New York City Health and Hospitals Corporation
Billing Swing
Experienced over 200% change in year-over-year billing with >$1M absolute change.
Billing changed from $8.7M (2019) to $26.2M (2020) — a 201% swing with $17.5M absolute change.
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:
Billing Swing
Billing Swing means this provider's total billing changed dramatically from one year to the next — increasing or decreasing by more than 200% with over $1M in absolute change. This could indicate a change in practice scope, a billing scheme ramping up, or legitimate growth.
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 $179.92 per claim for 99283 (Emergency dept visit, moderate complexity) — 4.2× the national median of $42.48.
Bills $194.07 per claim for 99282 (Emergency dept visit, low complexity) — 5.2× the national median of $37.72.
Bills $13.62 per claim for 36415 (Collection of venous blood by venipuncture) — 8.7× the national median of $1.57.
Billing above the 90th percentile for 15 procedure codes simultaneously.
This is a statistical summary, not an accusation. See our methodology.
Compared to Internal Medicine Peers
Total spending distribution among 26 providers in this specialty
This provider's total spending of $160.3M is at the 75th percentile among 26 Internal Medicine providers.
Total Paid
$160.3M
$160,323,581
Total Claims
4.0M
Beneficiaries
3.5M
1.1 claims/patient
Avg Cost/Claim
$41
#648 of 618K providers by total spending(top 0.1%)
🔍 Analysis
Provider Overview
New York City Health and Hospitals Corporation is a Internal Medicine provider based in Bronx, NY. From the 2018–2024 period, this provider received $160.3M in Medicaid payments across 4.0M claims.
Why This Matters
This provider received $160.3M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 20,040 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 (99283 (Emergency dept visit, moderate complexity)) accounts for 17% of total spending.
$27.4M
152K claims
$179.92
$42.48
Emergency dept visit, moderate complexity
$27.4M
152K claims · 17.1%
$14.1M
78K claims
$181.50
$69.51
Emergency dept visit, high complexity
$14.1M
78K claims · 8.8%
$13.4M
173K claims
$77.42
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$13.4M
173K claims · 8.4%
$8.6M
92K claims
$94.35
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$8.6M
92K claims · 5.4%
Emergency dept visit, low complexity
$6.2M
32K claims · 3.9%
$4.7M
83K claims
$56.50
$63.08
Infectious disease detection (COVID-19)
$4.7M
83K claims · 2.9%
$4.1M
304K claims
$13.62
$1.57
Collection of venous blood by venipuncture
$4.1M
304K claims · 2.6%
$2.9M
27K claims
$105.99
$57.85
Office/outpatient visit, new patient, low-mod complexity
$2.9M
27K claims · 1.8%
$2.8M
26K claims
$104.85
$103.99
Global fee, urgent care centers
$2.8M
26K claims · 1.7%
$2.6M
42K claims
$62.33
$25.06
Office/outpatient visit, low complexity
$2.6M
42K claims · 1.6%
$2.4M
15K claims
$156.55
$84.03
Office/outpatient visit, new patient, mod-high complexity
$2.4M
15K claims · 1.5%
CT head/brain without contrast
$2.2M
12K claims · 1.4%
$1.9M
22K claims
$86.28
$38.92
IV infusion, hydration, each additional hour
$1.9M
22K claims · 1.2%
$1.7M
10K claims
$173.27
$85.65
Emergency dept visit, high/urgent complexity
$1.7M
10K claims · 1.1%
Psychotherapy, 45 minutes
$1.7M
10K claims · 1.1%
$1.5M
1K claims
$1,177.89
$99.39
Hospital observation service, per hour
$1.5M
1K claims · 0.9%
$1.3M
1K claims · 0.8%
$1.3M
9K claims
$144.76
$74.09
Office/outpatient visit, high complexity
$1.3M
9K claims · 0.8%
$1.3M
71K claims
$17.69
$12.93
Office/outpatient visit, minimal complexity
$1.3M
71K claims · 0.8%
$1.1M
19K claims
$58.33
$22.44
Telephone E/M by physician, 11-20 minutes
$1.1M
19K claims · 0.7%
$1.0M
2K claims
$674.50
$358.21
Fetal chromosomal aneuploidy genomic sequence analysis
$1.0M
2K claims · 0.6%
Psychotherapy, 30 minutes
$995K
8K claims · 0.6%
$966K
14K claims
$68.23
$47.08
Ophthalmological exam, comprehensive, established patient
$966K
14K claims · 0.6%
$894K
23K claims
$38.92
$69.35
Preventive medicine, established patient, infant (under 1)
$894K
23K claims · 0.6%
Ultrasound, pelvic, complete
$852K
5K claims · 0.5%
Colonoscopy, diagnostic
$851K
1K claims · 0.5%
$835K
51K claims
$16.35
$9.56
Therapeutic injection, subcutaneous/intramuscular
$835K
51K claims · 0.5%
CFTR gene analysis, common variants
$813K
2K claims · 0.5%
$806K
6K claims
$140.23
$65.76
CT abdomen and pelvis with contrast
$806K
6K claims · 0.5%
$770K
6K claims
$132.79
$37.60
Unspecified adjunctive procedure, by report
$770K
6K claims · 0.5%
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