Rector & Visitors of the University of Virginia
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $202.61 per claim for 99214 (Office/outpatient visit, est. patient, mod-high complexity), which is 3.8× the national median of $53.41.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 262 procedure codes: 99214 at 3.8× median, 99213 at 5.4× 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:
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.
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 $202.61 per claim for 99214 (Office/outpatient visit, est. patient, mod-high complexity) — 3.8× the national median of $53.41.
Bills $205.24 per claim for 99213 (Office/outpatient visit, est. patient, low-mod complexity) — 5.4× the national median of $37.81.
Bills $309.04 per claim for 90935 (Hemodialysis, one evaluation) — 13.0× the national median of $23.72.
Billing in the top 1% nationally for 5 procedure codes: 99214, 99213, 99212.
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 $500.5M is at the 90th percentile among 156 General Acute Care Hospital providers.
Above 90th percentile for this specialty — higher spending than 140 of 156 peers
Total Paid
$500.5M
$500,546,324
Total Claims
7.2M
Beneficiaries
5.1M
1.4 claims/patient
Avg Cost/Claim
$70
#123 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Rector & Visitors of the University of Virginia is a General Acute Care Hospital provider based in Charlottesville, VA. From the 2018–2024 period, this provider received $500.5M in Medicaid payments across 7.2M claims.
Why This Matters
This provider received $500.5M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 62,568 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.
$71.1M
351K claims
$202.61
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$71.1M
351K claims · 14.2%
$50.7M
247K claims
$205.24
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$50.7M
247K claims · 10.1%
Hemodialysis, one evaluation
$43.0M
139K claims · 8.6%
$23.8M
114K claims
$209.43
$25.06
Office/outpatient visit, low complexity
$23.8M
114K claims · 4.8%
$12.2M
2K claims
$5,921.53
$5,391.55
Injection, pembrolizumab, 1 mg
$12.2M
2K claims · 2.4%
$11.3M
30K claims · 2.3%
$10.0M
40K claims
$248.09
$85.65
Emergency dept visit, high/urgent complexity
$10.0M
40K claims · 2.0%
Emergency dept visit, high complexity
$9.9M
42K claims · 2.0%
$9.6M
7K claims · 1.9%
$9.4M
38K claims
$245.59
$42.48
Emergency dept visit, moderate complexity
$9.4M
38K claims · 1.9%
$7.8M
17K claims
$455.77
$38.92
IV infusion, hydration, each additional hour
$7.8M
17K claims · 1.6%
$7.6M
38K claims
$201.99
$12.93
Office/outpatient visit, minimal complexity
$7.6M
38K claims · 1.5%
$7.3M
15K claims
$492.31
$54.68
Echocardiography, transthoracic, complete, with Doppler
$7.3M
15K claims · 1.5%
$5.2M
286 claims
$18,161.64
$17,264.74
Ocrelizumab (Ocrevus) injection, 1 mg
$5.2M
286 claims · 1.0%
$5.0M
34K claims
$148.29
$99.39
Hospital observation service, per hour
$5.0M
34K claims · 1.0%
$4.7M
23K claims
$203.66
$84.03
Office/outpatient visit, new patient, mod-high complexity
$4.7M
23K claims · 0.9%
$4.5M
24K claims
$186.50
$54.77
IV infusion, therapeutic/prophylactic/diagnostic, initial, up to 1 hour
$4.5M
24K claims · 0.9%
Upper GI endoscopy with biopsy
$4.4M
5K claims · 0.9%
$4.3M
8K claims
$514.27
$43.68
Chemotherapy infusion, each additional hour
$4.3M
8K claims · 0.9%
$3.9M
24K claims
$162.83
$75.28
Chemotherapy administration, IV infusion, up to 1 hour
$3.9M
24K claims · 0.8%
$3.9M
21K claims
$183.75
$74.09
Office/outpatient visit, high complexity
$3.9M
21K claims · 0.8%
$3.5M
17K claims
$200.82
$57.85
Office/outpatient visit, new patient, low-mod complexity
$3.5M
17K claims · 0.7%
$3.3M
2K claims · 0.7%
CT abdomen and pelvis with contrast
$3.2M
10K claims · 0.6%
Colonoscopy with biopsy
$3.0M
4K claims · 0.6%
$3.0M
8K claims
$365.39
$40.12
IV infusion, therapeutic/prophylactic/diagnostic, each additional hour
$3.0M
8K claims · 0.6%
$2.7M
173K claims
$15.81
$26.41
Hospital outpatient clinic visit
$2.7M
173K claims · 0.5%
$2.7M
3K claims
$849.39
$255.17
Colonoscopy with polyp removal, snare technique
$2.7M
3K claims · 0.5%
$2.7M
2K claims
$1,475.46
$1,587.53
Injection, infliximab, excludes biosimilar, 10 mg
$2.7M
2K claims · 0.5%
Fetal non-stress test
$2.6M
9K claims · 0.5%
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