Charleston Area Medical Center INC
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 267 procedure codes: 99285 at 5.0× median, 99284 at 2.5× 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.
Risk Assessment
Bills $428.11 per claim for 99285 (Emergency dept visit, high/urgent complexity) — 5.0× the national median of $85.65.
Bills $263.67 per claim for 74177 (CT abdomen and pelvis with contrast) — 4.0× the national median of $65.76.
Bills $14.64 per claim for 85025 (Complete blood count (CBC) with differential, automated) — 3.1× the national median of $4.71.
Billing in the top 1% nationally for 3 procedure codes: J3010, J1100, J2250.
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 $199.8M is at the 50th percentile among 156 General Acute Care Hospital providers.
Total Paid
$199.8M
$199,836,982
Total Claims
4.0M
Beneficiaries
3.3M
1.2 claims/patient
Avg Cost/Claim
$50
#458 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Charleston Area Medical Center INC is a General Acute Care Hospital provider based in Charleston, WV. From the 2018–2024 period, this provider received $199.8M in Medicaid payments across 4.0M claims.
Why This Matters
This provider received $199.8M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 24,979 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 12% of total spending.
$24.9M
58K claims
$428.11
$85.65
Emergency dept visit, high/urgent complexity
$24.9M
58K claims · 12.5%
$18.2M
104K claims
$174.84
$69.51
Emergency dept visit, high complexity
$18.2M
104K claims · 9.1%
$9.1M
95K claims
$95.66
$42.48
Emergency dept visit, moderate complexity
$9.1M
95K claims · 4.5%
$7.3M
6K claims
$1,138.23
$763.43
Unlisted procedure, dentoalveolar structures
$7.3M
6K claims · 3.6%
$5.0M
907 claims
$5,478.89
$5,391.55
Injection, pembrolizumab, 1 mg
$5.0M
907 claims · 2.5%
CT abdomen and pelvis with contrast
$4.1M
16K claims · 2.1%
$3.8M
257K claims
$14.64
$4.71
Complete blood count (CBC) with differential, automated
$3.8M
257K claims · 1.9%
$2.8M
144K claims
$19.59
$1.57
Collection of venous blood by venipuncture
$2.8M
144K claims · 1.4%
$2.7M
7K claims
$383.22
$99.39
Hospital observation service, per hour
$2.7M
7K claims · 1.3%
$2.6M
41K claims · 1.3%
$2.5M
139K claims · 1.3%
$2.3M
59K claims · 1.1%
$2.1M
115K claims · 1.1%
$2.0M
8K claims
$252.77
$169.17
Respiratory virus detection, 12-25 targets, nucleic acid
$2.0M
8K claims · 1.0%
$2.0M
33K claims · 1.0%
Comprehensive metabolic panel
$1.9M
118K claims · 1.0%
$1.8M
12K claims
$156.66
$75.28
Chemotherapy administration, IV infusion, up to 1 hour
$1.8M
12K claims · 0.9%
$1.8M
2K claims · 0.9%
$1.8M
97K claims
$18.40
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$1.8M
97K claims · 0.9%
$1.7M
96K claims
$17.99
$7.50
Electrocardiogram, tracing only, without interpretation
$1.7M
96K claims · 0.9%
CT head/brain without contrast
$1.7M
20K claims · 0.8%
$1.6M
927 claims
$1,746.76
$1,587.53
Injection, infliximab, excludes biosimilar, 10 mg
$1.6M
927 claims · 0.8%
$1.6M
32K claims · 0.8%
$1.5M
2K claims · 0.8%
$1.5M
20K claims · 0.8%
$1.5M
12K claims
$128.00
$54.68
Echocardiography, transthoracic, complete, with Doppler
$1.5M
12K claims · 0.8%
$1.5M
2K claims · 0.7%
Upper GI endoscopy with biopsy
$1.4M
5K claims · 0.7%
$1.4M
44K claims
$32.20
$21.76
Therapeutic/prophylactic/diagnostic IV push, single substance
$1.4M
44K claims · 0.7%
Troponin, quantitative
$1.3M
59K claims · 0.7%
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