Mcallen Hospitals L P
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $598.40 per claim for 99284 (Emergency dept visit, high complexity), which is 8.6× the national median of $69.51.
Billing Swing
Experienced over 200% change in year-over-year billing with >$1M absolute change.
Billing changed from $4.0M (2020) to $20.8M (2021) — a 414% swing with $16.7M 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
▼
Each flag represents a statistical test that identified unusual billing patterns. Here's what each flag on this provider means in plain English:
Cost Outlier
Cost Outlier means this provider charges significantly more per claim than other providers billing the same procedure codes. This could indicate upcoding, inflated charges, or specialized services that justify higher costs.
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 $598.40 per claim for 99284 (Emergency dept visit, high complexity) — 8.6× the national median of $69.51.
Bills $656.97 per claim for 99285 (Emergency dept visit, high/urgent complexity) — 7.7× the national median of $85.65.
Bills $819.55 per claim for G0378 (Hospital observation service, per hour) — 8.3× the national median of $99.39.
Billing in the top 1% nationally for 3 procedure codes: 99284, 99285, 80050.
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 $124.6M is at the below 25th percentile among 156 General Acute Care Hospital providers.
Total Paid
$124.6M
$124,608,404
Total Claims
1.3M
Beneficiaries
1.2M
1.1 claims/patient
Avg Cost/Claim
$97
#951 of 618K providers by total spending(top 0.2%)
🔍 Analysis
Provider Overview
Mcallen Hospitals L P is a General Acute Care Hospital provider based in Edinburg, TX. From the 2018–2024 period, this provider received $124.6M in Medicaid payments across 1.3M claims.
Why This Matters
This provider received $124.6M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 15,576 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 (99284 (Emergency dept visit, high complexity)) accounts for 51% of total spending.
$62.9M
105K claims
$598.40
$69.51
Emergency dept visit, high complexity
$62.9M
105K claims · 50.5%
$26.3M
40K claims
$656.97
$85.65
Emergency dept visit, high/urgent complexity
$26.3M
40K claims · 21.1%
$9.1M
114K claims
$79.98
$42.48
Emergency dept visit, moderate complexity
$9.1M
114K claims · 7.3%
$3.2M
4K claims
$819.55
$99.39
Hospital observation service, per hour
$3.2M
4K claims · 2.6%
$2.1M
44K claims
$46.60
$30.04
SARS-CoV-2 COVID-19 antigen detection, immunoassay
$2.1M
44K claims · 1.7%
Influenza virus detection, rapid test
$1.9M
84K claims · 1.5%
CT abdomen and pelvis with contrast
$1.4M
4K claims · 1.1%
$1.3M
61K claims · 1.1%
$1.3M
18K claims
$71.18
$7.50
Electrocardiogram, tracing only, without interpretation
$1.3M
18K claims · 1.0%
$1.1M
21K claims
$55.06
$28.46
Streptococcus Group A detection, nucleic acid, amplified probe
$1.1M
21K claims · 0.9%
$1.1M
2K claims
$436.53
$38.92
IV infusion, hydration, each additional hour
$1.1M
2K claims · 0.9%
Chest X-ray, single view
$827K
26K claims · 0.7%
Comprehensive metabolic panel
$744K
61K claims · 0.6%
General health panel
$713K
2K claims · 0.6%
$701K
81K claims
$8.69
$4.71
Complete blood count (CBC) with differential, automated
$701K
81K claims · 0.6%
$699K
11K claims
$65.95
$37.72
Emergency dept visit, low complexity
$699K
11K claims · 0.6%
$631K
9K claims
$70.92
$35.43
Drug test, presumptive, by chemistry analyzers
$631K
9K claims · 0.5%
CT head/brain without contrast
$612K
5K claims · 0.5%
$603K
26K claims · 0.5%
$452K
2K claims
$184.11
$60.19
CT abdomen and pelvis without contrast
$452K
2K claims · 0.4%
$409K
749 claims · 0.3%
$340K
12K claims
$27.82
$0.91
Injection, ketorolac tromethamine, fifteen milligrams
$340K
12K claims · 0.3%
$309K
27K claims
$11.57
$5.89
Bacterial culture, any source except blood or urine
$309K
27K claims · 0.2%
Ultrasound, abdominal, limited
$260K
2K claims · 0.2%
Chest X-ray, 2 views
$258K
5K claims · 0.2%
$253K
5K claims
$53.83
$52.03
Emergency dept visit, minimal complexity
$253K
5K claims · 0.2%
Urine pregnancy test
$249K
22K claims · 0.2%
$245K
5K claims · 0.2%
$240K
2K claims
$116.76
$58.16
Ultrasound, pregnant uterus, single fetus, first trimester
$240K
2K claims · 0.2%
Urinalysis, automated, with microscopy
$236K
62K claims · 0.2%
Other Top Providers in Texas
View all →Similar Providers
Other top providers in General Acute Care Hospital