Brigham & Womens Hospital Inc.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 92 procedure codes: 99211 at 9.8× median, 99213 at 2.4× 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:
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 $127.15 per claim for 99211 (Office/outpatient visit, minimal complexity) — 9.8× the national median of $12.93.
Bills $370.45 per claim for 96361 (IV infusion, hydration, each additional hour) — 9.5× the national median of $38.92.
Bills $141.09 per claim for 99283 (Emergency dept visit, moderate complexity) — 3.3× the national median of $42.48.
Billing in the top 1% nationally for 1 procedure code: 96365.
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 $252.6M is at the 50th percentile among 156 General Acute Care Hospital providers.
Total Paid
$252.6M
$252,584,160
Total Claims
6.3M
Beneficiaries
5.5M
1.2 claims/patient
Avg Cost/Claim
$40
#327 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Brigham & Womens Hospital Inc. is a General Acute Care Hospital provider based in Boston, MA. From the 2018–2024 period, this provider received $252.6M in Medicaid payments across 6.3M claims.
Why This Matters
This provider received $252.6M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 31,573 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 (99211 (Office/outpatient visit, minimal complexity)) accounts for 19% of total spending.
$47.3M
372K claims
$127.15
$12.93
Office/outpatient visit, minimal complexity
$47.3M
372K claims · 18.7%
$13.7M
148K claims
$92.30
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$13.7M
148K claims · 5.4%
$8.6M
1K claims
$7,032.52
$17,264.74
Ocrelizumab (Ocrevus) injection, 1 mg
$8.6M
1K claims · 3.4%
$8.6M
23K claims
$370.45
$38.92
IV infusion, hydration, each additional hour
$8.6M
23K claims · 3.4%
$7.0M
50K claims
$141.09
$42.48
Emergency dept visit, moderate complexity
$7.0M
50K claims · 2.8%
$6.9M
23K claims
$302.26
$54.77
IV infusion, therapeutic/prophylactic/diagnostic, initial, up to 1 hour
$6.9M
23K claims · 2.7%
$5.7M
39K claims
$145.87
$69.51
Emergency dept visit, high complexity
$5.7M
39K claims · 2.3%
$5.4M
278K claims
$19.60
$26.41
Hospital outpatient clinic visit
$5.4M
278K claims · 2.2%
$4.7M
26K claims
$183.01
$85.65
Emergency dept visit, high/urgent complexity
$4.7M
26K claims · 1.9%
$4.1M
73K claims
$55.81
$63.08
Infectious disease detection (COVID-19)
$4.1M
73K claims · 1.6%
$3.8M
28K claims
$138.00
$99.39
Hospital observation service, per hour
$3.8M
28K claims · 1.5%
$3.7M
14K claims
$265.27
$133.68
MRI brain without contrast, then with contrast
$3.7M
14K claims · 1.5%
Therapeutic exercises, each 15 min
$3.4M
63K claims · 1.3%
$3.0M
3K claims
$945.57
$1,587.53
Injection, infliximab, excludes biosimilar, 10 mg
$3.0M
3K claims · 1.2%
Upper GI endoscopy with biopsy
$2.8M
5K claims · 1.1%
$2.6M
21K claims
$121.11
$65.76
CT abdomen and pelvis with contrast
$2.6M
21K claims · 1.0%
Psychotherapy, 45 minutes
$2.6M
42K claims · 1.0%
Colonoscopy with biopsy
$2.5M
4K claims · 1.0%
$2.4M
1K claims · 0.9%
$2.2M
49K claims
$45.23
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$2.2M
49K claims · 0.9%
$2.1M
906 claims · 0.8%
$2.0M
14K claims
$144.59
$54.68
Echocardiography, transthoracic, complete, with Doppler
$2.0M
14K claims · 0.8%
Fetal non-stress test
$1.9M
8K claims · 0.8%
$1.8M
8K claims
$232.05
$75.28
Chemotherapy administration, IV infusion, up to 1 hour
$1.8M
8K claims · 0.7%
Unclassified drugs
$1.7M
25K claims · 0.7%
$1.6M
8K claims
$193.70
$40.12
IV infusion, therapeutic/prophylactic/diagnostic, each additional hour
$1.6M
8K claims · 0.6%
PET imaging for limited area
$1.5M
2K claims · 0.6%
$1.5M
17K claims
$89.05
$58.55
Ultrasound, pregnant uterus, follow-up
$1.5M
17K claims · 0.6%
Injection, omalizumab, 5 mg
$1.5M
3K claims · 0.6%
$1.4M
1K claims · 0.6%
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