Nyu Langone Hospitals
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 169 procedure codes: G0378 at 12.1× median, 99283 at 5.9× median.
Explosive Growth
Billing increased over 500% year-over-year — far beyond normal growth patterns.
Billing grew 527% from 2018 to 2019.
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.
Explosive Growth
Explosive Growth means this provider's billing increased by more than 500% year-over-year. While rapid expansion can be legitimate, this pattern has been observed in fraud schemes that ramp up billing quickly before detection.
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 $1,201.40 per claim for G0378 (Hospital observation service, per hour) — 12.1× the national median of $99.39.
Bills $250.11 per claim for 99283 (Emergency dept visit, moderate complexity) — 5.9× the national median of $42.48.
Bills $215.88 per claim for 99284 (Emergency dept visit, high complexity) — 3.1× the national median of $69.51.
Billing above the 90th percentile for 19 procedure codes simultaneously.
This is a statistical summary, not an accusation. See our methodology.
Total Paid
$238.7M
$238,686,702
Total Claims
4.7M
Beneficiaries
4.2M
1.1 claims/patient
Avg Cost/Claim
$51
#352 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Nyu Langone Hospitals is a Clinic/Center, Oncology provider based in New York, NY. From the 2018–2024 period, this provider received $238.7M in Medicaid payments across 4.7M claims.
Why This Matters
This provider received $238.7M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 29,835 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 (G0378 (Hospital observation service, per hour)) accounts for 4% of total spending.
$10.3M
9K claims
$1,201.40
$99.39
Hospital observation service, per hour
$10.3M
9K claims · 4.3%
$10.1M
2K claims
$6,085.06
$4,027.41
Injection, vedolizumab, one milligram
$10.1M
2K claims · 4.2%
$8.7M
35K claims
$250.11
$42.48
Emergency dept visit, moderate complexity
$8.7M
35K claims · 3.6%
$8.1M
37K claims
$215.88
$69.51
Emergency dept visit, high complexity
$8.1M
37K claims · 3.4%
$7.2M
40K claims
$178.84
$85.65
Emergency dept visit, high/urgent complexity
$7.2M
40K claims · 3.0%
Upper GI endoscopy with biopsy
$7.1M
10K claims · 3.0%
$6.0M
2K claims · 2.5%
Hospital outpatient clinic visit
$5.9M
38K claims · 2.5%
Therapeutic exercises, each 15 min
$5.8M
70K claims · 2.5%
Colonoscopy with biopsy
$5.8M
7K claims · 2.4%
$5.7M
17K claims · 2.4%
Emergency dept visit, low complexity
$5.0M
20K claims · 2.1%
$4.6M
22K claims
$210.30
$38.92
IV infusion, hydration, each additional hour
$4.6M
22K claims · 1.9%
$4.4M
2K claims
$1,832.92
$183.33
Left heart catheterization with imaging
$4.4M
2K claims · 1.8%
$3.8M
19K claims
$195.32
$54.68
Echocardiography, transthoracic, complete, with Doppler
$3.8M
19K claims · 1.6%
Injection, pembrolizumab, 1 mg
$3.3M
405 claims · 1.4%
$3.0M
13K claims
$236.25
$75.28
Chemotherapy administration, IV infusion, up to 1 hour
$3.0M
13K claims · 1.3%
$2.8M
1K claims · 1.2%
$2.5M
355 claims
$7,180.26
$2,797.07
Injection, natalizumab, one milligram
$2.5M
355 claims · 1.1%
$2.5M
2K claims
$1,511.46
$1,587.53
Injection, infliximab, excludes biosimilar, 10 mg
$2.5M
2K claims · 1.1%
$2.5M
14K claims
$183.49
$54.77
IV infusion, therapeutic/prophylactic/diagnostic, initial, up to 1 hour
$2.5M
14K claims · 1.1%
Colonoscopy, diagnostic
$2.5M
3K claims · 1.0%
$2.4M
33K claims
$71.67
$63.08
Infectious disease detection (COVID-19)
$2.4M
33K claims · 1.0%
$2.2M
1K claims · 0.9%
$2.1M
3K claims
$611.49
$106.14
Myocardial perfusion imaging, SPECT, multiple studies
$2.1M
3K claims · 0.9%
$2.1M
1K claims · 0.9%
$2.1M
67 claims
$30,756.11
$17,264.74
Ocrelizumab (Ocrevus) injection, 1 mg
$2.1M
67 claims · 0.9%
$2.0M
1K claims · 0.9%
CT abdomen and pelvis with contrast
$1.9M
8K claims · 0.8%
Comprehensive metabolic panel
$1.9M
185K claims · 0.8%