The Nemours Foundation
Explosive Growth
Billing increased over 500% year-over-year — far beyond normal growth patterns.
Billing grew 874% from 2018 to 2019.
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:
Explosive Growth
Explosive Growth means this provider's billing increased by more than 500% year-over-year. While rapid expansion can be legitimate, this pattern has been observed in fraud schemes that ramp up billing quickly before detection.
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 $152.35 per claim for 99233 (Subsequent hospital care, per day, high complexity) — 4.3× the national median of $35.30.
Bills $97.00 per claim for 99232 (Subsequent hospital care, per day, moderate complexity) — 4.0× the national median of $23.99.
Bills $406.88 per claim for 93303 (Echocardiography, transthoracic, limited) — 3.6× the national median of $112.83.
Billing in the top 1% nationally for 3 procedure codes: 99472, 99233, 99232.
This is a statistical summary, not an accusation. See our methodology.
Compared to Clinic/Center, Developmental Disabilities Peers
Total spending distribution among 8 providers in this specialty
This provider's total spending of $172.1M is at the 75th percentile among 8 Clinic/Center, Developmental Disabilities providers.
Total Paid
$172.1M
$172,062,055
Total Claims
2.9M
Beneficiaries
2.2M
1.3 claims/patient
Avg Cost/Claim
$60
#569 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
The Nemours Foundation is a Clinic/Center, Developmental Disabilities provider based in Wilmington, DE. From the 2018–2024 period, this provider received $172.1M in Medicaid payments across 2.9M claims.
Why This Matters
This provider received $172.1M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 21,507 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 (99213 (Office/outpatient visit, est. patient, low-mod complexity)) accounts for 8% of total spending.
$13.6M
275K claims
$49.57
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$13.6M
275K claims · 7.9%
$11.6M
17K claims
$682.22
$307.98
Subsequent pediatric critical care, per day, age 2-5
$11.6M
17K claims · 6.7%
$9.6M
131K claims
$73.31
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$9.6M
131K claims · 5.6%
$9.4M
100K claims
$93.97
$42.48
Emergency dept visit, moderate complexity
$9.4M
100K claims · 5.5%
$7.3M
42K claims
$171.85
$69.51
Emergency dept visit, high complexity
$7.3M
42K claims · 4.2%
$6.4M
42K claims
$152.35
$35.30
Subsequent hospital care, per day, high complexity
$6.4M
42K claims · 3.7%
$6.1M
76K claims
$80.26
$75.18
Preventive medicine, established patient, age 1-4
$6.1M
76K claims · 3.6%
$4.8M
57K claims
$84.62
$74.82
Preventive medicine, established patient, age 5-11
$4.8M
57K claims · 2.8%
$4.7M
73K claims
$64.22
$69.35
Preventive medicine, established patient, infant (under 1)
$4.7M
73K claims · 2.7%
$4.5M
40K claims
$113.30
$74.09
Office/outpatient visit, high complexity
$4.5M
40K claims · 2.6%
$4.1M
33K claims
$124.78
$84.03
Office/outpatient visit, new patient, mod-high complexity
$4.1M
33K claims · 2.4%
$4.0M
45K claims
$89.48
$57.85
Office/outpatient visit, new patient, low-mod complexity
$4.0M
45K claims · 2.3%
$3.5M
37K claims
$95.01
$80.15
Preventive medicine, established patient, age 12-17
$3.5M
37K claims · 2.1%
$3.5M
36K claims
$97.00
$23.99
Subsequent hospital care, per day, moderate complexity
$3.5M
36K claims · 2.0%
$3.4M
8K claims
$406.88
$112.83
Echocardiography, transthoracic, limited
$3.4M
8K claims · 2.0%
$3.2M
13K claims
$241.09
$85.65
Emergency dept visit, high/urgent complexity
$3.2M
13K claims · 1.9%
$2.5M
5K claims
$466.79
$54.68
Echocardiography, transthoracic, complete, with Doppler
$2.5M
5K claims · 1.4%
$2.3M
5K claims · 1.3%
Critical care, first 30-74 minutes
$2.3M
7K claims · 1.3%
$2.1M
3K claims
$591.23
$293.45
Subsequent intensive care, very low birth weight infant
$2.1M
3K claims · 1.2%
$1.9M
13K claims
$150.29
$111.09
Office/outpatient visit, new patient, high complexity
$1.9M
13K claims · 1.1%
Anesthesia for intraoral procedures
$1.8M
5K claims · 1.0%
$1.8M
11K claims
$164.09
$51.25
Initial hospital care, per day, moderate complexity
$1.8M
11K claims · 1.0%
$1.6M
11K claims
$138.37
$91.47
Proprietary lab analysis, genomic sequencing
$1.6M
11K claims · 0.9%
$1.6M
14K claims · 0.9%
$1.5M
9K claims · 0.9%
$1.5M
19K claims
$79.32
$99.21
Psychiatric diagnostic evaluation
$1.5M
19K claims · 0.9%
$1.5M
20K claims
$74.05
$37.22
Hospital discharge day management, 30 minutes or less
$1.5M
20K claims · 0.9%
$1.5M
8K claims
$192.92
$67.32
Initial hospital care, per day, high complexity
$1.5M
8K claims · 0.8%
$1.5M
24K claims
$60.17
$77.33
Family psychotherapy with patient, 50 min
$1.5M
24K claims · 0.8%
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