Statistical flags indicate unusual patterns — not proof of fraud or wrongdoing. Read our methodology

Texas Children's Hospital

General Acute Care Hospital Children·Houston, TX·NPI: 1477643690SharePrint Report
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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:

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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.

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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.

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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

Change PointBilling shifted 12.3x in 2021-02

These signals use advanced statistical methods including digit distribution analysis, change-point detection, and market concentration metrics. Learn more.

Risk Assessment

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Bills $956.64 per claim for 99285 (Emergency dept visit, high/urgent complexity) — 11.2× the national median of $85.65.

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Bills $795.85 per claim for 99284 (Emergency dept visit, high complexity) — 11.4× the national median of $69.51.

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Bills $223.68 per claim for 97110 (Therapeutic exercises, each 15 min) — 9.1× the national median of $24.49.

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Billing in the top 1% nationally for 14 procedure codes: 99285, 99284, 97110.

This is a statistical summary, not an accusation. See our methodology.

Compared to General Acute Care Hospital Children Peers

Total spending distribution among 16 providers in this specialty

P25MedianP75P90

This provider's total spending of $277.3M is at the 50th percentile among 16 General Acute Care Hospital Children providers.

Active Billing Period:2018-01→2024-12(74 months)
Sharp billing drop in final month

Total Paid

$277.3M

$277,277,790

Total Claims

1.8M

Beneficiaries

1.5M

1.1 claims/patient

Avg Cost/Claim

$158

#281 of 618K providers by total spending(top <0.1%)

🔍 Analysis

Provider Overview

Texas Children's Hospital is a General Acute Care Hospital Children provider based in Houston, TX. From the 2018–2024 period, this provider received $277.3M in Medicaid payments across 1.8M claims.

Why This Matters

This provider received $277.3M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 34,659 Medicaid beneficiaries for a full year at average per-enrollee costs.

↑ 92794% growthsince first billing year

Monthly Spending Trend

Yearly Spending

2018
$63K
-29%
2019
$45K
+19208%
2020
$8.7M
+491%
2021
$51.4M
+34%
2022
$68.8M
+30%
2023
$89.3M
-34%
2024
$58.9M

Procedure Breakdown

Cost per claim compared to national benchmarks

This provider bills for 30 distinct procedure codes. The top code (99285 (Emergency dept visit, high/urgent complexity)) accounts for 29% of total spending.

