Baystate Medical Center INC
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $146.05 per claim for 99211 (Office/outpatient visit, minimal complexity), which is 11.3× the national median of $12.93.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 123 procedure codes: 99211 at 11.3× median, 99283 at 3.7× 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:
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.
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 $146.05 per claim for 99211 (Office/outpatient visit, minimal complexity) — 11.3× the national median of $12.93.
Bills $157.73 per claim for 99283 (Emergency dept visit, moderate complexity) — 3.7× the national median of $42.48.
Bills $139.54 per claim for 99212 (Office/outpatient visit, low complexity) — 5.6× the national median of $25.06.
Billing above the 90th percentile for 15 procedure codes simultaneously.
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 $374.5M is at the 75th percentile among 156 General Acute Care Hospital providers.
Total Paid
$374.5M
$374,467,034
Total Claims
7.8M
Beneficiaries
6.8M
1.2 claims/patient
Avg Cost/Claim
$48
#174 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Baystate Medical Center INC is a General Acute Care Hospital provider based in Springfield, MA. From the 2018–2024 period, this provider received $374.5M in Medicaid payments across 7.8M claims.
Why This Matters
This provider received $374.5M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 46,808 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 19% of total spending.
$72.4M
496K claims
$146.05
$12.93
Office/outpatient visit, minimal complexity
$72.4M
496K claims · 19.3%
$18.2M
118K claims
$155.00
$69.51
Emergency dept visit, high complexity
$18.2M
118K claims · 4.9%
$17.1M
88K claims
$195.57
$85.65
Emergency dept visit, high/urgent complexity
$17.1M
88K claims · 4.6%
$17.1M
109K claims
$157.73
$42.48
Emergency dept visit, moderate complexity
$17.1M
109K claims · 4.6%
$13.3M
95K claims
$139.54
$25.06
Office/outpatient visit, low complexity
$13.3M
95K claims · 3.5%
$11.8M
38K claims
$310.27
$38.92
IV infusion, hydration, each additional hour
$11.8M
38K claims · 3.1%
$7.7M
235K claims
$32.62
$26.41
Hospital outpatient clinic visit
$7.7M
235K claims · 2.1%
$6.2M
41K claims
$150.93
$74.09
Office/outpatient visit, high complexity
$6.2M
41K claims · 1.7%
Therapeutic exercises, each 15 min
$5.2M
84K claims · 1.4%
$5.2M
29K claims
$175.29
$54.77
IV infusion, therapeutic/prophylactic/diagnostic, initial, up to 1 hour
$5.2M
29K claims · 1.4%
$5.1M
10K claims · 1.4%
Fetal non-stress test
$4.8M
20K claims · 1.3%
$4.7M
38K claims
$121.83
$99.39
Hospital observation service, per hour
$4.7M
38K claims · 1.3%
$4.6M
37K claims
$124.34
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$4.6M
37K claims · 1.2%
$4.4M
25K claims
$177.73
$75.28
Chemotherapy administration, IV infusion, up to 1 hour
$4.4M
25K claims · 1.2%
Upper GI endoscopy with biopsy
$3.9M
6K claims · 1.0%
$3.5M
2K claims
$1,452.82
$763.43
Unlisted procedure, dentoalveolar structures
$3.5M
2K claims · 0.9%
$3.4M
56K claims
$61.83
$63.08
Infectious disease detection (COVID-19)
$3.4M
56K claims · 0.9%
$3.4M
13K claims
$270.81
$40.12
IV infusion, therapeutic/prophylactic/diagnostic, each additional hour
$3.4M
13K claims · 0.9%
$3.4M
9K claims
$398.95
$501.33
Crisis intervention mental health services, per diem
$3.4M
9K claims · 0.9%
CT head/brain without contrast
$3.0M
24K claims · 0.8%
$3.0M
23K claims
$130.46
$65.76
CT abdomen and pelvis with contrast
$3.0M
23K claims · 0.8%
$2.8M
51K claims
$53.82
$35.43
Drug test, presumptive, by chemistry analyzers
$2.8M
51K claims · 0.7%
Ultrasound, abdominal, limited
$2.7M
24K claims · 0.7%
$2.3M
23K claims
$100.02
$69.35
Preventive medicine, established patient, infant (under 1)
$2.3M
23K claims · 0.6%
$2.2M
3K claims
$887.27
$233.73
Polysomnography, sleep study, 6+ hours
$2.2M
3K claims · 0.6%
$2.2M
3K claims · 0.6%
$2.2M
1K claims · 0.6%
Injection, pembrolizumab, 1 mg
$2.1M
216 claims · 0.5%
$2.0M
11K claims
$184.57
$54.68
Echocardiography, transthoracic, complete, with Doppler
$2.0M
11K claims · 0.5%
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