Miami Valley Hospital
Billing Swing
Experienced over 200% change in year-over-year billing with >$1M absolute change.
Billing changed from $15.7M (2022) to $58.1M (2023) — a 271% swing with $42.4M 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 $289.51 per claim for 96361 (IV infusion, hydration, each additional hour) — 7.4× the national median of $38.92.
Bills $227.99 per claim for 70450 (CT head/brain without contrast) — 5.0× the national median of $45.53.
Bills $93.47 per claim for G0463 (Hospital outpatient clinic visit) — 3.5× the national median of $26.41.
Billing above the 90th percentile for 8 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 $159.3M is at the 25th percentile among 156 General Acute Care Hospital providers.
Total Paid
$159.3M
$159,264,364
Total Claims
3.6M
Beneficiaries
2.5M
1.4 claims/patient
Avg Cost/Claim
$44
#657 of 618K providers by total spending(top 0.1%)
🔍 Analysis
Provider Overview
Miami Valley Hospital is a General Acute Care Hospital provider based in Dayton, OH. From the 2018–2024 period, this provider received $159.3M in Medicaid payments across 3.6M claims.
Why This Matters
This provider received $159.3M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 19,908 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 14% of total spending.
$22.4M
175K claims
$128.03
$69.51
Emergency dept visit, high complexity
$22.4M
175K claims · 14.1%
$20.5M
176K claims
$115.90
$42.48
Emergency dept visit, moderate complexity
$20.5M
176K claims · 12.8%
$18.7M
65K claims
$289.51
$38.92
IV infusion, hydration, each additional hour
$18.7M
65K claims · 11.8%
$10.9M
76K claims
$144.11
$85.65
Emergency dept visit, high/urgent complexity
$10.9M
76K claims · 6.8%
$10.6M
498 claims
$21,298.59
$17,264.74
Ocrelizumab (Ocrevus) injection, 1 mg
$10.6M
498 claims · 6.7%
CT head/brain without contrast
$5.3M
23K claims · 3.3%
Hospital outpatient clinic visit
$4.0M
43K claims · 2.5%
$3.9M
531 claims
$7,425.32
$5,391.55
Injection, pembrolizumab, 1 mg
$3.9M
531 claims · 2.5%
$3.7M
33K claims
$113.47
$91.47
Proprietary lab analysis, genomic sequencing
$3.7M
33K claims · 2.4%
$3.7M
61K claims
$60.64
$99.39
Hospital observation service, per hour
$3.7M
61K claims · 2.3%
CT abdomen and pelvis with contrast
$3.3M
17K claims · 2.1%
Therapeutic exercises, each 15 min
$3.3M
48K claims · 2.0%
$3.2M
2K claims
$1,455.30
$1,650.68
Ambulance service, conventional air, transport, one way
$3.2M
2K claims · 2.0%
Emergency dept visit, low complexity
$3.1M
33K claims · 1.9%
Fetal non-stress test
$2.6M
18K claims · 1.6%
$1.9M
17K claims
$107.84
$54.77
IV infusion, therapeutic/prophylactic/diagnostic, initial, up to 1 hour
$1.9M
17K claims · 1.2%
$1.8M
21K claims
$84.84
$10.88
Pressurized or nonpressurized inhalation treatment
$1.8M
21K claims · 1.1%
$1.6M
9K claims
$179.72
$40.12
IV infusion, therapeutic/prophylactic/diagnostic, each additional hour
$1.6M
9K claims · 1.0%
$1.5M
7K claims
$213.49
$60.19
CT abdomen and pelvis without contrast
$1.5M
7K claims · 0.9%
CT chest with contrast
$1.4M
9K claims · 0.9%
$1.3M
8K claims
$154.54
$252.36
Ambulance, specialty care transport
$1.3M
8K claims · 0.8%
$1.1M
10K claims
$117.90
$58.55
Ultrasound, pregnant uterus, follow-up
$1.1M
10K claims · 0.7%
Basic metabolic panel
$1.1M
175K claims · 0.7%
$1.0M
7K claims
$137.44
$61.57
IV infusion, hydration, initial, 31 minutes to 1 hour
$1.0M
7K claims · 0.6%
$965K
562 claims · 0.6%
$913K
3K claims
$335.63
$106.14
Myocardial perfusion imaging, SPECT, multiple studies
$913K
3K claims · 0.6%
$806K
450 claims · 0.5%
Psychiatric diagnostic evaluation
$758K
4K claims · 0.5%
$742K
144 claims
$5,153.37
$2,797.07
Injection, natalizumab, one milligram
$742K
144 claims · 0.5%
$648K
3K claims
$194.34
$54.68
Echocardiography, transthoracic, complete, with Doppler
$648K
3K claims · 0.4%
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