99285Top 1%

Emergency dept visit, high/urgent complexity

$80.5M

84K claims · 29.0%

Your Cost: $956.64/claim|Median: $85.65
11.2× median
99284Top 1%

Emergency dept visit, high complexity

$52.7M

66K claims · 19.0%

Your Cost: $795.85/claim|Median: $69.51
11.4× median
97110Top 1%

Therapeutic exercises, each 15 min

$12.6M

56K claims · 4.5%

Your Cost: $223.68/claim|Median: $24.49
9.1× median
41899Top 10%

Unlisted procedure, dentoalveolar structures

$8.1M

4K claims · 2.9%

Your Cost: $2,248.51/claim|Median: $763.43
3.0× median
42820Top 10%

Tonsillectomy and adenoidectomy, under age 12

$8.0M

3K claims · 2.9%

Your Cost: $2,453.24/claim|Median: $331.68
7.4× median
97530Top 1%

Therapeutic activities, each 15 min

$7.5M

32K claims · 2.7%

Your Cost: $233.29/claim|Median: $33.11
7.0× median
87635Top 5%

COVID-19 SARS-CoV-2 amplified probe detection

$4.9M

72K claims · 1.8%

Your Cost: $67.32/claim|Median: $39.70
1.7× median
69436Top 5%

Tympanostomy, general anesthesia

$4.7M

3K claims · 1.7%

Your Cost: $1,649.08/claim|Median: $205.50
8.0× median
92507Top 5%

Speech/hearing/language treatment

$4.5M

38K claims · 1.6%

Your Cost: $118.44/claim|Median: $49.45
2.4× median
95004Top 5%

Percutaneous allergy skin tests, each

$4.4M

12K claims · 1.6%

Your Cost: $380.28/claim|Median: $134.97
2.8× median
93005Top 1%

Electrocardiogram, tracing only, without interpretation

$4.2M

25K claims · 1.5%

Your Cost: $166.62/claim|Median: $7.50
22.2× median
76816Top 1%

Ultrasound, pregnant uterus, follow-up

$4.1M

18K claims · 1.5%

Your Cost: $225.53/claim|Median: $58.55
3.9× median
G0378Top 10%

Hospital observation service, per hour

$4.0M

6K claims · 1.4%

Your Cost: $700.40/claim|Median: $99.39
7.0× median
87632Top 1%

$3.7M

11K claims · 1.3%

Your Cost: $341.31/claim|Median: $88.01
3.9× median
97112Top 1%

Therapeutic procedure, neuromuscular reeducation, per 15 minutes

$3.6M

16K claims · 1.3%

Your Cost: $221.90/claim|Median: $20.04
11.1× median
99283Normal range

Emergency dept visit, moderate complexity

$3.5M

64K claims · 1.3%

Your Cost: $55.31/claim|Median: $42.48
1.3× median
70553Top 1%

MRI brain without contrast, then with contrast

$3.4M

2K claims · 1.2%

Your Cost: $1,501.50/claim|Median: $133.68
11.2× median
93306Top 1%

Echocardiography, transthoracic, complete, with Doppler

$3.2M

3K claims · 1.2%

Your Cost: $951.67/claim|Median: $54.68
17.4× median
80048Top 1%

Basic metabolic panel

$3.0M

21K claims · 1.1%

Your Cost: $139.67/claim|Median: $5.78
24.2× median
93303Top 1%

Echocardiography, transthoracic, limited

$2.9M

4K claims · 1.0%

Your Cost: $791.93/claim|Median: $112.83
7.0× median
85025Top 5%

Complete blood count (CBC) with differential, automated

$2.4M

69K claims · 0.9%

Your Cost: $35.22/claim|Median: $4.71
7.5× median
76811Top 5%

Ultrasound, pregnant uterus, detailed, single fetus

$2.3M

9K claims · 0.8%

Your Cost: $241.98/claim|Median: $106.79
2.3× median
92567Top 5%

$2.0M

42K claims · 0.7%

Your Cost: $48.81/claim|Median: $11.50
4.2× median
93325Top 5%

$2.0M

11K claims · 0.7%

Your Cost: $178.97/claim|Median: $14.61
12.3× median
92579Top 5%

$2.0M

16K claims · 0.7%

Your Cost: $127.79/claim|Median: $30.58
4.2× median
92587Top 10%

$1.8M

31K claims · 0.7%

Your Cost: $59.83/claim|Median: $19.24
3.1× median
59025Top 1%

Fetal non-stress test

$1.8M

6K claims · 0.7%

Your Cost: $315.14/claim|Median: $26.45
11.9× median
99212Normal range

Office/outpatient visit, low complexity

$1.8M

122K claims · 0.6%

Your Cost: $14.53/claim|Median: $25.06
0.6× median
93320Top 1%

$1.5M

4K claims · 0.5%

Your Cost: $400.46/claim|Median: $28.68
14.0× median
95810Top 5%

Polysomnography, sleep study, 6+ hours

$1.4M

1K claims · 0.5%

Your Cost: $1,432.21/claim|Median: $233.73
6.1× median

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Similar Providers

Other top providers in General Acute Care Hospital Children

Children's Hospital Medical Center of Akron

Akron, OH

$556.6M

Phoenix Children's Hospital

Phoenix, AZ

$555.7M

Childrens Hospital of Philadelphia

Philadelphia, PA

$286.9M

Cook Children's Medical Center

Fort Worth, TX

$286.7M

Children's Health System of Texas

Dallas, TX

$263.8M

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