Virginia Commonwealth University Health System Authority
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $185.10 per claim for G0463 (Hospital outpatient clinic visit), which is 7.0× the national median of $26.41.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 313 procedure codes: G0463 at 7.0× median, 99283 at 5.8× median.
Unusually High Spending
This provider's total payments are significantly above the median for their specialty.
High Cost Per Claim
Average payment per claim is much higher than peers billing the same procedures.
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:
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.
Unusually High Spending
Unusually High Spending means this provider's total Medicaid payments are significantly above the median for their specialty. This doesn't necessarily indicate fraud — high volume practices and those serving complex populations may legitimately bill more.
High Cost Per Claim
High Cost Per Claim means each individual claim from this provider costs significantly more than what other providers charge for the same services. This could indicate upcoding (billing for more expensive services than provided) or legitimate specialized care.
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 $185.10 per claim for G0463 (Hospital outpatient clinic visit) — 7.0× the national median of $26.41.
Bills $246.12 per claim for 99283 (Emergency dept visit, moderate complexity) — 5.8× the national median of $42.48.
Bills $164.68 per claim for 99214 (Office/outpatient visit, est. patient, mod-high complexity) — 3.1× the national median of $53.41.
Billing in the top 1% nationally for 5 procedure codes: 92507, 99213, 96110.
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 $658.5M is at the 90th percentile among 156 General Acute Care Hospital providers.
Above 90th percentile for this specialty — higher spending than 140 of 156 peers
Total Paid
$658.5M
$658,485,314
Total Claims
8.5M
Beneficiaries
6.3M
1.3 claims/patient
Avg Cost/Claim
$78
#77 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Virginia Commonwealth University Health System Authority is a General Acute Care Hospital provider based in Richmond, VA. From the 2018–2024 period, this provider received $658.5M in Medicaid payments across 8.5M claims.
Why This Matters
This provider received $658.5M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 82,310 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 (G0463 (Hospital outpatient clinic visit)) accounts for 18% of total spending.
Hospital outpatient clinic visit
$120.6M
651K claims · 18.3%
$28.3M
115K claims
$246.12
$42.48
Emergency dept visit, moderate complexity
$28.3M
115K claims · 4.3%
$26.4M
160K claims
$164.68
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$26.4M
160K claims · 4.0%
Speech/hearing/language treatment
$24.2M
86K claims · 3.7%
$19.4M
84K claims
$231.76
$69.51
Emergency dept visit, high complexity
$19.4M
84K claims · 2.9%
$18.5M
117K claims
$158.32
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$18.5M
117K claims · 2.8%
$16.2M
66K claims
$243.80
$85.65
Emergency dept visit, high/urgent complexity
$16.2M
66K claims · 2.5%
$15.8M
26K claims
$612.37
$9.10
Developmental screening, per standardized instrument
$15.8M
26K claims · 2.4%
$14.7M
35K claims
$420.35
$38.92
IV infusion, hydration, each additional hour
$14.7M
35K claims · 2.2%
$14.1M
2K claims
$6,012.47
$5,391.55
Injection, pembrolizumab, 1 mg
$14.1M
2K claims · 2.1%
$9.9M
5K claims · 1.5%
Therapeutic exercises, each 15 min
$9.4M
154K claims · 1.4%
$9.2M
49K claims
$187.29
$99.39
Hospital observation service, per hour
$9.2M
49K claims · 1.4%
$8.8M
4K claims
$1,960.09
$763.43
Unlisted procedure, dentoalveolar structures
$8.8M
4K claims · 1.3%
$7.2M
48K claims
$151.90
$25.06
Office/outpatient visit, low complexity
$7.2M
48K claims · 1.1%
$6.7M
12K claims
$575.49
$260.56
Intensity modulated radiation treatment delivery, complex
$6.7M
12K claims · 1.0%
$6.3M
14K claims
$445.97
$54.68
Echocardiography, transthoracic, complete, with Doppler
$6.3M
14K claims · 1.0%
Therapeutic activities, each 15 min
$6.3M
85K claims · 1.0%
$6.2M
17K claims
$372.03
$40.12
IV infusion, therapeutic/prophylactic/diagnostic, each additional hour
$6.2M
17K claims · 0.9%
$6.2M
39K claims
$158.90
$54.77
IV infusion, therapeutic/prophylactic/diagnostic, initial, up to 1 hour
$6.2M
39K claims · 0.9%
CT abdomen and pelvis with contrast
$5.4M
20K claims · 0.8%
$5.4M
27K claims
$198.30
$75.28
Chemotherapy administration, IV infusion, up to 1 hour
$5.4M
27K claims · 0.8%
CT head/brain without contrast
$5.4M
21K claims · 0.8%
$5.4M
4K claims
$1,512.22
$1,587.53
Injection, infliximab, excludes biosimilar, 10 mg
$5.4M
4K claims · 0.8%
Upper GI endoscopy with biopsy
$4.9M
6K claims · 0.7%
$4.8M
10K claims
$454.54
$133.68
MRI brain without contrast, then with contrast
$4.8M
10K claims · 0.7%
Emergency dept visit, low complexity
$4.8M
21K claims · 0.7%
$3.6M
13K claims
$278.73
$29.03
Arthrocentesis, aspiration/injection, major joint
$3.6M
13K claims · 0.5%
$3.3M
7K claims · 0.5%
$3.1M
7K claims · 0.5%
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