Children's Hospital
General Acute Care Hospital Children
Washington, District of Columbia
NPI: 1912939703
Risk Tier
High
Total Paid
$243.0M
$242,963,811
Total Claims
2.2M
Beneficiaries
1.9M
Avg Cost/Claim
$110.61
Active billing period: 84 months (2018-01 to 2024-12)
Statistical Fraud Flags (2)
Cost Outlier
Billing over 3× the national median for specific procedure codes.
Bills $219.60 per claim for 99212 (Office/outpatient visit, low complexity), which is 8.8× the national median of $25.06.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 166 procedure codes: 99212 at 8.8× median, 99283 at 6.2× median.
Disclaimer: Statistical flags indicate unusual billing patterns — they are not proof of fraud or wrongdoing. Some entities (government agencies, home care programs, hospitals) may legitimately bill at higher rates due to patient acuity, overhead costs, or specialized services. This report is generated from public HHS data and statistical analysis only. No clinical or investigative review has been performed.
Generated by OpenMedicaid | openmedicaid.org | Data: HHS 2018-2024