Mcallen Hospitals L P
General Acute Care Hospital
Edinburg, Texas
NPI: 1770573586
Risk Tier
High
Total Paid
$124.6M
$124,608,404
Total Claims
1.3M
Beneficiaries
1.2M
Avg Cost/Claim
$97.25
Active billing period: 71 months (2019-02 to 2024-12)
Statistical Fraud Flags (2)
Cost Outlier
Billing over 3× the national median for specific procedure codes.
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.
Advanced Detection Signals
CUSUM Change Point
Billing shifted 7.9x in 2021-05 — a statistically significant structural change in billing behavior was detected.
Disclaimer: Statistical flags indicate unusual billing patterns — they are not proof of fraud or wrongdoing. Some entities (government agencies, home care programs, hospitals) may legitimately bill at higher rates due to patient acuity, overhead costs, or specialized services. This report is generated from public HHS data and statistical analysis only. No clinical or investigative review has been performed.
Generated by OpenMedicaid | openmedicaid.org | Data: HHS 2018-2024