University Hospitals Cleveland Medical Center
Billing Swing
Experienced over 200% change in year-over-year billing with >$1M absolute change.
Billing changed from $11.7M (2022) to $57.3M (2023) — a 389% swing with $45.6M 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
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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:
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 $145.85 per claim for 99283 (Emergency dept visit, moderate complexity) — 3.4× the national median of $42.48.
Bills $128.75 per claim for 99213 (Office/outpatient visit, est. patient, low-mod complexity) — 3.4× the national median of $37.81.
Bills $288.57 per claim for 96361 (IV infusion, hydration, each additional hour) — 7.4× the national median of $38.92.
Billing in the top 1% nationally for 1 procedure code: D2930.
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 $156.8M is at the 25th percentile among 156 General Acute Care Hospital providers.
Total Paid
$156.8M
$156,831,349
Total Claims
2.7M
Beneficiaries
2.0M
1.4 claims/patient
Avg Cost/Claim
$57
#674 of 618K providers by total spending(top 0.1%)
🔍 Analysis
Provider Overview
University Hospitals Cleveland Medical Center is a General Acute Care Hospital provider based in Cleveland, OH. From the 2018–2024 period, this provider received $156.8M in Medicaid payments across 2.7M claims.
Why This Matters
This provider received $156.8M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 19,603 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 (J9271 (Injection, pembrolizumab, 1 mg)) accounts for 9% of total spending.
$14.6M
2K claims
$7,698.89
$5,391.55
Injection, pembrolizumab, 1 mg
$14.6M
2K claims · 9.3%
$13.0M
89K claims
$145.85
$42.48
Emergency dept visit, moderate complexity
$13.0M
89K claims · 8.3%
$12.8M
98K claims
$130.28
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$12.8M
98K claims · 8.2%
$10.4M
68K claims
$153.99
$69.51
Emergency dept visit, high complexity
$10.4M
68K claims · 6.6%
$9.2M
72K claims
$128.75
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$9.2M
72K claims · 5.9%
$8.1M
56K claims
$145.22
$85.65
Emergency dept visit, high/urgent complexity
$8.1M
56K claims · 5.2%
$4.5M
32K claims
$140.23
$58.55
Ultrasound, pregnant uterus, follow-up
$4.5M
32K claims · 2.9%
$4.3M
15K claims
$288.57
$38.92
IV infusion, hydration, each additional hour
$4.3M
15K claims · 2.7%
CT head/brain without contrast
$3.8M
13K claims · 2.4%
$3.1M
26K claims
$119.90
$74.09
Office/outpatient visit, high complexity
$3.1M
26K claims · 2.0%
Therapeutic exercises, each 15 min
$2.8M
33K claims · 1.8%
$2.5M
27K claims
$91.69
$49.45
Fetal biophysical profile with non-stress test
$2.5M
27K claims · 1.6%
$2.2M
6K claims
$367.11
$260.56
Intensity modulated radiation treatment delivery, complex
$2.2M
6K claims · 1.4%
$2.0M
13K claims
$161.89
$106.79
Ultrasound, pregnant uterus, detailed, single fetus
$2.0M
13K claims · 1.3%
$1.8M
3K claims
$702.65
$233.73
Polysomnography, sleep study, 6+ hours
$1.8M
3K claims · 1.1%
$1.8M
12K claims
$140.59
$75.28
Chemotherapy administration, IV infusion, up to 1 hour
$1.8M
12K claims · 1.1%
Fetal non-stress test
$1.7M
10K claims · 1.1%
$1.7M
3K claims
$523.60
$120.85
Prefabricated stainless steel crown, primary tooth
$1.7M
3K claims · 1.1%
$1.6M
10K claims
$156.64
$54.77
IV infusion, therapeutic/prophylactic/diagnostic, initial, up to 1 hour
$1.6M
10K claims · 1.0%
$1.4M
1K claims
$985.00
$763.43
Unlisted procedure, dentoalveolar structures
$1.4M
1K claims · 0.9%
$1.4M
9K claims
$151.50
$58.16
Ultrasound, pregnant uterus, single fetus, first trimester
$1.4M
9K claims · 0.9%
$1.3M
5K claims
$262.70
$40.12
IV infusion, therapeutic/prophylactic/diagnostic, each additional hour
$1.3M
5K claims · 0.8%
$1.3M
8K claims
$161.48
$65.76
CT abdomen and pelvis with contrast
$1.3M
8K claims · 0.8%
$1.3M
12K claims
$107.09
$12.93
Office/outpatient visit, minimal complexity
$1.3M
12K claims · 0.8%
$1.1M
227 claims
$4,899.50
$3,562.28
Nivolumab (Opdivo) injection, 1 mg
$1.1M
227 claims · 0.7%
$1.0M
17K claims
$60.39
$99.39
Hospital observation service, per hour
$1.0M
17K claims · 0.7%
$853K
4K claims
$229.16
$61.57
IV infusion, hydration, initial, 31 minutes to 1 hour
$853K
4K claims · 0.5%
Speech/hearing/language treatment
$815K
9K claims · 0.5%
$808K
3K claims
$262.35
$54.68
Echocardiography, transthoracic, complete, with Doppler
$808K
3K claims · 0.5%
$759K
6K claims
$121.06
$10.88
Pressurized or nonpressurized inhalation treatment
$759K
6K claims · 0.5%
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