New York City Health and Hospitals Corporation
Billing Swing
Experienced over 200% change in year-over-year billing with >$1M absolute change.
Billing changed from $12.0M (2019) to $38.5M (2020) — a 221% swing with $26.5M absolute change.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 134 procedure codes: 99283 at 4.4× median, 99213 at 2.2× median.
Explosive Growth
Billing increased over 500% year-over-year — far beyond normal growth patterns.
Billing grew 1187% from 2018 to 2019.
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.
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.
Explosive Growth
Explosive Growth means this provider's billing increased by more than 500% year-over-year. While rapid expansion can be legitimate, this pattern has been observed in fraud schemes that ramp up billing quickly before detection.
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 $188.12 per claim for 99283 (Emergency dept visit, moderate complexity) — 4.4× the national median of $42.48.
Bills $309.60 per claim for G9005 (Coordinated care fee, risk-adjusted, ESRD) — 6.6× the national median of $47.08.
Bills $205.63 per claim for 99282 (Emergency dept visit, low complexity) — 5.5× the national median of $37.72.
Billing in the top 1% nationally for 1 procedure code: 90791.
This is a statistical summary, not an accusation. See our methodology.
Compared to Internal Medicine Peers
Total spending distribution among 26 providers in this specialty
This provider's total spending of $217.7M is at the 99th percentile among 26 Internal Medicine providers.
Above 99th percentile for this specialty — higher spending than 25 of 26 peers
Total Paid
$217.7M
$217,677,572
Total Claims
4.7M
Beneficiaries
4.3M
1.1 claims/patient
Avg Cost/Claim
$46
#396 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
New York City Health and Hospitals Corporation is a Internal Medicine provider based in Bronx, NY. From the 2018–2024 period, this provider received $217.7M in Medicaid payments across 4.7M claims.
Why This Matters
This provider received $217.7M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 27,209 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 (99283 (Emergency dept visit, moderate complexity)) accounts for 11% of total spending.
$24.4M
130K claims
$188.12
$42.48
Emergency dept visit, moderate complexity
$24.4M
130K claims · 11.2%
$15.3M
181K claims
$84.40
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$15.3M
181K claims · 7.0%
$14.0M
78K claims
$180.03
$69.51
Emergency dept visit, high complexity
$14.0M
78K claims · 6.4%
$13.5M
44K claims
$309.60
$47.08
Coordinated care fee, risk-adjusted, ESRD
$13.5M
44K claims · 6.2%
$10.4M
93K claims
$112.09
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$10.4M
93K claims · 4.8%
Emergency dept visit, low complexity
$7.6M
37K claims · 3.5%
Case management, each 15 min
$7.6M
31K claims · 3.5%
Psychiatric diagnostic evaluation
$6.8M
14K claims · 3.1%
$5.2M
91K claims
$56.79
$63.08
Infectious disease detection (COVID-19)
$5.2M
91K claims · 2.4%
$3.8M
57K claims
$66.29
$25.06
Office/outpatient visit, low complexity
$3.8M
57K claims · 1.7%
$3.1M
29K claims
$109.67
$85.62
Nursing care, in the home, by RN, per diem
$3.1M
29K claims · 1.4%
$2.7M
2K claims · 1.2%
$2.6M
275K claims
$9.32
$1.57
Collection of venous blood by venipuncture
$2.6M
275K claims · 1.2%
$2.5M
15K claims
$165.02
$84.03
Office/outpatient visit, new patient, mod-high complexity
$2.5M
15K claims · 1.1%
$2.3M
14K claims
$162.14
$74.09
Office/outpatient visit, high complexity
$2.3M
14K claims · 1.1%
Psychotherapy, 30 minutes
$2.2M
16K claims · 1.0%
$2.1M
39K claims
$54.22
$69.35
Preventive medicine, established patient, infant (under 1)
$2.1M
39K claims · 1.0%
$2.1M
18K claims
$120.60
$57.85
Office/outpatient visit, new patient, low-mod complexity
$2.1M
18K claims · 1.0%
Psychotherapy, 45 minutes
$2.1M
12K claims · 1.0%
$1.7M
10K claims
$169.63
$85.65
Emergency dept visit, high/urgent complexity
$1.7M
10K claims · 0.8%
$1.7M
19K claims
$90.62
$38.92
IV infusion, hydration, each additional hour
$1.7M
19K claims · 0.8%
CT head/brain without contrast
$1.7M
8K claims · 0.8%
CFTR gene analysis, common variants
$1.5M
3K claims · 0.7%
$1.5M
2K claims
$693.21
$358.21
Fetal chromosomal aneuploidy genomic sequence analysis
$1.5M
2K claims · 0.7%
$1.5M
11K claims
$137.18
$37.60
Unspecified adjunctive procedure, by report
$1.5M
11K claims · 0.7%
$1.4M
10K claims
$134.06
$124.86
Nursing care, in the home, by RN, per 15 minutes
$1.4M
10K claims · 0.6%
$1.3M
81K claims
$16.48
$12.93
Office/outpatient visit, minimal complexity
$1.3M
81K claims · 0.6%
$1.3M
23K claims
$56.66
$22.44
Telephone E/M by physician, 11-20 minutes
$1.3M
23K claims · 0.6%
Ultrasound, pelvic, complete
$1.3M
7K claims · 0.6%
Comprehensive metabolic panel
$1.3M
123K claims · 0.6%
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