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

Grossmont Hospital Corporation

General Acute Care Hospital·La Mesa, CA·NPI: 1528041811SharePrint 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.

Risk Assessment

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Bills $440.13 per claim for 99283 (Emergency dept visit, moderate complexity) — 10.4× the national median of $42.48.

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Bills $287.69 per claim for 0450 (Emergency room visit) — 6.4× the national median of $44.95.

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Bills $262.16 per claim for 99499 (Unlisted evaluation and management service) — 8.5× the national median of $30.88.

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Billing in the top 1% nationally for 2 procedure codes: 99283, 99199.

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

P25MedianP75P90

This provider's total spending of $226.7M is at the 50th percentile among 156 General Acute Care Hospital providers.

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

Total Paid

$226.7M

$226,695,572

Total Claims

2.4M

Beneficiaries

2.1M

1.2 claims/patient

Avg Cost/Claim

$93

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

🔍 Analysis

Provider Overview

Grossmont Hospital Corporation is a General Acute Care Hospital provider based in La Mesa, CA. From the 2018–2024 period, this provider received $226.7M in Medicaid payments across 2.4M claims.

Why This Matters

This provider received $226.7M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 28,336 Medicaid beneficiaries for a full year at average per-enrollee costs.

↓ 24% growthsince first billing year

Monthly Spending Trend

Yearly Spending

2018
$32.7M
-3%
2019
$31.8M
-17%
2020
$26.3M
+27%
2021
$33.4M
+18%
2022
$39.4M
-3%
2023
$38.1M
-34%
2024
$25.0M

Procedure Breakdown

Cost per claim compared to national benchmarks

This provider bills for 30 distinct procedure codes. The top code (99283 (Emergency dept visit, moderate complexity)) accounts for 15% of total spending.

99283Top 1%

Emergency dept visit, moderate complexity

$34.2M

78K claims · 15.1%

Your Cost: $440.13/claim|Median: $42.48
10.4× median
0450Top 5%

Emergency room visit

$31.9M

111K claims · 14.1%

Your Cost: $287.69/claim|Median: $44.95
6.4× median
99499Top 5%

Unlisted evaluation and management service

$13.9M

53K claims · 6.1%

Your Cost: $262.16/claim|Median: $30.88
8.5× median
74177Top 5%

CT abdomen and pelvis with contrast

$12.4M

18K claims · 5.5%

Your Cost: $673.68/claim|Median: $65.76
10.2× median
99199Top 1%

Unlisted special service, procedure, or report

$7.7M

11K claims · 3.4%

Your Cost: $671.68/claim|Median: $5.39
124.6× median
80053Top 5%

Comprehensive metabolic panel

$6.9M

171K claims · 3.0%

Your Cost: $40.22/claim|Median: $7.24
5.6× median
70450Top 5%

CT head/brain without contrast

$5.7M

23K claims · 2.5%

Your Cost: $248.80/claim|Median: $45.53
5.5× median
0762Top 25%

$5.6M

12K claims · 2.5%

Your Cost: $480.33/claim|Median: $102.28
4.7× median
0360Top 5%

$5.0M

6K claims · 2.2%

Your Cost: $832.57/claim|Median: $95.40
8.7× median
93005Top 10%

Electrocardiogram, tracing only, without interpretation

$4.3M

75K claims · 1.9%

Your Cost: $57.09/claim|Median: $7.50
7.6× median
99284Top 5%

Emergency dept visit, high complexity

$4.2M

15K claims · 1.8%

Your Cost: $289.03/claim|Median: $69.51
4.2× median
99285Top 5%

Emergency dept visit, high/urgent complexity

$4.1M

11K claims · 1.8%

Your Cost: $362.69/claim|Median: $85.65
4.2× median
85025Top 10%

Complete blood count (CBC) with differential, automated

$3.4M

188K claims · 1.5%

Your Cost: $17.98/claim|Median: $4.71
3.8× median
0121Top 25%

Revenue code, all-inclusive room and board

$3.3M

446 claims · 1.5%

Your Cost: $7,463.45/claim|Median: $2,650.78
2.8× median
74176Top 5%

CT abdomen and pelvis without contrast

$2.6M

6K claims · 1.2%

Your Cost: $404.05/claim|Median: $60.19
6.7× median
96374Top 25%

Therapeutic/prophylactic/diagnostic IV push, single substance

$2.6M

35K claims · 1.1%

Your Cost: $74.02/claim|Median: $21.76
3.4× median
80307Top 5%

Drug test, presumptive, by chemistry analyzers

$2.6M

33K claims · 1.1%

Your Cost: $76.97/claim|Median: $35.43
2.2× median
78815Top 25%

PET imaging for limited area

$2.3M

3K claims · 1.0%

Your Cost: $772.47/claim|Median: $325.10
2.4× median
96375Top 5%

Therapeutic/prophylactic/diagnostic IV push, each additional substance

$2.2M

23K claims · 1.0%

Your Cost: $99.59/claim|Median: $14.92
6.7× median
71046Top 5%

Chest X-ray, 2 views

$2.1M

40K claims · 0.9%

Your Cost: $53.59/claim|Median: $8.92
6.0× median
0206Top 10%

$1.9M

215 claims · 0.8%

Your Cost: $8,688.48/claim|Median: $2,282.75
3.8× median
0160Top 25%

$1.8M

3K claims · 0.8%

Your Cost: $664.61/claim|Median: $54.01
12.3× median
95811Top 10%

$1.8M

3K claims · 0.8%

Your Cost: $679.65/claim|Median: $255.03
2.7× median
71275Top 5%

CT angiography, chest, with contrast

$1.6M

4K claims · 0.7%

Your Cost: $444.78/claim|Median: $92.96
4.8× median
84484Top 5%

Troponin, quantitative

$1.5M

54K claims · 0.7%

Your Cost: $27.64/claim|Median: $4.84
5.7× median
76815Top 5%

Ultrasound, pregnant uterus, limited

$1.4M

12K claims · 0.6%

Your Cost: $114.75/claim|Median: $36.79
3.1× median
96361Normal range

IV infusion, hydration, each additional hour

$1.4M

25K claims · 0.6%

Your Cost: $55.14/claim|Median: $38.92
1.4× median
59025Top 10%

Fetal non-stress test

$1.4M

10K claims · 0.6%

Your Cost: $141.98/claim|Median: $26.45
5.4× median
96372Top 5%

Therapeutic injection, subcutaneous/intramuscular

$1.3M

34K claims · 0.6%

Your Cost: $39.24/claim|Median: $9.56
4.1× median
71045Top 10%

Chest X-ray, single view

$1.3M

32K claims · 0.6%

Your Cost: $41.42/claim|Median: $4.93
8.4× median

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