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

Genedx LLC

Medical Genetics, Ph.D. Medical Genetics·Gaithersburg, MD·NPI: 1487632998SharePrint 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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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 6.8x in 2022-01

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 $199.16 per claim for 81479 (Unlisted molecular pathology procedure) — 5.2× the national median of $38.66.

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Bills $1,467.07 per claim for 81426 — 3.6× the national median of $409.74.

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Bills $57.88 per claim for 81189 — 4.4× the national median of $13.20.

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Billing in the top 1% nationally for 6 procedure codes: 81470, 81471, 81425.

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

Active Billing Period:2018-01→2024-12(84 months)

Total Paid

$215.3M

$215,335,419

Total Claims

446K

Beneficiaries

386K

1.2 claims/patient

Avg Cost/Claim

$483

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

🔍 Analysis

Provider Overview

Genedx LLC is a Medical Genetics, Ph.D. Medical Genetics provider based in Gaithersburg, MD. From the 2018–2024 period, this provider received $215.3M in Medicaid payments across 446K claims.

Why This Matters

This provider received $215.3M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 26,916 Medicaid beneficiaries for a full year at average per-enrollee costs.

↑ 1301% growthsince first billing year

Monthly Spending Trend

Yearly Spending

2018
$5.6M
+16%
2019
$6.5M
-5%
2020
$6.2M
+177%
2021
$17.0M
+120%
2022
$37.5M
+71%
2023
$64.2M
+22%
2024
$78.3M

Procedure Breakdown

Cost per claim compared to national benchmarks

This provider bills for 30 distinct procedure codes. The top code (81416 (Exome sequence analysis)) accounts for 49% of total spending.

81416Normal range

Exome sequence analysis

$105.8M

47K claims · 49.1%

Your Cost: $2,250.85/claim|Median: $1,030.45
2.2× median
81415Normal range

$59.4M

65K claims · 27.6%

Your Cost: $914.36/claim|Median: $1,342.29
0.7× median
81229Normal range

$15.6M

58K claims · 7.2%

Your Cost: $267.24/claim|Median: $372.17
0.7× median
81408Normal range

Molecular pathology procedure, level nine

$5.1M

15K claims · 2.4%

Your Cost: $346.13/claim|Median: $158.72
2.2× median
81460Normal range

$5.1M

29K claims · 2.4%

Your Cost: $172.23/claim|Median: $286.53
0.6× median
81479Top 25%

Unlisted molecular pathology procedure

$3.2M

16K claims · 1.5%

Your Cost: $199.16/claim|Median: $38.66
5.2× median
81465Normal range

$2.5M

17K claims · 1.2%

Your Cost: $143.59/claim|Median: $260.74
0.6× median
81407Normal range

$1.8M

15K claims · 0.9%

Your Cost: $124.27/claim|Median: $98.12
1.3× median
81470Top 1%

$1.8M

13K claims · 0.9%

Your Cost: $146.30/claim|Median: $124.03
1.2× median
81406Normal range

$1.8M

23K claims · 0.8%

Your Cost: $79.24/claim|Median: $50.07
1.6× median
81405Normal range

$1.7M

22K claims · 0.8%

Your Cost: $74.75/claim|Median: $55.02
1.4× median
81471Top 1%

$1.5M

13K claims · 0.7%

Your Cost: $120.16/claim|Median: $118.82
1.0× median
81404Normal range

$1.5M

20K claims · 0.7%

Your Cost: $76.62/claim|Median: $48.77
1.6× median
81425Top 1%

$1.5M

868 claims · 0.7%

Your Cost: $1,676.00/claim|Median: $576.97
2.9× median
81426Top 1%

$1.0M

712 claims · 0.5%

Your Cost: $1,467.07/claim|Median: $409.74
3.6× median
81302Normal range

$793K

7K claims · 0.4%

Your Cost: $107.61/claim|Median: $44.17
2.4× median
81162Normal range

$730K

2K claims · 0.3%

Your Cost: $468.09/claim|Median: $484.02
1.0× median
81243Normal range

$670K

36K claims · 0.3%

Your Cost: $18.44/claim|Median: $21.92
0.8× median
81321Normal range

$585K

7K claims · 0.3%

Your Cost: $81.82/claim|Median: $81.34
1.0× median
81430Top 1%

$570K

2K claims · 0.3%

Your Cost: $289.14/claim|Median: $145.98
2.0× median
81411Normal range

$404K

2K claims · 0.2%

Your Cost: $201.51/claim|Median: $201.51
1.0× median
81403Normal range

$348K

8K claims · 0.2%

Your Cost: $45.48/claim|Median: $42.54
1.1× median
81185Normal range

$235K

2K claims · 0.1%

Your Cost: $146.12/claim|Median: $55.85
2.6× median
81410Normal range

$232K

2K claims · 0.1%

Your Cost: $114.37/claim|Median: $114.37
1.0× median
81431Top 1%

$196K

2K claims · 0.1%

Your Cost: $102.09/claim|Median: $102.09
1.0× median
81323Normal range

$166K

6K claims · 0.1%

Your Cost: $28.56/claim|Median: $28.56
1.0× median
81419Normal range

$165K

341 claims · 0.1%

Your Cost: $484.15/claim|Median: $386.39
1.3× median
81189Top 25%

$114K

2K claims · 0.1%

Your Cost: $57.88/claim|Median: $13.20
4.4× median
81228Normal range

$113K

303 claims · 0.1%

Your Cost: $374.55/claim|Median: $196.14
1.9× median
81292Normal range

$102K

717 claims · 0.0%

Your Cost: $142.06/claim|Median: $142.06
1.0× median

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