University of Cincinnati Medical Center, LLC
Billing Swing
Experienced over 200% change in year-over-year billing with >$1M absolute change.
Billing changed from $16.4M (2022) to $61.7M (2023) — a 276% swing with $45.3M absolute change.
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
▼
Each flag represents a statistical test that identified unusual billing patterns. Here's what each flag on this provider means in plain English:
Billing Swing
Billing Swing means this provider's total billing changed dramatically from one year to the next — increasing or decreasing by more than 200% with over $1M in absolute change. This could indicate a change in practice scope, a billing scheme ramping up, or legitimate growth.
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 $99.02 per claim for 99211 (Office/outpatient visit, minimal complexity) — 7.7× the national median of $12.93.
Bills $5,283.43 per claim for J0741 — 4.2× the national median of $1,261.25.
Bills $301.24 per claim for 96366 (IV infusion, therapeutic/prophylactic/diagnostic, each additional hour) — 7.5× the national median of $40.12.
Billing above the 90th percentile for 11 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 $176.5M is at the 50th percentile among 156 General Acute Care Hospital providers.
Total Paid
$176.5M
$176,532,495
Total Claims
3.8M
Beneficiaries
3.0M
1.3 claims/patient
Avg Cost/Claim
$47
#548 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
University of Cincinnati Medical Center, LLC is a General Acute Care Hospital provider based in Cincinnati, OH. From the 2018–2024 period, this provider received $176.5M in Medicaid payments across 3.8M claims.
Why This Matters
This provider received $176.5M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 22,066 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 (99211 (Office/outpatient visit, minimal complexity)) accounts for 15% of total spending.
$26.1M
263K claims
$99.02
$12.93
Office/outpatient visit, minimal complexity
$26.1M
263K claims · 14.8%
$15.0M
729 claims
$20,634.84
$17,264.74
Ocrelizumab (Ocrevus) injection, 1 mg
$15.0M
729 claims · 8.5%
$13.9M
238K claims
$58.25
$26.41
Hospital outpatient clinic visit
$13.9M
238K claims · 7.9%
$8.6M
58K claims
$147.61
$69.51
Emergency dept visit, high complexity
$8.6M
58K claims · 4.9%
$7.9M
1K claims · 4.5%
$6.0M
50K claims
$120.21
$42.48
Emergency dept visit, moderate complexity
$6.0M
50K claims · 3.4%
$5.8M
32K claims
$180.13
$85.65
Emergency dept visit, high/urgent complexity
$5.8M
32K claims · 3.3%
$5.3M
33K claims
$162.59
$63.08
Infectious disease detection (COVID-19)
$5.3M
33K claims · 3.0%
$4.6M
735 claims
$6,215.96
$5,391.55
Injection, pembrolizumab, 1 mg
$4.6M
735 claims · 2.6%
$2.4M
1K claims · 1.4%
$2.2M
792 claims · 1.2%
$2.2M
22K claims
$101.19
$99.39
Hospital observation service, per hour
$2.2M
22K claims · 1.2%
$2.2M
7K claims
$301.24
$40.12
IV infusion, therapeutic/prophylactic/diagnostic, each additional hour
$2.2M
7K claims · 1.2%
CT abdomen and pelvis with contrast
$2.1M
6K claims · 1.2%
$2.0M
12K claims
$162.42
$75.28
Chemotherapy administration, IV infusion, up to 1 hour
$2.0M
12K claims · 1.1%
$2.0M
408 claims
$4,839.72
$2,797.07
Injection, natalizumab, one milligram
$2.0M
408 claims · 1.1%
$2.0M
3K claims
$566.79
$470.36
Injection, onabotulinumtoxinA, 1 unit
$2.0M
3K claims · 1.1%
$2.0M
19K claims
$103.47
$25.06
Office/outpatient visit, low complexity
$2.0M
19K claims · 1.1%
$1.8M
14K claims
$127.19
$54.77
IV infusion, therapeutic/prophylactic/diagnostic, initial, up to 1 hour
$1.8M
14K claims · 1.0%
$1.8M
7K claims
$254.90
$38.92
IV infusion, hydration, each additional hour
$1.8M
7K claims · 1.0%
Fetal non-stress test
$1.7M
11K claims · 1.0%
Comprehensive metabolic panel
$1.6M
133K claims · 0.9%
$1.5M
13K claims
$119.37
$58.55
Ultrasound, pregnant uterus, follow-up
$1.5M
13K claims · 0.9%
$1.4M
15K claims
$95.78
$49.45
Fetal biophysical profile with non-stress test
$1.4M
15K claims · 0.8%
CT head/brain without contrast
$1.4M
6K claims · 0.8%
$1.2M
323K claims
$3.56
$1.57
Collection of venous blood by venipuncture
$1.2M
323K claims · 0.7%
$998K
7K claims
$138.51
$29.03
Arthrocentesis, aspiration/injection, major joint
$998K
7K claims · 0.6%
$989K
4K claims
$248.07
$54.68
Echocardiography, transthoracic, complete, with Doppler
$989K
4K claims · 0.6%
$910K
8K claims
$111.26
$91.47
Proprietary lab analysis, genomic sequencing
$910K
8K claims · 0.5%
$805K
3K claims
$278.44
$43.68
Chemotherapy infusion, each additional hour
$805K
3K claims · 0.5%
Other Top Providers in Ohio
View all →The Cleveland Clinic Foundation
General Acute Care Hospital
$863.5M
Nationwide Children's Hospital
General Acute Care Hospital
$777.5M
Laboratory Corporation of America Holdings
Clinical Medical Laboratory
$617.0M
The Metrohealth System
General Acute Care Hospital
$574.1M
Children's Hospital Medical Center of Akron
General Acute Care Hospital Children
$556.6M
Similar Providers
Other top providers in General Acute Care Hospital