Rhode Island Hospital
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 532 procedure codes: G0378 at 22.2× median, 99285 at 10.0× 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 $2,209.41 per claim for G0378 (Hospital observation service, per hour) — 22.2× the national median of $99.39.
Bills $859.04 per claim for 99285 (Emergency dept visit, high/urgent complexity) — 10.0× the national median of $85.65.
Bills $592.41 per claim for 99284 (Emergency dept visit, high complexity) — 8.5× the national median of $69.51.
Billing in the top 1% nationally for 14 procedure codes: G0378, 99285, 99284.
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 $380.8M is at the 75th percentile among 156 General Acute Care Hospital providers.
Total Paid
$380.8M
$380,766,370
Total Claims
2.2M
Beneficiaries
1.6M
1.4 claims/patient
Avg Cost/Claim
$176
#169 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Rhode Island Hospital is a General Acute Care Hospital provider based in Providence, RI. From the 2018–2024 period, this provider received $380.8M in Medicaid payments across 2.2M claims.
Why This Matters
This provider received $380.8M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 47,595 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 (G0378 (Hospital observation service, per hour)) accounts for 6% of total spending.
$22.2M
10K claims
$2,209.41
$99.39
Hospital observation service, per hour
$22.2M
10K claims · 5.8%
$21.2M
25K claims
$859.04
$85.65
Emergency dept visit, high/urgent complexity
$21.2M
25K claims · 5.6%
$20.7M
35K claims
$592.41
$69.51
Emergency dept visit, high complexity
$20.7M
35K claims · 5.4%
$17.9M
53K claims
$335.42
$42.48
Emergency dept visit, moderate complexity
$17.9M
53K claims · 4.7%
$15.9M
4K claims
$4,153.25
$1,587.53
Injection, infliximab, excludes biosimilar, 10 mg
$15.9M
4K claims · 4.2%
Unlisted dialysis procedure
$10.4M
12K claims · 2.7%
$7.9M
8K claims
$1,019.36
$148.53
Mental health partial hospitalization, treatment, per hour
$7.9M
8K claims · 2.1%
$7.3M
2K claims · 1.9%
$6.9M
16K claims
$431.91
$75.28
Chemotherapy administration, IV infusion, up to 1 hour
$6.9M
16K claims · 1.8%
$6.5M
1K claims
$5,814.71
$5,391.55
Injection, pembrolizumab, 1 mg
$6.5M
1K claims · 1.7%
$5.8M
47K claims
$123.17
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$5.8M
47K claims · 1.5%
$5.4M
5K claims
$1,113.39
$133.68
MRI brain without contrast, then with contrast
$5.4M
5K claims · 1.4%
$5.2M
84K claims
$61.78
$4.71
Complete blood count (CBC) with differential, automated
$5.2M
84K claims · 1.4%
$5.1M
26K claims
$194.45
$14.92
Therapeutic/prophylactic/diagnostic IV push, each additional substance
$5.1M
26K claims · 1.3%
$5.0M
4K claims
$1,275.95
$260.56
Intensity modulated radiation treatment delivery, complex
$5.0M
4K claims · 1.3%
$4.6M
16K claims · 1.2%
$4.5M
14K claims
$324.94
$1.11
Normal saline solution infusion, 500 cc
$4.5M
14K claims · 1.2%
$4.4M
21K claims
$206.10
$54.77
IV infusion, therapeutic/prophylactic/diagnostic, initial, up to 1 hour
$4.4M
21K claims · 1.1%
$4.3M
46K claims
$92.50
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$4.3M
46K claims · 1.1%
$4.3M
2K claims
$1,734.30
$233.73
Polysomnography, sleep study, 6+ hours
$4.3M
2K claims · 1.1%
$3.4M
35K claims
$98.10
$25.06
Office/outpatient visit, low complexity
$3.4M
35K claims · 0.9%
Comprehensive metabolic panel
$3.4M
37K claims · 0.9%
Emergency dept visit, low complexity
$3.4M
22K claims · 0.9%
$3.3M
12K claims · 0.9%
Therapeutic activities, each 15 min
$3.3M
37K claims · 0.9%
$3.3M
18K claims
$184.11
$0.58
Injection, ondansetron HCl, per one milligram
$3.3M
18K claims · 0.9%
$3.2M
12K claims
$259.03
$38.92
IV infusion, hydration, each additional hour
$3.2M
12K claims · 0.8%
$3.2M
5K claims
$696.37
$54.68
Echocardiography, transthoracic, complete, with Doppler
$3.2M
5K claims · 0.8%
$2.9M
10K claims
$304.41
$0.82
Normal saline solution infusion, 250 cc
$2.9M
10K claims · 0.8%
$2.8M
7K claims · 0.7%
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