Bronxcare Health System
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $122.78 per claim for 99213 (Office/outpatient visit, est. patient, low-mod complexity), which is 3.2× the national median of $37.81.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 150 procedure codes: 99213 at 3.2× median, 99214 at 2.6× median.
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
▼
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.
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 $122.78 per claim for 99213 (Office/outpatient visit, est. patient, low-mod complexity) — 3.3× the national median of $37.81.
Bills $202.83 per claim for 99283 (Emergency dept visit, moderate complexity) — 4.8× the national median of $42.48.
Bills $108.57 per claim for 99212 (Office/outpatient visit, low complexity) — 4.3× the national median of $25.06.
Billing in the top 1% nationally for 1 procedure code: 90791.
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 $348.4M is at the 75th percentile among 156 General Acute Care Hospital providers.
Total Paid
$348.4M
$348,432,639
Total Claims
5.7M
Beneficiaries
4.4M
1.3 claims/patient
Avg Cost/Claim
$61
#200 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Bronxcare Health System is a General Acute Care Hospital provider based in Bronx, NY. From the 2018–2024 period, this provider received $348.4M in Medicaid payments across 5.7M claims.
Why This Matters
This provider received $348.4M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 43,554 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 19% of total spending.
$64.7M
527K claims
$122.78
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$64.7M
527K claims · 18.6%
$36.9M
270K claims
$136.74
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$36.9M
270K claims · 10.6%
$20.8M
103K claims
$202.83
$42.48
Emergency dept visit, moderate complexity
$20.8M
103K claims · 6.0%
$17.8M
91K claims
$194.81
$69.51
Emergency dept visit, high complexity
$17.8M
91K claims · 5.1%
Psychotherapy, 30 minutes
$15.5M
131K claims · 4.4%
$14.6M
134K claims
$108.57
$25.06
Office/outpatient visit, low complexity
$14.6M
134K claims · 4.2%
Psychiatric diagnostic evaluation
$10.9M
14K claims · 3.1%
Emergency dept visit, low complexity
$10.3M
44K claims · 2.9%
$7.5M
39K claims
$192.73
$85.65
Emergency dept visit, high/urgent complexity
$7.5M
39K claims · 2.2%
$6.0M
357K claims
$16.91
$1.57
Collection of venous blood by venipuncture
$6.0M
357K claims · 1.7%
Comprehensive metabolic panel
$5.4M
240K claims · 1.5%
Hot/cold packs application
$4.8M
122K claims · 1.4%
Therapeutic exercises, each 15 min
$4.0M
68K claims · 1.2%
$4.0M
90K claims
$44.44
$9.56
Therapeutic injection, subcutaneous/intramuscular
$4.0M
90K claims · 1.2%
$3.9M
71K claims
$55.23
$69.35
Preventive medicine, established patient, infant (under 1)
$3.9M
71K claims · 1.1%
$3.7M
53K claims
$68.88
$63.08
Infectious disease detection (COVID-19)
$3.7M
53K claims · 1.0%
$3.4M
18K claims
$190.88
$52.03
Emergency dept visit, minimal complexity
$3.4M
18K claims · 1.0%
$3.3M
106K claims
$30.93
$18.95
Alcohol/drug services; methadone administration
$3.3M
106K claims · 0.9%
Colonoscopy with biopsy
$3.0M
3K claims · 0.9%
$3.0M
26K claims
$116.72
$54.77
IV infusion, therapeutic/prophylactic/diagnostic, initial, up to 1 hour
$3.0M
26K claims · 0.9%
$2.9M
33K claims
$88.75
$38.23
Ophthalmological exam, intermediate, established patient
$2.9M
33K claims · 0.8%
$2.7M
5K claims · 0.8%
$2.5M
18K claims
$135.62
$57.85
Office/outpatient visit, new patient, low-mod complexity
$2.5M
18K claims · 0.7%
$2.5M
24K claims
$102.96
$38.92
IV infusion, hydration, each additional hour
$2.5M
24K claims · 0.7%
Upper GI endoscopy with biopsy
$2.4M
3K claims · 0.7%
$2.1M
29K claims
$70.54
$75.18
Preventive medicine, established patient, age 1-4
$2.1M
29K claims · 0.6%
$2.0M
2K claims
$1,159.30
$501.33
Crisis intervention mental health services, per diem
$2.0M
2K claims · 0.6%
Basic metabolic panel
$2.0M
66K claims · 0.6%
Group psychotherapy
$1.9M
27K claims · 0.5%
$1.9M
9K claims
$203.87
$73.29
Medication-assisted treatment, opioid use disorder, per month
$1.9M
9K claims · 0.5%
Other Top Providers in New York
View all →Similar Providers
Other top providers in General Acute Care Hospital