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

Children's Hospital Medical Center

Clinic/Center, Primary Care·Cincinnati, OH·NPI: 1548212988SharePrint 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 $143.73 per claim for 99283 (Emergency dept visit, moderate complexity) — 3.4× the national median of $42.48.

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Bills $106.57 per claim for 99212 (Office/outpatient visit, low complexity) — 4.3× the national median of $25.06.

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Bills $1,128.36 per claim for 69436 (Tympanostomy, general anesthesia) — 5.5× the national median of $205.50.

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Billing in the top 1% nationally for 5 procedure codes: 96127, 96110, 99219.

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

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

Total Paid

$386.7M

$386,699,974

Total Claims

5.3M

Beneficiaries

4.4M

1.2 claims/patient

Avg Cost/Claim

$73

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

🔍 Analysis

Provider Overview

Children's Hospital Medical Center is a Clinic/Center, Primary Care provider based in Cincinnati, OH. From the 2018–2024 period, this provider received $386.7M in Medicaid payments across 5.3M claims.

Why This Matters

This provider received $386.7M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 48,337 Medicaid beneficiaries for a full year at average per-enrollee costs.

↑ 192% growthsince first billing year

Monthly Spending Trend

Yearly Spending

2018
$32.2M
+6%
2019
$34.2M
-8%
2020
$31.4M
+25%
2021
$39.4M
+26%
2022
$49.8M
+113%
2023
$106.0M
-12%
2024
$93.8M

Procedure Breakdown

Cost per claim compared to national benchmarks

This provider bills for 30 distinct procedure codes. The top code (99213 (Office/outpatient visit, est. patient, low-mod complexity)) accounts for 16% of total spending.

99213Top 5%

Office/outpatient visit, est. patient, low-mod complexity

$61.8M

573K claims · 16.0%

Your Cost: $107.88/claim|Median: $37.81
2.9× median
99283Top 10%

Emergency dept visit, moderate complexity

$20.1M

140K claims · 5.2%

Your Cost: $143.73/claim|Median: $42.48
3.4× median
99212Top 5%

Office/outpatient visit, low complexity

$17.4M

163K claims · 4.5%

Your Cost: $106.57/claim|Median: $25.06
4.3× median
99214Top 10%

Office/outpatient visit, est. patient, mod-high complexity

$14.9M

142K claims · 3.9%

Your Cost: $105.06/claim|Median: $53.41
2.0× median
69436Top 10%

Tympanostomy, general anesthesia

$11.2M

10K claims · 2.9%

Your Cost: $1,128.36/claim|Median: $205.50
5.5× median
96127Top 1%

Brief emotional/behavioral assessment, per standardized instrument

$11.0M

95K claims · 2.8%

Your Cost: $116.25/claim|Median: $3.67
31.7× median
96110Top 1%

Developmental screening, per standardized instrument

$10.9M

44K claims · 2.8%

Your Cost: $249.47/claim|Median: $9.10
27.4× median
90834Top 10%

Psychotherapy, 45 minutes

$8.2M

65K claims · 2.1%

Your Cost: $126.21/claim|Median: $63.65
2.0× median
97530Top 25%

Therapeutic activities, each 15 min

$7.3M

103K claims · 1.9%

Your Cost: $71.09/claim|Median: $33.11
2.1× median
99282Top 25%

Emergency dept visit, low complexity

$6.3M

47K claims · 1.6%

Your Cost: $134.52/claim|Median: $37.72
3.6× median
99284Top 10%

Emergency dept visit, high complexity

$6.1M

35K claims · 1.6%

Your Cost: $172.05/claim|Median: $69.51
2.5× median
99392Top 10%

Preventive medicine, established patient, age 1-4

$6.0M

50K claims · 1.5%

Your Cost: $119.12/claim|Median: $75.18
1.6× median
90791Top 5%

Psychiatric diagnostic evaluation

$5.9M

22K claims · 1.5%

Your Cost: $263.63/claim|Median: $99.21
2.7× median
92507Top 25%

Speech/hearing/language treatment

$5.9M

76K claims · 1.5%

Your Cost: $76.93/claim|Median: $49.45
1.6× median
42820Normal range

Tonsillectomy and adenoidectomy, under age 12

$5.7M

5K claims · 1.5%

Your Cost: $1,119.65/claim|Median: $331.68
3.4× median
97110Top 5%

Therapeutic exercises, each 15 min

$5.7M

63K claims · 1.5%

Your Cost: $90.14/claim|Median: $24.49
3.7× median
99391Top 10%

Preventive medicine, established patient, infant (under 1)

$5.4M

48K claims · 1.4%

Your Cost: $113.88/claim|Median: $69.35
1.6× median
99393Top 10%

Preventive medicine, established patient, age 5-11

$5.4M

46K claims · 1.4%

Your Cost: $117.99/claim|Median: $74.82
1.6× median
99215Normal range

Office/outpatient visit, high complexity

$5.4M

51K claims · 1.4%

Your Cost: $104.43/claim|Median: $74.09
1.4× median
H2020Normal range

Day habilitation, waiver, per 15 minutes

$4.3M

29K claims · 1.1%

Your Cost: $149.14/claim|Median: $144.05
1.0× median
90837Top 10%

Psychotherapy, 60 minutes

$4.3M

31K claims · 1.1%

Your Cost: $136.67/claim|Median: $85.66
1.6× median
S0201Top 25%

Partial hospitalization services, per diem

$3.5M

6K claims · 0.9%

Your Cost: $600.38/claim|Median: $445.16
1.4× median
99219Top 1%

$3.5M

10K claims · 0.9%

Your Cost: $356.82/claim|Median: $63.35
5.6× median
99285Top 10%

Emergency dept visit, high/urgent complexity

$3.4M

13K claims · 0.9%

Your Cost: $256.40/claim|Median: $85.65
3.0× median
G0378Normal range

Hospital observation service, per hour

$3.2M

22K claims · 0.8%

Your Cost: $144.95/claim|Median: $99.39
1.5× median
99401Top 1%

$2.9M

14K claims · 0.7%

Your Cost: $199.29/claim|Median: $16.53
12.1× median
H2019Normal range

Therapeutic behavioral services, per 15 min

$2.8M

22K claims · 0.7%

Your Cost: $129.66/claim|Median: $84.12
1.5× median
D2930Top 1%

Prefabricated stainless steel crown, primary tooth

$2.7M

5K claims · 0.7%

Your Cost: $564.85/claim|Median: $120.85
4.7× median
70551Top 5%

MRI brain without contrast

$2.7M

6K claims · 0.7%

Your Cost: $444.98/claim|Median: $85.39
5.2× median
J1569Normal range

$2.7M

1K claims · 0.7%

Your Cost: $2,186.82/claim|Median: $1,387.65
1.6× median

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