Mount Sinai Hospital
Ambulance
New York, New York
NPI: 1932103413
Risk Tier
Critical
Total Paid
$279.0M
$278,959,195
Total Claims
5.0M
Beneficiaries
4.0M
Avg Cost/Claim
$55.66
Active billing period: 84 months (2018-01 to 2024-12)
Statistical Fraud Flags (3)
Billing Swing
Experienced over 200% change in year-over-year billing with >$1M absolute change.
Billing changed from $2.1M (2018) to $17.0M (2019) — a 723% swing with $14.9M absolute change.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 118 procedure codes: 99213 at 2.9× median, 99214 at 2.0× median.
Explosive Growth
Billing increased over 500% year-over-year — far beyond normal growth patterns.
Billing grew 723% from 2018 to 2019.
Advanced Detection Signals
CUSUM Change Point
Billing shifted 17.3x in 2019-09 — a statistically significant structural change in billing behavior was detected.
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