Norton Hospitals INC
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 175 procedure codes: 99284 at 4.5× median, 99283 at 5.2× 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 $312.18 per claim for 99284 (Emergency dept visit, high complexity) — 4.5× the national median of $69.51.
Bills $222.71 per claim for 99283 (Emergency dept visit, moderate complexity) — 5.2× the national median of $42.48.
Bills $296.37 per claim for 99285 (Emergency dept visit, high/urgent complexity) — 3.5× the national median of $85.65.
Billing in the top 1% nationally for 1 procedure code: C1776.
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 $419.6M is at the 75th percentile among 156 General Acute Care Hospital providers.
Total Paid
$419.6M
$419,580,329
Total Claims
5.9M
Beneficiaries
4.2M
1.4 claims/patient
Avg Cost/Claim
$71
#151 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Norton Hospitals INC is a General Acute Care Hospital provider based in Louisville, KY. From the 2018–2024 period, this provider received $419.6M in Medicaid payments across 5.9M claims.
Why This Matters
This provider received $419.6M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 52,447 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 (99284 (Emergency dept visit, high complexity)) accounts for 13% of total spending.
$53.8M
172K claims
$312.18
$69.51
Emergency dept visit, high complexity
$53.8M
172K claims · 12.8%
$40.5M
182K claims
$222.71
$42.48
Emergency dept visit, moderate complexity
$40.5M
182K claims · 9.6%
$19.1M
64K claims
$296.37
$85.65
Emergency dept visit, high/urgent complexity
$19.1M
64K claims · 4.5%
CT abdomen and pelvis with contrast
$12.0M
32K claims · 2.9%
Emergency dept visit, low complexity
$11.5M
57K claims · 2.8%
$9.3M
19K claims
$483.35
$54.68
Echocardiography, transthoracic, complete, with Doppler
$9.3M
19K claims · 2.2%
$8.2M
53K claims
$155.81
$99.39
Hospital observation service, per hour
$8.2M
53K claims · 2.0%
$7.5M
782 claims · 1.8%
$7.3M
1K claims
$5,430.22
$5,391.55
Injection, pembrolizumab, 1 mg
$7.3M
1K claims · 1.7%
$7.2M
5K claims
$1,354.81
$123.40
Anchor or screw for tissue to bone fixation
$7.2M
5K claims · 1.7%
CT head/brain without contrast
$7.1M
36K claims · 1.7%
MRI brain without contrast
$5.9M
12K claims · 1.4%
MRI lumbar spine without contrast
$5.8M
11K claims · 1.4%
$5.5M
11K claims
$518.69
$133.68
MRI brain without contrast, then with contrast
$5.5M
11K claims · 1.3%
$4.6M
75K claims
$62.00
$14.92
Therapeutic/prophylactic/diagnostic IV push, each additional substance
$4.6M
75K claims · 1.1%
$4.6M
2K claims
$2,862.07
$1,587.53
Injection, infliximab, excludes biosimilar, 10 mg
$4.6M
2K claims · 1.1%
PET imaging for limited area
$3.9M
2K claims · 0.9%
$3.6M
136K claims
$26.34
$21.76
Therapeutic/prophylactic/diagnostic IV push, single substance
$3.6M
136K claims · 0.9%
$3.5M
76K claims
$46.72
$54.77
IV infusion, therapeutic/prophylactic/diagnostic, initial, up to 1 hour
$3.5M
76K claims · 0.8%
$3.5M
12K claims
$298.20
$60.19
CT abdomen and pelvis without contrast
$3.5M
12K claims · 0.8%
CT angiography, chest, with contrast
$3.3M
11K claims · 0.8%
$3.3M
8K claims
$431.78
$260.56
Intensity modulated radiation treatment delivery, complex
$3.3M
8K claims · 0.8%
$3.2M
6K claims
$549.59
$112.68
MRI of cervical spine without contrast
$3.2M
6K claims · 0.8%
$3.2M
94K claims
$33.84
$38.92
IV infusion, hydration, each additional hour
$3.2M
94K claims · 0.8%
$3.0M
25K claims
$120.50
$100.62
Respiratory virus detection, 3-5 targets, nucleic acid
$3.0M
25K claims · 0.7%
$3.0M
10K claims
$307.78
$106.14
Myocardial perfusion imaging, SPECT, multiple studies
$3.0M
10K claims · 0.7%
Upper GI endoscopy with biopsy
$2.8M
8K claims · 0.7%
$2.7M
6K claims
$429.53
$470.36
Injection, onabotulinumtoxinA, 1 unit
$2.7M
6K claims · 0.6%
CT chest with contrast
$2.6M
9K claims · 0.6%
$2.5M
19K claims
$130.15
$75.28
Chemotherapy administration, IV infusion, up to 1 hour
$2.5M
19K claims · 0.6%
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