Statistical flags indicate unusual patterns — not proof of fraud or wrongdoing. Read our methodology

Dana-farber Cancer Institute, Inc.

General Acute Care Hospital·Boston, MA·NPI: 1851333686SharePrint Report
View on Risk Watchlist →

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:

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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.

Risk Assessment

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Bills $206.20 per claim for 99212 (Office/outpatient visit, low complexity) — 8.2× the national median of $25.06.

•

Bills $1,315.87 per claim for J9035 (Injection, bevacizumab, 10 mg) — 30.1× the national median of $43.71.

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Bills $335.16 per claim for 96361 (IV infusion, hydration, each additional hour) — 8.6× the national median of $38.92.

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Billing in the top 1% nationally for 1 procedure code: 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

P25MedianP75P90

This provider's total spending of $240.2M is at the 50th percentile among 156 General Acute Care Hospital providers.

Active Billing Period:2018-01→2024-12(84 months)

Total Paid

$240.2M

$240,209,149

Total Claims

2.4M

Beneficiaries

1.6M

1.5 claims/patient

Avg Cost/Claim

$101

#349 of 618K providers by total spending(top <0.1%)

🔍 Analysis

Provider Overview

Dana-farber Cancer Institute, Inc. is a General Acute Care Hospital provider based in Boston, MA. From the 2018–2024 period, this provider received $240.2M in Medicaid payments across 2.4M claims.

Why This Matters

This provider received $240.2M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 30,026 Medicaid beneficiaries for a full year at average per-enrollee costs.

↑ 148% growthsince first billing year

Monthly Spending Trend

Yearly Spending

2018
$18.9M
+17%
2019
$22.1M
+19%
2020
$26.3M
+37%
2021
$36.1M
+11%
2022
$40.1M
+24%
2023
$49.8M
-6%
2024
$46.9M

Procedure Breakdown

Cost per claim compared to national benchmarks

This provider bills for 30 distinct procedure codes. The top code (J9271 (Injection, pembrolizumab, 1 mg)) accounts for 14% of total spending.

J9271Normal range

Injection, pembrolizumab, 1 mg

$33.0M

6K claims · 13.7%

Your Cost: $5,341.57/claim|Median: $5,391.55
1.0× median
99212Top 1%

Office/outpatient visit, low complexity

$25.4M

123K claims · 10.6%

Your Cost: $206.20/claim|Median: $25.06
8.2× median
96413Top 25%

Chemotherapy administration, IV infusion, up to 1 hour

$13.1M

75K claims · 5.5%

Your Cost: $174.60/claim|Median: $75.28
2.3× median
J2506Top 10%

$11.1M

5K claims · 4.6%

Your Cost: $2,198.72/claim|Median: $997.36
2.2× median
J9299Normal range

Nivolumab (Opdivo) injection, 1 mg

$10.9M

3K claims · 4.5%

Your Cost: $3,963.97/claim|Median: $3,562.28
1.1× median
J9035Top 5%

Injection, bevacizumab, 10 mg

$8.8M

7K claims · 3.7%

Your Cost: $1,315.87/claim|Median: $43.71
30.1× median
J2505Normal range

$8.7M

4K claims · 3.6%

Your Cost: $2,221.07/claim|Median: $1,842.27
1.2× median
96361Top 10%

IV infusion, hydration, each additional hour

$7.1M

21K claims · 3.0%

Your Cost: $335.16/claim|Median: $38.92
8.6× median
J9355Normal range

$5.1M

3K claims · 2.1%

Your Cost: $1,496.91/claim|Median: $1,942.13
0.8× median
G0463Normal range

Hospital outpatient clinic visit

$4.6M

149K claims · 1.9%

Your Cost: $30.93/claim|Median: $26.41
1.2× median
96415Top 10%

$4.4M

15K claims · 1.8%

Your Cost: $297.28/claim|Median: $43.68
6.8× median
J9306Normal range

$4.3M

2K claims · 1.8%

Your Cost: $2,522.22/claim|Median: $3,571.19
0.7× median
96375Top 5%

Therapeutic/prophylactic/diagnostic IV push, each additional substance

$4.1M

51K claims · 1.7%

Your Cost: $80.08/claim|Median: $14.92
5.4× median
J9144Normal range

$4.0M

2K claims · 1.7%

Your Cost: $2,441.81/claim|Median: $3,253.39
0.8× median
80053Top 25%

Comprehensive metabolic panel

$4.0M

191K claims · 1.7%

Your Cost: $20.94/claim|Median: $7.24
2.9× median
36430Top 10%

$3.7M

11K claims · 1.5%

Your Cost: $341.53/claim|Median: $111.66
3.1× median
78815Top 25%

PET imaging for limited area

$3.4M

4K claims · 1.4%

Your Cost: $955.08/claim|Median: $325.10
2.9× median
J9358Normal range

$3.4M

1K claims · 1.4%

Your Cost: $2,741.31/claim|Median: $3,408.30
0.8× median
99214Top 5%

Office/outpatient visit, est. patient, mod-high complexity

$3.2M

22K claims · 1.3%

Your Cost: $142.41/claim|Median: $53.41
2.7× median
96365Top 10%

IV infusion, therapeutic/prophylactic/diagnostic, initial, up to 1 hour

$3.0M

19K claims · 1.2%

Your Cost: $155.63/claim|Median: $54.77
2.8× median
J2796Normal range

$2.9M

4K claims · 1.2%

Your Cost: $800.92/claim|Median: $800.92
1.0× median
J0185Top 25%

$2.8M

13K claims · 1.2%

Your Cost: $216.56/claim|Median: $125.72
1.7× median
74177Top 25%

CT abdomen and pelvis with contrast

$2.6M

12K claims · 1.1%

Your Cost: $218.64/claim|Median: $65.76
3.3× median
J9217Top 25%

$2.3M

5K claims · 1.0%

Your Cost: $482.61/claim|Median: $211.50
2.3× median
J9041Top 25%

$2.2M

6K claims · 0.9%

Your Cost: $387.72/claim|Median: $157.53
2.5× median
96372Top 5%

Therapeutic injection, subcutaneous/intramuscular

$2.2M

28K claims · 0.9%

Your Cost: $78.84/claim|Median: $9.56
8.3× median
99215Top 5%

Office/outpatient visit, high complexity

$2.2M

10K claims · 0.9%

Your Cost: $226.08/claim|Median: $74.09
3.0× median
96360Top 25%

IV infusion, hydration, initial, 31 minutes to 1 hour

$2.0M

13K claims · 0.8%

Your Cost: $151.85/claim|Median: $61.57
2.5× median
99203Top 5%

Office/outpatient visit, new patient, low-mod complexity

$1.8M

11K claims · 0.8%

Your Cost: $159.55/claim|Median: $57.85
2.8× median
J1561Normal range

$1.8M

3K claims · 0.8%

Your Cost: $584.41/claim|Median: $1,482.84
0.4× median

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