University of Texas Medical Branch at Galveston
Billing Swing
Experienced over 200% change in year-over-year billing with >$1M absolute change.
Billing changed from $5.5M (2020) to $32.9M (2021) — a 494% swing with $27.4M absolute change.
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:
Billing Swing
Billing Swing means this provider's total billing changed dramatically from one year to the next — increasing or decreasing by more than 200% with over $1M in absolute change. This could indicate a change in practice scope, a billing scheme ramping up, or legitimate growth.
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 $240.05 per claim for 99283 (Emergency dept visit, moderate complexity) — 5.7× the national median of $42.48.
Bills $533.43 per claim for 99284 (Emergency dept visit, high complexity) — 7.7× the national median of $69.51.
Bills $75.80 per claim for 99212 (Office/outpatient visit, low complexity) — 3.0× the national median of $25.06.
Billing in the top 1% nationally for 2 procedure codes: 99284, 42820.
This is a statistical summary, not an accusation. See our methodology.
Compared to Clinic/Center, Ambulatory Surgical Peers
Total spending distribution among 9 providers in this specialty
This provider's total spending of $150.3M is at the 50th percentile among 9 Clinic/Center, Ambulatory Surgical providers.
Total Paid
$150.3M
$150,326,466
Total Claims
2.8M
Beneficiaries
2.5M
1.1 claims/patient
Avg Cost/Claim
$53
#713 of 618K providers by total spending(top 0.1%)
🔍 Analysis
Provider Overview
University of Texas Medical Branch at Galveston is a Clinic/Center, Ambulatory Surgical provider based in Galveston, TX. From the 2018–2024 period, this provider received $150.3M in Medicaid payments across 2.8M claims.
Why This Matters
This provider received $150.3M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 18,790 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 (99213 (Office/outpatient visit, est. patient, low-mod complexity)) accounts for 37% of total spending.
$56.0M
708K claims
$79.08
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$56.0M
708K claims · 37.3%
$11.3M
47K claims
$240.05
$42.48
Emergency dept visit, moderate complexity
$11.3M
47K claims · 7.5%
Emergency dept visit, high complexity
$8.0M
15K claims · 5.3%
$6.2M
82K claims
$75.80
$25.06
Office/outpatient visit, low complexity
$6.2M
82K claims · 4.1%
$6.1M
68K claims
$89.28
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$6.1M
68K claims · 4.0%
$5.3M
68K claims
$77.07
$60.05
COVID-19 test, nucleic acid detection, CDC lab only
$5.3M
68K claims · 3.5%
$3.6M
36K claims
$99.59
$65.64
Influenza virus detection, reverse transcription, amplified probe
$3.6M
36K claims · 2.4%
$2.7M
23K claims
$119.77
$58.55
Ultrasound, pregnant uterus, follow-up
$2.7M
23K claims · 1.8%
$2.1M
451 claims
$4,639.03
$331.68
Tonsillectomy and adenoidectomy, under age 12
$2.1M
451 claims · 1.4%
$2.1M
56K claims
$36.87
$28.46
Streptococcus Group A detection, nucleic acid, amplified probe
$2.1M
56K claims · 1.4%
$2.0M
67K claims
$30.53
$24.95
Chlamydia detection, nucleic acid, amplified probe
$2.0M
67K claims · 1.4%
$2.0M
67K claims
$30.52
$23.39
Neisseria gonorrhoeae detection, nucleic acid, amplified probe
$2.0M
67K claims · 1.4%
$1.7M
17K claims
$99.86
$47.65
Ultrasound, pregnant uterus, transvaginal
$1.7M
17K claims · 1.1%
$1.6M
9K claims
$174.39
$106.79
Ultrasound, pregnant uterus, detailed, single fetus
$1.6M
9K claims · 1.1%
$1.6M
6K claims
$269.48
$112.83
Echocardiography, transthoracic, limited
$1.6M
6K claims · 1.1%
$1.4M
12K claims
$119.87
$74.78
Ultrasound, pregnant uterus, complete, single fetus
$1.4M
12K claims · 0.9%
$1.3M
55K claims
$23.90
$15.76
Infectious disease detection, COVID-19, antigen
$1.3M
55K claims · 0.9%
$1.2M
61K claims
$20.00
$18.03
HIV-1 antigen with HIV-1 and HIV-2 antibodies
$1.2M
61K claims · 0.8%
$1.2M
10K claims · 0.8%
$1.2M
4K claims · 0.8%
Emergency dept visit, low complexity
$1.2M
7K claims · 0.8%
$1.2M
11K claims · 0.8%
$1.1M
9K claims
$116.13
$58.16
Ultrasound, pregnant uterus, single fetus, first trimester
$1.1M
9K claims · 0.7%
$931K
33K claims
$28.00
$21.08
Trichomonas vaginalis detection, nucleic acid, amplified probe
$931K
33K claims · 0.6%
$908K
25K claims · 0.6%
Therapeutic exercises, each 15 min
$866K
15K claims · 0.6%
$839K
2K claims
$413.89
$85.65
Emergency dept visit, high/urgent complexity
$839K
2K claims · 0.6%
Fetal non-stress test
$778K
7K claims · 0.5%
$756K
6K claims · 0.5%
$738K
762 claims
$968.67
$233.73
Polysomnography, sleep study, 6+ hours
$738K
762 claims · 0.5%
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