Group Health Plan, Inc.
Billing Swing
Experienced over 200% change in year-over-year billing with >$1M absolute change.
Billing changed from $10.6M (2018) to $40.0M (2019) — a 276% swing with $29.4M absolute change.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 51 procedure codes: U0005 at 1.7× median, 99309 at 2.8× 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:
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.
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 $29.71 per claim for S0302 — 3.3× the national median of $9.05.
This is a statistical summary, not an accusation. See our methodology.
Compared to Clinic/Center, Multi-Specialty Peers
Total spending distribution among 12 providers in this specialty
This provider's total spending of $204.3M is at the 99th percentile among 12 Clinic/Center, Multi-Specialty providers.
Above 99th percentile for this specialty — higher spending than 11 of 12 peers
Total Paid
$204.3M
$204,323,294
Total Claims
6.1M
Beneficiaries
5.3M
1.2 claims/patient
Avg Cost/Claim
$33
#441 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Group Health Plan, Inc. is a Clinic/Center, Multi-Specialty provider based in Minneapolis, MN. From the 2018–2024 period, this provider received $204.3M in Medicaid payments across 6.1M claims.
Why This Matters
This provider received $204.3M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 25,540 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 (99214 (Office/outpatient visit, est. patient, mod-high complexity)) accounts for 14% of total spending.
$28.8M
437K claims
$65.82
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$28.8M
437K claims · 14.1%
$23.6M
497K claims
$47.40
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$23.6M
497K claims · 11.5%
$14.4M
273K claims
$52.70
$35.30
Subsequent hospital care, per day, high complexity
$14.4M
273K claims · 7.1%
$6.3M
66K claims
$96.36
$67.32
Initial hospital care, per day, high complexity
$6.3M
66K claims · 3.1%
$5.0M
58K claims
$85.90
$74.09
Office/outpatient visit, high complexity
$5.0M
58K claims · 2.4%
$4.6M
156K claims · 2.3%
$4.4M
51K claims
$86.54
$63.08
Infectious disease detection (COVID-19)
$4.4M
51K claims · 2.2%
$4.4M
69K claims
$63.60
$57.85
Office/outpatient visit, new patient, low-mod complexity
$4.4M
69K claims · 2.2%
$3.7M
41K claims
$91.39
$84.03
Office/outpatient visit, new patient, mod-high complexity
$3.7M
41K claims · 1.8%
$3.5M
4K claims
$954.28
$1,482.45
Routine obstetric care, vaginal delivery, including postpartum
$3.5M
4K claims · 1.7%
$3.2M
29K claims
$107.56
$101.24
Critical care, first 30-74 minutes
$3.2M
29K claims · 1.6%
$3.1M
47K claims
$65.87
$75.18
Preventive medicine, established patient, age 1-4
$3.1M
47K claims · 1.5%
$3.0M
39K claims
$77.46
$47.08
Ophthalmological exam, comprehensive, established patient
$3.0M
39K claims · 1.5%
$2.9M
87K claims
$32.90
$23.99
Subsequent hospital care, per day, moderate complexity
$2.9M
87K claims · 1.4%
$2.8M
46K claims · 1.4%
$2.8M
103K claims
$27.41
$17.85
Immunization administration, first vaccine/toxoid, with counseling
$2.8M
103K claims · 1.4%
$2.7M
29K claims
$91.07
$59.72
Ophthalmological exam, comprehensive, new patient
$2.7M
29K claims · 1.3%
$2.4M
82K claims
$29.40
$17.67
Sign language or oral interpretive services, per 15 minutes
$2.4M
82K claims · 1.2%
$2.4M
37K claims
$64.03
$74.82
Preventive medicine, established patient, age 5-11
$2.4M
37K claims · 1.2%
$2.4M
35K claims
$68.52
$35.80
Surgical pathology, gross and microscopic examination
$2.4M
35K claims · 1.2%
$2.3M
41K claims
$57.20
$69.35
Preventive medicine, established patient, infant (under 1)
$2.3M
41K claims · 1.1%
$2.3M
69K claims · 1.1%
$2.1M
38K claims
$54.68
$43.85
Hospital discharge day management, more than 30 minutes
$2.1M
38K claims · 1.0%
$1.5M
40K claims
$38.21
$40.11
Office/outpatient visit, new patient, low complexity
$1.5M
40K claims · 0.7%
$1.5M
1K claims · 0.7%
$1.5M
21K claims
$69.17
$80.15
Preventive medicine, established patient, age 12-17
$1.5M
21K claims · 0.7%
$1.4M
108K claims
$13.07
$9.80
Immunization administration, 1 vaccine, percutaneous/ID/SC/IM
$1.4M
108K claims · 0.7%
$1.3M
379K claims
$3.36
$1.57
Collection of venous blood by venipuncture
$1.3M
379K claims · 0.6%
$1.2M
15K claims
$81.82
$76.06
Preventive medicine, established patient, age 40-64
$1.2M
15K claims · 0.6%
$1.2M
17K claims
$73.15
$72.71
Preventive medicine, established patient, age 18-39
$1.2M
17K claims · 0.6%
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