Beth Israel Deaconess Medical Center, Inc.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 107 procedure codes: 99212 at 5.6× median, 99213 at 3.5× 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:
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 $140.20 per claim for 99212 (Office/outpatient visit, low complexity) — 5.6× the national median of $25.06.
Bills $132.71 per claim for 99213 (Office/outpatient visit, est. patient, low-mod complexity) — 3.5× the national median of $37.81.
Bills $144.41 per claim for 99211 (Office/outpatient visit, minimal complexity) — 11.2× the national median of $12.93.
Billing above the 90th percentile for 13 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 $270.3M is at the 75th percentile among 156 General Acute Care Hospital providers.
Total Paid
$270.3M
$270,281,400
Total Claims
7.8M
Beneficiaries
6.8M
1.1 claims/patient
Avg Cost/Claim
$35
#293 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Beth Israel Deaconess Medical Center, Inc. is a General Acute Care Hospital provider based in Boston, MA. From the 2018–2024 period, this provider received $270.3M in Medicaid payments across 7.8M claims.
Why This Matters
This provider received $270.3M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 33,785 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 (99212 (Office/outpatient visit, low complexity)) accounts for 10% of total spending.
$25.8M
184K claims
$140.20
$25.06
Office/outpatient visit, low complexity
$25.8M
184K claims · 9.5%
$15.8M
119K claims
$132.71
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$15.8M
119K claims · 5.8%
$14.1M
98K claims
$144.41
$12.93
Office/outpatient visit, minimal complexity
$14.1M
98K claims · 5.2%
$9.1M
30K claims
$300.28
$75.28
Chemotherapy administration, IV infusion, up to 1 hour
$9.1M
30K claims · 3.4%
$8.3M
312K claims
$26.63
$26.41
Hospital outpatient clinic visit
$8.3M
312K claims · 3.1%
$7.8M
22K claims
$361.41
$38.92
IV infusion, hydration, each additional hour
$7.8M
22K claims · 2.9%
Injection, pembrolizumab, 1 mg
$7.6M
968 claims · 2.8%
$6.8M
37K claims
$186.90
$85.65
Emergency dept visit, high/urgent complexity
$6.8M
37K claims · 2.5%
Upper GI endoscopy with biopsy
$5.1M
9K claims · 1.9%
$5.1M
43K claims
$117.91
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$5.1M
43K claims · 1.9%
$4.9M
3K claims
$1,587.53
$1,587.53
Injection, infliximab, excludes biosimilar, 10 mg
$4.9M
3K claims · 1.8%
Colonoscopy with biopsy
$4.7M
7K claims · 1.7%
$4.6M
9K claims · 1.7%
$4.6M
6K claims
$769.44
$255.17
Colonoscopy with polyp removal, snare technique
$4.6M
6K claims · 1.7%
$4.4M
29K claims
$149.31
$69.51
Emergency dept visit, high complexity
$4.4M
29K claims · 1.6%
$3.8M
28K claims
$136.80
$54.77
IV infusion, therapeutic/prophylactic/diagnostic, initial, up to 1 hour
$3.8M
28K claims · 1.4%
Colonoscopy, diagnostic
$3.4M
5K claims · 1.2%
$3.3M
10K claims
$340.40
$40.12
IV infusion, therapeutic/prophylactic/diagnostic, each additional hour
$3.3M
10K claims · 1.2%
$3.0M
638 claims · 1.1%
Therapeutic exercises, each 15 min
$2.9M
56K claims · 1.1%
PET imaging for limited area
$2.7M
3K claims · 1.0%
$2.6M
48K claims
$54.39
$63.08
Infectious disease detection (COVID-19)
$2.6M
48K claims · 1.0%
$2.5M
16K claims
$151.74
$74.09
Office/outpatient visit, high complexity
$2.5M
16K claims · 0.9%
$2.1M
15K claims
$139.62
$42.48
Emergency dept visit, moderate complexity
$2.1M
15K claims · 0.8%
$2.0M
8K claims
$261.58
$133.68
MRI brain without contrast, then with contrast
$2.0M
8K claims · 0.7%
$2.0M
17K claims
$114.40
$99.39
Hospital observation service, per hour
$2.0M
17K claims · 0.7%
$1.9M
15K claims
$122.70
$65.76
CT abdomen and pelvis with contrast
$1.9M
15K claims · 0.7%
$1.8M
12K claims
$150.64
$54.68
Echocardiography, transthoracic, complete, with Doppler
$1.8M
12K claims · 0.7%
$1.7M
64K claims
$26.66
$24.95
Chlamydia detection, nucleic acid, amplified probe
$1.7M
64K claims · 0.6%
$1.7M
64K claims
$26.32
$23.39
Neisseria gonorrhoeae detection, nucleic acid, amplified probe
$1.7M
64K claims · 0.6%
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