.53
2.5× median
99282Top 5%

Emergency dept visit, low complexity

$6.7M

35K claims · 3.4%

Your Cost: $192.46/claim|Median: $37.72
5.1× median
J9271Normal range

Injection, pembrolizumab, 1 mg

$5.4M

888 claims · 2.7%

Your Cost: $6,066.36/claim|Median: $5,391.55
1.1× median
43239Top 1%

Upper GI endoscopy with biopsy

$4.2M

3K claims · 2.1%

Your Cost: $1,262.44/claim|Median: $151.68
8.3× median
J2505Top 10%

$3.8M

766 claims · 1.9%

Your Cost: $4,900.37/claim|Median: $1,842.27
2.7× median
41899Top 25%

Unlisted procedure, dentoalveolar structures

$2.7M

1K claims · 1.4%

Your Cost: $1,883.20/claim|Median: $763.43
2.5× median
OP710Normal range

$2.6M

27K claims · 1.3%

Your Cost: $97.32/claim|Median: $68.93
1.4× median
96375Top 5%

Therapeutic/prophylactic/diagnostic IV push, each additional substance

$2.3M

29K claims · 1.2%

Your Cost: $80.42/claim|Median: $14.92
5.4× median
80053Top 25%

Comprehensive metabolic panel

$2.2M

113K claims · 1.1%

Your Cost: $19.74/claim|Median: $7.24
2.7× median
42820Top 25%

Tonsillectomy and adenoidectomy, under age 12

$2.1M

1K claims · 1.0%

Your Cost: $1,770.79/claim|Median: $331.68
5.3× median
77386Top 25%

Intensity modulated radiation treatment delivery, complex

$1.8M

5K claims · 0.9%

Your Cost: $387.65/claim|Median: $260.56
1.5× median
45380Top 5%

Colonoscopy with biopsy

$1.8M

2K claims · 0.9%

Your Cost: $792.57/claim|Median: $200.68
4.0× median
77334Top 1%

$1.7M

2K claims · 0.9%

Your Cost: $852.81/claim|Median: $99.06
8.6× median
96415Top 25%

$1.6M

8K claims · 0.8%

Your Cost: $215.79/claim|Median: $43.68
4.9× median
OP370Normal range

$1.6M

35K claims · 0.8%

Your Cost: $45.93/claim|Median: $82.47
0.6× median
96365Top 25%

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

$1.6M

15K claims · 0.8%

Your Cost: $106.21/claim|Median: $54.77
1.9× median
36430Top 25%

$1.4M

6K claims · 0.7%

Your Cost: $242.15/claim|Median: $111.66
2.2× median
J1561Normal range

$1.3M

991 claims · 0.7%

Your Cost: $1,326.34/claim|Median: $1,482.84
0.9× median
69436Top 25%

Tympanostomy, general anesthesia

$1.3M

1K claims · 0.6%

Your Cost: $945.65/claim|Median: $205.50
4.6× median
93306Top 5%

Echocardiography, transthoracic, complete, with Doppler

$1.2M

3K claims · 0.6%

Your Cost: $474.43/claim|Median: $54.68
8.7× median
J2506Normal range

$1.2M

820 claims · 0.6%

Your Cost: $1,409.05/claim|Median: $997.36
1.4× median
OP272Top 25%

$1.1M

19K claims · 0.5%

Your Cost: $58.40/claim|Median: $28.37
2.1× median
74177Normal range

CT abdomen and pelvis with contrast

$1.1M

9K claims · 0.5%

Your Cost: $119.84/claim|Median: $65.76
1.8× median
OP270Top 5%

$1.0M

17K claims · 0.5%

Your Cost: $60.05/claim|Median: $7.34
8.2× median

Other Top Providers in New Jersey

View all →

Department of Health and Senior Services

Specialist

$1.07B

Laboratory Corporation of America Holdings

Clinical Medical Laboratory

$717.5M

Care Finders Total Care LLC

Home Health

$708.7M

Quest Diagnostics Incorporated

Clinical Medical Laboratory

$637.7M

Bioreference Health LLC

Clinical Medical Laboratory

$620.1M

Similar Providers

Other top providers in General Acute Care Hospital

Yale New Haven Hospital

New Haven, CT

$1.08B

Montefiore Medical Center

Bronx, NY

$961.1M

The Cleveland Clinic Foundation

Cleveland, OH

$863.5M

Nationwide Children's Hospital

Columbus, OH

$777.5M

Boston Medical Center Corporation

Boston, MA

$768.5M

← All providersRisk Watchlist →All providers in New Jersey →How we detect fraud →