Texas Children's Hospital
General Acute Care Hospital Children
Houston, Texas
NPI: 1477643690
Risk Tier
Critical
Total Paid
$277.3M
$277,277,790
Total Claims
1.8M
Beneficiaries
1.5M
Avg Cost/Claim
$158.15
Active billing period: 74 months (2018-01 to 2024-12)
Statistical Fraud Flags (3)
Cost Outlier
Billing over 3× the national median for specific procedure codes.
Bills $956.64 per claim for 99285 (Emergency dept visit, high/urgent complexity), which is 11.2× the national median of $85.65.
Billing Swing
Experienced over 200% change in year-over-year billing with >$1M absolute change.
Billing changed from $8.7M (2020) to $51.4M (2021) — a 491% swing with $42.7M absolute change.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 257 procedure codes: 99285 at 11.2× median, 99284 at 11.4× median.
Advanced Detection Signals
CUSUM Change Point
Billing shifted 12.3x in 2021-02 — a statistically significant structural change in billing behavior was detected.
Disclaimer: Statistical flags indicate unusual billing patterns — they are not proof of fraud or wrongdoing. Some entities (government agencies, home care programs, hospitals) may legitimately bill at higher rates due to patient acuity, overhead costs, or specialized services. This report is generated from public HHS data and statistical analysis only. No clinical or investigative review has been performed.
Generated by OpenMedicaid | openmedicaid.org | Data: HHS 2018-2024