Nationwide Children's Hospital
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 191 procedure codes: 99213 at 2.2× median, 99214 at 1.9× median.
Unusually High Spending
This provider's total payments are significantly above the median for their specialty.
High Cost Per Claim
Average payment per claim is much higher than peers billing the same procedures.
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.
Unusually High Spending
Unusually High Spending means this provider's total Medicaid payments are significantly above the median for their specialty. This doesn't necessarily indicate fraud — high volume practices and those serving complex populations may legitimately bill more.
High Cost Per Claim
High Cost Per Claim means each individual claim from this provider costs significantly more than what other providers charge for the same services. This could indicate upcoding (billing for more expensive services than provided) or legitimate specialized care.
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 $248.86 per claim for 96110 (Developmental screening, per standardized instrument) — 27.4× the national median of $9.10.
Bills $114.05 per claim for 96127 (Brief emotional/behavioral assessment, per standardized instrument) — 31.1× the national median of $3.67.
Bills $146.68 per claim for 99283 (Emergency dept visit, moderate complexity) — 3.5× the national median of $42.48.
Billing in the top 1% nationally for 6 procedure codes: 96110, 96127, 92551.
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 $777.5M is at the 90th percentile among 156 General Acute Care Hospital providers.
Above 90th percentile for this specialty — higher spending than 140 of 156 peers
Total Paid
$777.5M
$777,537,649
Total Claims
11.0M
Beneficiaries
8.5M
1.3 claims/patient
Avg Cost/Claim
$71
#53 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Nationwide Children's Hospital is a General Acute Care Hospital provider based in Columbus, OH. From the 2018–2024 period, this provider received $777.5M in Medicaid payments across 11.0M claims.
Why This Matters
This provider received $777.5M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 97,192 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 (99213 (Office/outpatient visit, est. patient, low-mod complexity)) accounts for 20% of total spending.
$154.8M
1.8M claims
$84.99
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$154.8M
1.8M claims · 19.9%
$75.5M
736K claims
$102.68
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$75.5M
736K claims · 9.7%
$46.5M
187K claims
$248.86
$9.10
Developmental screening, per standardized instrument
$46.5M
187K claims · 6.0%
$27.1M
125K claims
$216.55
$77.33
Family psychotherapy with patient, 50 min
$27.1M
125K claims · 3.5%
$23.9M
315K claims
$75.75
$75.18
Preventive medicine, established patient, age 1-4
$23.9M
315K claims · 3.1%
$23.6M
302K claims
$78.10
$69.35
Preventive medicine, established patient, infant (under 1)
$23.6M
302K claims · 3.0%
$21.1M
185K claims
$114.05
$3.67
Brief emotional/behavioral assessment, per standardized instrument
$21.1M
185K claims · 2.7%
$21.0M
143K claims
$146.68
$42.48
Emergency dept visit, moderate complexity
$21.0M
143K claims · 2.7%
Psychotherapy, 60 minutes
$20.3M
131K claims · 2.6%
Psychiatric diagnostic evaluation
$19.5M
63K claims · 2.5%
$18.9M
221K claims
$85.68
$6.61
Screening audiometry, pure tone, air only
$18.9M
221K claims · 2.4%
$17.4M
232K claims
$75.09
$74.82
Preventive medicine, established patient, age 5-11
$17.4M
232K claims · 2.2%
$13.8M
187K claims
$73.77
$25.06
Office/outpatient visit, low complexity
$13.8M
187K claims · 1.8%
Speech/hearing/language treatment
$13.4M
150K claims · 1.7%
$12.8M
58K claims
$219.15
$76.61
Family psychotherapy without patient, 50 min
$12.8M
58K claims · 1.6%
Tympanostomy, general anesthesia
$12.3M
8K claims · 1.6%
$11.3M
93K claims
$121.34
$74.09
Office/outpatient visit, high complexity
$11.3M
93K claims · 1.5%
$11.2M
136K claims
$82.31
$80.15
Preventive medicine, established patient, age 12-17
$11.2M
136K claims · 1.4%
Psychotherapy, 45 minutes
$10.8M
81K claims · 1.4%
Therapeutic exercises, each 15 min
$10.6M
103K claims · 1.4%
$9.9M
66K claims
$150.45
$69.51
Emergency dept visit, high complexity
$9.9M
66K claims · 1.3%
$8.2M
13K claims
$649.24
$120.85
Prefabricated stainless steel crown, primary tooth
$8.2M
13K claims · 1.1%
$7.3M
61K claims · 0.9%
$6.5M
5K claims
$1,261.85
$470.36
Injection, onabotulinumtoxinA, 1 unit
$6.5M
5K claims · 0.8%
Unclassified drugs
$6.3M
247K claims · 0.8%
$5.9M
90K claims
$66.14
$76.05
Community psychiatric supportive treatment, per 15 min
$5.9M
90K claims · 0.8%
$5.3M
5K claims
$1,165.95
$331.68
Tonsillectomy and adenoidectomy, under age 12
$5.3M
5K claims · 0.7%
Therapeutic activities, each 15 min
$5.2M
56K claims · 0.7%
$4.4M
8K claims
$565.78
$57.39
Extraction, erupted tooth or exposed root
$4.4M
8K claims · 0.6%
Psychotherapy, 30 minutes
$4.0M
44K claims · 0.5%
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