Ohio State University Hospitals
Billing Swing
Experienced over 200% change in year-over-year billing with >$1M absolute change.
Billing changed from $16.3M (2022) to $79.1M (2023) — a 386% swing with $62.8M absolute change.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 201 procedure codes: 99211 at 8.4× median, 97110 at 3.6× 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
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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.
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 $108.40 per claim for 99211 (Office/outpatient visit, minimal complexity) — 8.4× the national median of $12.93.
Bills $88.54 per claim for 97110 (Therapeutic exercises, each 15 min) — 3.6× the national median of $24.49.
Bills $146.34 per claim for 99283 (Emergency dept visit, moderate complexity) — 3.4× the national median of $42.48.
Billing in the top 1% nationally for 1 procedure code: U0004.
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 $197.9M is at the 50th percentile among 156 General Acute Care Hospital providers.
Total Paid
$197.9M
$197,865,657
Total Claims
4.1M
Beneficiaries
3.2M
1.3 claims/patient
Avg Cost/Claim
$48
#466 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Ohio State University Hospitals is a General Acute Care Hospital provider based in Columbus, OH. From the 2018–2024 period, this provider received $197.9M in Medicaid payments across 4.1M claims.
Why This Matters
This provider received $197.9M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 24,733 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 (99211 (Office/outpatient visit, minimal complexity)) accounts for 8% of total spending.
$16.6M
153K claims
$108.40
$12.93
Office/outpatient visit, minimal complexity
$16.6M
153K claims · 8.4%
Therapeutic exercises, each 15 min
$10.3M
116K claims · 5.2%
$10.0M
66K claims
$151.14
$85.65
Emergency dept visit, high/urgent complexity
$10.0M
66K claims · 5.1%
$7.9M
6K claims
$1,279.06
$1,587.53
Injection, infliximab, excludes biosimilar, 10 mg
$7.9M
6K claims · 4.0%
$7.0M
47K claims
$149.92
$69.51
Emergency dept visit, high complexity
$7.0M
47K claims · 3.5%
$6.1M
42K claims
$146.34
$42.48
Emergency dept visit, moderate complexity
$6.1M
42K claims · 3.1%
$5.6M
57K claims
$98.04
$25.06
Office/outpatient visit, low complexity
$5.6M
57K claims · 2.8%
$3.6M
135 claims
$26,838.78
$17,264.74
Ocrelizumab (Ocrevus) injection, 1 mg
$3.6M
135 claims · 1.8%
$3.5M
3K claims · 1.8%
$3.4M
5K claims
$757.28
$470.36
Injection, onabotulinumtoxinA, 1 unit
$3.4M
5K claims · 1.7%
$3.3M
10K claims
$344.43
$38.92
IV infusion, hydration, each additional hour
$3.3M
10K claims · 1.7%
$3.1M
21K claims
$145.11
$58.55
Ultrasound, pregnant uterus, follow-up
$3.1M
21K claims · 1.6%
Fetal non-stress test
$3.0M
15K claims · 1.5%
$2.9M
36K claims
$79.38
$99.39
Hospital observation service, per hour
$2.9M
36K claims · 1.5%
$2.6M
457 claims · 1.3%
$2.4M
13K claims
$190.72
$54.77
IV infusion, therapeutic/prophylactic/diagnostic, initial, up to 1 hour
$2.4M
13K claims · 1.2%
$2.4M
447 claims
$5,392.28
$4,027.41
Injection, vedolizumab, one milligram
$2.4M
447 claims · 1.2%
CT abdomen and pelvis with contrast
$2.3M
9K claims · 1.2%
CT head/brain without contrast
$2.1M
7K claims · 1.0%
Emergency dept visit, low complexity
$2.0M
15K claims · 1.0%
$1.8M
2K claims
$822.20
$268.70
Extracapsular cataract removal with IOL insertion
$1.8M
2K claims · 0.9%
Injection, aflibercept, 1 mg
$1.8M
2K claims · 0.9%
$1.7M
11K claims · 0.9%
$1.7M
4K claims
$370.22
$43.68
Chemotherapy infusion, each additional hour
$1.7M
4K claims · 0.8%
Group psychotherapy
$1.7M
14K claims · 0.8%
$1.6M
2K claims
$779.46
$233.73
Polysomnography, sleep study, 6+ hours
$1.6M
2K claims · 0.8%
$1.6M
5K claims
$331.48
$40.12
IV infusion, therapeutic/prophylactic/diagnostic, each additional hour
$1.6M
5K claims · 0.8%
$1.6M
9K claims
$179.78
$60.05
COVID-19 test, nucleic acid detection, CDC lab only
$1.6M
9K claims · 0.8%
$1.5M
8K claims
$195.63
$58.82
Intravitreal injection of a pharmacologic agent
$1.5M
8K claims · 0.8%
$1.5M
14K claims
$102.92
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$1.5M
14K claims · 0.7%
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