Medstar Washington Hospital Center
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 152 procedure codes: G0463 at 4.1× median, 99213 at 5.7× 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.
Risk Assessment
Bills $108.65 per claim for G0463 (Hospital outpatient clinic visit) — 4.1× the national median of $26.41.
Bills $213.70 per claim for 99213 (Office/outpatient visit, est. patient, low-mod complexity) — 5.7× the national median of $37.81.
Bills $215.48 per claim for 99283 (Emergency dept visit, moderate complexity) — 5.1× the national median of $42.48.
Billing in the top 1% nationally for 6 procedure codes: 99213, 96361, 99214.
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 $239.1M is at the 50th percentile among 156 General Acute Care Hospital providers.
Total Paid
$239.1M
$239,081,014
Total Claims
2.8M
Beneficiaries
2.3M
1.2 claims/patient
Avg Cost/Claim
$84
#350 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Medstar Washington Hospital Center is a General Acute Care Hospital provider based in Washington, DC. From the 2018–2024 period, this provider received $239.1M in Medicaid payments across 2.8M claims.
Why This Matters
This provider received $239.1M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 29,885 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 (G0463 (Hospital outpatient clinic visit)) accounts for 7% of total spending.
Hospital outpatient clinic visit
$16.3M
150K claims · 6.8%
$15.7M
73K claims
$213.70
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$15.7M
73K claims · 6.6%
$15.6M
72K claims
$215.48
$42.48
Emergency dept visit, moderate complexity
$15.6M
72K claims · 6.5%
$14.3M
61K claims
$232.16
$69.51
Emergency dept visit, high complexity
$14.3M
61K claims · 6.0%
$14.0M
27K claims
$518.21
$38.92
IV infusion, hydration, each additional hour
$14.0M
27K claims · 5.9%
$11.1M
57K claims
$195.49
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$11.1M
57K claims · 4.6%
$10.8M
56K claims
$194.04
$74.09
Office/outpatient visit, high complexity
$10.8M
56K claims · 4.5%
$9.4M
47K claims
$198.89
$85.65
Emergency dept visit, high/urgent complexity
$9.4M
47K claims · 3.9%
$8.6M
49K claims
$176.87
$25.06
Office/outpatient visit, low complexity
$8.6M
49K claims · 3.6%
$8.0M
1K claims
$7,189.46
$5,391.55
Injection, pembrolizumab, 1 mg
$8.0M
1K claims · 3.3%
CT head/brain without contrast
$4.7M
19K claims · 2.0%
Fetal non-stress test
$4.5M
14K claims · 1.9%
Upper GI endoscopy with biopsy
$3.4M
5K claims · 1.4%
$3.3M
9K claims
$387.86
$54.68
Echocardiography, transthoracic, complete, with Doppler
$3.3M
9K claims · 1.4%
$3.0M
13K claims
$238.48
$61.57
IV infusion, hydration, initial, 31 minutes to 1 hour
$3.0M
13K claims · 1.3%
Emergency dept visit, low complexity
$3.0M
17K claims · 1.3%
CT abdomen and pelvis with contrast
$2.9M
14K claims · 1.2%
$2.5M
9K claims
$270.51
$52.03
Emergency dept visit, minimal complexity
$2.5M
9K claims · 1.1%
$2.3M
13K claims
$173.84
$57.85
Office/outpatient visit, new patient, low-mod complexity
$2.3M
13K claims · 1.0%
$2.3M
8K claims · 1.0%
$2.3M
13K claims
$178.41
$84.03
Office/outpatient visit, new patient, mod-high complexity
$2.3M
13K claims · 1.0%
Colonoscopy with biopsy
$2.2M
4K claims · 0.9%
$2.2M
6K claims
$374.13
$29.03
Arthrocentesis, aspiration/injection, major joint
$2.2M
6K claims · 0.9%
$2.1M
3K claims
$844.09
$255.17
Colonoscopy with polyp removal, snare technique
$2.1M
3K claims · 0.9%
PET imaging for limited area
$2.0M
2K claims · 0.8%
Colonoscopy, diagnostic
$1.9M
2K claims · 0.8%
$1.7M
2K claims
$1,054.28
$268.70
Extracapsular cataract removal with IOL insertion
$1.7M
2K claims · 0.7%
CT angiography, chest, with contrast
$1.5M
5K claims · 0.6%
$1.5M
6K claims
$277.79
$135.70
Intensive outpatient psychiatric services, per diem
$1.5M
6K claims · 0.6%
$1.5M
873 claims · 0.6%
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