Saint Francis Hospital and Medical Center
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 58 procedure codes: 99285 at 6.0× median, 99284 at 4.4× 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 $513.12 per claim for 99285 (Emergency dept visit, high/urgent complexity) — 6.0× the national median of $85.65.
Bills $306.81 per claim for 99284 (Emergency dept visit, high complexity) — 4.4× the national median of $69.51.
Bills $93.00 per claim for G0463 (Hospital outpatient clinic visit) — 3.5× the national median of $26.41.
Billing above the 90th percentile for 15 procedure codes simultaneously.
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 $266.4M is at the 75th percentile among 156 General Acute Care Hospital providers.
Total Paid
$266.4M
$266,391,325
Total Claims
7.4M
Beneficiaries
5.8M
1.3 claims/patient
Avg Cost/Claim
$36
#299 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Saint Francis Hospital and Medical Center is a General Acute Care Hospital provider based in Hartford, CT. From the 2018–2024 period, this provider received $266.4M in Medicaid payments across 7.4M claims.
Why This Matters
This provider received $266.4M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 33,298 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 (99285 (Emergency dept visit, high/urgent complexity)) accounts for 19% of total spending.
$50.3M
98K claims
$513.12
$85.65
Emergency dept visit, high/urgent complexity
$50.3M
98K claims · 18.9%
$31.4M
2K claims
$16,262.06
$17,264.74
Ocrelizumab (Ocrevus) injection, 1 mg
$31.4M
2K claims · 11.8%
$24.7M
81K claims
$306.81
$69.51
Emergency dept visit, high complexity
$24.7M
81K claims · 9.3%
Hospital outpatient clinic visit
$18.2M
196K claims · 6.8%
$15.7M
4K claims · 5.9%
$15.3M
74K claims
$205.84
$42.48
Emergency dept visit, moderate complexity
$15.3M
74K claims · 5.7%
$9.8M
70K claims
$140.23
$21.76
Therapeutic/prophylactic/diagnostic IV push, single substance
$9.8M
70K claims · 3.7%
Critical care, first 30-74 minutes
$4.4M
6K claims · 1.6%
$4.2M
711 claims
$5,846.51
$5,391.55
Injection, pembrolizumab, 1 mg
$4.2M
711 claims · 1.6%
$3.7M
2K claims · 1.4%
$3.4M
16K claims
$215.29
$75.28
Chemotherapy administration, IV infusion, up to 1 hour
$3.4M
16K claims · 1.3%
$3.0M
21K claims
$146.13
$65.76
CT abdomen and pelvis with contrast
$3.0M
21K claims · 1.1%
CT head/brain without contrast
$3.0M
24K claims · 1.1%
$2.8M
42K claims
$66.72
$63.08
Infectious disease detection (COVID-19)
$2.8M
42K claims · 1.1%
$2.7M
23K claims
$117.40
$54.77
IV infusion, therapeutic/prophylactic/diagnostic, initial, up to 1 hour
$2.7M
23K claims · 1.0%
Upper GI endoscopy with biopsy
$2.5M
5K claims · 1.0%
$2.2M
48K claims
$46.05
$38.92
IV infusion, hydration, each additional hour
$2.2M
48K claims · 0.8%
$2.2M
606 claims · 0.8%
$2.2M
16K claims
$135.30
$61.57
IV infusion, hydration, initial, 31 minutes to 1 hour
$2.2M
16K claims · 0.8%
Emergency dept visit, low complexity
$2.0M
16K claims · 0.7%
Chest X-ray, 2 views
$2.0M
38K claims · 0.7%
$1.8M
48K claims
$38.16
$14.92
Therapeutic/prophylactic/diagnostic IV push, each additional substance
$1.8M
48K claims · 0.7%
$1.7M
3K claims · 0.7%
Colonoscopy with biopsy
$1.7M
3K claims · 0.6%
Fetal non-stress test
$1.5M
10K claims · 0.6%
$1.5M
14K claims
$105.74
$39.33
Screening mammography, bilateral, including CAD
$1.5M
14K claims · 0.6%
$1.4M
7K claims
$200.70
$106.79
Ultrasound, pregnant uterus, detailed, single fetus
$1.4M
7K claims · 0.5%
PET imaging for limited area
$1.3M
2K claims · 0.5%
$1.3M
5K claims
$239.63
$54.68
Echocardiography, transthoracic, complete, with Doppler
$1.3M
5K claims · 0.5%
$1.2M
12K claims · 0.4%
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