University of Kentucky
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $422.42 per claim for 99284 (Emergency dept visit, high complexity), which is 6.1× the national median of $69.51.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 447 procedure codes: 99284 at 6.1× median, 99285 at 9.0× median.
Unusually High Spending
This provider's total payments are significantly above the median for their specialty.
High Cost Per Claim
Average payment per claim is much higher than peers billing the same procedures.
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
▼
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.
Unusually High Spending
Unusually High Spending means this provider's total Medicaid payments are significantly above the median for their specialty. This doesn't necessarily indicate fraud — high volume practices and those serving complex populations may legitimately bill more.
High Cost Per Claim
High Cost Per Claim means each individual claim from this provider costs significantly more than what other providers charge for the same services. This could indicate upcoding (billing for more expensive services than provided) or legitimate specialized care.
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 $422.42 per claim for 99284 (Emergency dept visit, high complexity) — 6.1× the national median of $69.51.
Bills $772.35 per claim for 99285 (Emergency dept visit, high/urgent complexity) — 9.0× the national median of $85.65.
Bills $798.58 per claim for 74177 (CT abdomen and pelvis with contrast) — 12.1× the national median of $65.76.
Billing in the top 1% nationally for 4 procedure codes: 99285, 93306, 71260.
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 $716.4M is at the 90th percentile among 156 General Acute Care Hospital providers.
Above 90th percentile for this specialty — higher spending than 140 of 156 peers
Total Paid
$716.4M
$716,407,788
Total Claims
8.8M
Beneficiaries
6.9M
1.3 claims/patient
Avg Cost/Claim
$81
#66 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
University of Kentucky is a General Acute Care Hospital provider based in Lexington, KY. From the 2018–2024 period, this provider received $716.4M in Medicaid payments across 8.8M claims.
Why This Matters
This provider received $716.4M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 89,550 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 (99284 (Emergency dept visit, high complexity)) accounts for 10% of total spending.
$71.0M
168K claims
$422.42
$69.51
Emergency dept visit, high complexity
$71.0M
168K claims · 9.9%
$43.5M
56K claims
$772.35
$85.65
Emergency dept visit, high/urgent complexity
$43.5M
56K claims · 6.1%
$29.2M
597K claims
$48.88
$26.41
Hospital outpatient clinic visit
$29.2M
597K claims · 4.1%
Injection, pembrolizumab, 1 mg
$29.0M
3K claims · 4.0%
CT abdomen and pelvis with contrast
$22.9M
29K claims · 3.2%
$20.6M
75K claims
$276.71
$42.48
Emergency dept visit, moderate complexity
$20.6M
75K claims · 2.9%
$14.0M
22K claims
$639.39
$260.56
Intensity modulated radiation treatment delivery, complex
$14.0M
22K claims · 2.0%
$13.6M
267K claims
$50.85
$12.93
Office/outpatient visit, minimal complexity
$13.6M
267K claims · 1.9%
$13.3M
56K claims
$239.40
$99.39
Hospital observation service, per hour
$13.3M
56K claims · 1.9%
$11.4M
1K claims
$8,088.12
$3,562.28
Nivolumab (Opdivo) injection, 1 mg
$11.4M
1K claims · 1.6%
$10.3M
12K claims
$872.58
$133.68
MRI brain without contrast, then with contrast
$10.3M
12K claims · 1.4%
$9.5M
2K claims
$4,321.42
$1,587.53
Injection, infliximab, excludes biosimilar, 10 mg
$9.5M
2K claims · 1.3%
$8.2M
14K claims
$604.66
$54.68
Echocardiography, transthoracic, complete, with Doppler
$8.2M
14K claims · 1.1%
$7.2M
4K claims · 1.0%
CT chest with contrast
$7.0M
14K claims · 1.0%
$6.7M
9K claims · 0.9%
$6.4M
29K claims
$222.75
$75.28
Chemotherapy administration, IV infusion, up to 1 hour
$6.4M
29K claims · 0.9%
$6.4M
103K claims
$61.99
$7.50
Electrocardiogram, tracing only, without interpretation
$6.4M
103K claims · 0.9%
Comprehensive metabolic panel
$6.4M
361K claims · 0.9%
$6.0M
989 claims · 0.8%
CT angiography, chest, with contrast
$5.8M
12K claims · 0.8%
CT head/brain without contrast
$5.7M
21K claims · 0.8%
$5.5M
9K claims · 0.8%
$5.4M
39K claims
$141.39
$54.77
IV infusion, therapeutic/prophylactic/diagnostic, initial, up to 1 hour
$5.4M
39K claims · 0.8%
PET imaging for limited area
$4.9M
4K claims · 0.7%
Emergency dept visit, low complexity
$4.7M
31K claims · 0.7%
$4.6M
54K claims
$85.00
$14.92
Therapeutic/prophylactic/diagnostic IV push, each additional substance
$4.6M
54K claims · 0.6%
Upper GI endoscopy with biopsy
$4.5M
7K claims · 0.6%
$4.3M
29K claims
$148.89
$75.26
Drug test, definitive, 15-21 drug classes
$4.3M
29K claims · 0.6%
$4.3M
86K claims
$49.34
$21.76
Therapeutic/prophylactic/diagnostic IV push, single substance
$4.3M
86K claims · 0.6%
Other Top Providers in Kentucky
View all →Norton Hospitals INC
General Acute Care Hospital
$419.6M
Seven Counties Services Inc.
Clinic/Center Developmental Disabilities
$375.8M
Cumberland River Behavioral Health INC
Community/Behavioral Health
$349.2M
Addiction Recovery Care LLC
Community Based Residential Treatment Facility, Me
$309.0M
Norton Hospitals, INC
General Acute Care Hospital
$299.0M
Similar Providers
Other top providers in General Acute Care Hospital