The Children's Mercy Hospital
General Acute Care Hospital Children
Kansas City, Missouri
NPI: 1366515488
Risk Tier
Critical
Total Paid
$221.2M
$221,155,053
Total Claims
1.0M
Beneficiaries
998K
Avg Cost/Claim
$211.73
Active billing period: 84 months (2018-01 to 2024-12)
Statistical Fraud Flags (3)
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 160 procedure codes: G0463 at 6.3× median, X4011 at 3.4× median.
High Cost Per Claim
Average payment per claim is much higher than peers billing the same procedures.
Spending Spike
Experienced a dramatic increase in billing over a short period.
Advanced Detection Signals
CUSUM Change Point
Billing shifted 0.2x in 2020-03 — 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