Henry Ford Health System
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $305.56 per claim for 99285 (Emergency dept visit, high/urgent complexity), which is 3.6× the national median of $85.65.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 55 procedure codes: 99285 at 3.6× 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:
Cost Outlier
Cost Outlier means this provider charges significantly more per claim than other providers billing the same procedure codes. This could indicate upcoding, inflated charges, or specialized services that justify higher costs.
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 $305.56 per claim for 99285 (Emergency dept visit, high/urgent complexity) — 3.6× the national median of $85.65.
Bills $100.94 per claim for 96374 (Therapeutic/prophylactic/diagnostic IV push, single substance) — 4.6× the national median of $21.76.
Bills $38.37 per claim for 71046 (Chest X-ray, 2 views) — 4.3× the national median of $8.92.
Billing above the 90th percentile for 4 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 $334.9M is at the 75th percentile among 156 General Acute Care Hospital providers.
Total Paid
$334.9M
$334,910,515
Total Claims
9.6M
Beneficiaries
8.7M
1.1 claims/patient
Avg Cost/Claim
$35
#208 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Henry Ford Health System is a General Acute Care Hospital provider based in Detroit, MI. From the 2018–2024 period, this provider received $334.9M in Medicaid payments across 9.6M claims.
Why This Matters
This provider received $334.9M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 41,863 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 19% of total spending.
$62.1M
203K claims
$305.56
$85.65
Emergency dept visit, high/urgent complexity
$62.1M
203K claims · 18.5%
$42.1M
987K claims
$42.67
$26.41
Hospital outpatient clinic visit
$42.1M
987K claims · 12.6%
$22.4M
130K claims
$172.37
$69.51
Emergency dept visit, high complexity
$22.4M
130K claims · 6.7%
$20.4M
174K claims
$117.38
$42.48
Emergency dept visit, moderate complexity
$20.4M
174K claims · 6.1%
$12.3M
122K claims
$100.94
$21.76
Therapeutic/prophylactic/diagnostic IV push, single substance
$12.3M
122K claims · 3.7%
$6.9M
1K claims
$5,378.86
$5,391.55
Injection, pembrolizumab, 1 mg
$6.9M
1K claims · 2.1%
$6.5M
129K claims
$50.25
$38.92
IV infusion, hydration, each additional hour
$6.5M
129K claims · 1.9%
$5.8M
76K claims
$75.88
$97.61
Respiratory virus detection, 6-11 targets, nucleic acid
$5.8M
76K claims · 1.7%
$5.4M
21K claims
$264.52
$99.39
Hospital observation service, per hour
$5.4M
21K claims · 1.6%
$4.6M
46K claims
$98.63
$54.77
IV infusion, therapeutic/prophylactic/diagnostic, initial, up to 1 hour
$4.6M
46K claims · 1.4%
$4.3M
5K claims · 1.3%
$4.0M
31K claims
$130.41
$65.76
CT abdomen and pelvis with contrast
$4.0M
31K claims · 1.2%
$3.5M
33K claims
$105.17
$61.57
IV infusion, hydration, initial, 31 minutes to 1 hour
$3.5M
33K claims · 1.0%
Chest X-ray, 2 views
$3.3M
86K claims · 1.0%
$3.2M
100K claims
$31.46
$14.92
Therapeutic/prophylactic/diagnostic IV push, each additional substance
$3.2M
100K claims · 0.9%
$3.1M
63K claims · 0.9%
$3.0M
44K claims
$66.73
$75.18
Preventive medicine, established patient, age 1-4
$3.0M
44K claims · 0.9%
$2.9M
41K claims
$72.66
$37.72
Emergency dept visit, low complexity
$2.9M
41K claims · 0.9%
$2.8M
17K claims
$166.48
$75.28
Chemotherapy administration, IV infusion, up to 1 hour
$2.8M
17K claims · 0.9%
$2.5M
39K claims
$64.30
$69.35
Preventive medicine, established patient, infant (under 1)
$2.5M
39K claims · 0.8%
Upper GI endoscopy with biopsy
$2.4M
8K claims · 0.7%
$2.4M
105K claims
$22.98
$17.85
Immunization administration, first vaccine/toxoid, with counseling
$2.4M
105K claims · 0.7%
CT head/brain without contrast
$2.4M
25K claims · 0.7%
Critical care, first 30-74 minutes
$2.2M
4K claims · 0.7%
$1.9M
98K claims
$19.55
$24.49
Therapeutic exercises, each 15 min
$1.9M
98K claims · 0.6%
Colonoscopy with biopsy
$1.9M
4K claims · 0.6%
$1.8M
27K claims
$65.99
$74.82
Preventive medicine, established patient, age 5-11
$1.8M
27K claims · 0.5%
Fetal non-stress test
$1.7M
21K claims · 0.5%
$1.7M
2K claims · 0.5%
$1.5M
6K claims
$247.18
$133.68
MRI brain without contrast, then with contrast
$1.5M
6K claims · 0.5%
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