Statistical flags indicate unusual patterns — not proof of fraud or wrongdoing. Read our methodology

The Queens Medical Center

Psychiatric Unit·Honolulu, HI·NPI: 1184612764SharePrint Report

Red Flags Explained

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.

Risk Assessment

Bills $544.42 per claim for 99283 (Emergency dept visit, moderate complexity) — 12.8× the national median of $42.48.

Bills $882.39 per claim for 99285 (Emergency dept visit, high/urgent complexity) — 10.3× the national median of $85.65.

Bills $620.90 per claim for 99284 (Emergency dept visit, high complexity) — 8.9× the national median of $69.51.

Billing in the top 1% nationally for 8 procedure codes: 99283, 99285, 99284.

This is a statistical summary, not an accusation. See our methodology.

Compared to Psychiatric Unit Peers

Total spending distribution among 8 providers in this specialty

P25MedianP75P90

This provider's total spending of $200.0M is at the 50th percentile among 8 Psychiatric Unit providers.

Active Billing Period:2018-012024-12(84 months)

Total Paid

$200.0M

$200,025,638

Total Claims

2.5M

Beneficiaries

2.0M

1.2 claims/patient

Avg Cost/Claim

$81

#455 of 618K providers by total spending(top <0.1%)

🔍 Analysis

Provider Overview

The Queens Medical Center is a Psychiatric Unit provider based in Honolulu, HI. From the 2018–2024 period, this provider received $200.0M in Medicaid payments across 2.5M claims.

Why This Matters

This provider received $200.0M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 25,003 Medicaid beneficiaries for a full year at average per-enrollee costs.

19% growthsince first billing year

Monthly Spending Trend

Yearly Spending

2018
$30.7M
+2%
2019
$31.2M
-29%
2020
$22.1M
+18%
2021
$26.1M
+2%
2022
$26.6M
+0%
2023
$26.7M
+37%
2024
$36.6M

Procedure Breakdown

Cost per claim compared to national benchmarks

This provider bills for 30 distinct procedure codes. The top code (99283 (Emergency dept visit, moderate complexity)) accounts for 19% of total spending.

99283Top 1%

Emergency dept visit, moderate complexity

$37.4M

69K claims · 18.7%

Your Cost: $544.42/claim|Median: $42.48
12.8× median
99285Top 1%

Emergency dept visit, high/urgent complexity

$35.8M

41K claims · 17.9%

Your Cost: $882.39/claim|Median: $85.65
10.3× median
99284Top 1%

Emergency dept visit, high complexity

$35.4M

57K claims · 17.7%

Your Cost: $620.90/claim|Median: $69.51
8.9× median
74177Top 5%

CT abdomen and pelvis with contrast

$12.1M

15K claims · 6.0%

Your Cost: $813.83/claim|Median: $65.76
12.4× median
G0378Top 25%

Hospital observation service, per hour

$7.2M

19K claims · 3.6%

Your Cost: $377.69/claim|Median: $99.39
3.8× median
99282Top 1%

Emergency dept visit, low complexity

$5.1M

15K claims · 2.6%

Your Cost: $344.29/claim|Median: $37.72
9.1× median
74176Top 5%

CT abdomen and pelvis without contrast

$4.3M

6K claims · 2.1%

Your Cost: $697.83/claim|Median: $60.19
11.6× median
99291Top 1%

Critical care, first 30-74 minutes

$4.2M

3K claims · 2.1%

Your Cost: $1,437.83/claim|Median: $101.24
14.2× median
78815Top 5%

PET imaging for limited area

$3.3M

2K claims · 1.6%

Your Cost: $1,440.97/claim|Median: $325.10
4.4× median
11042Top 25%

Debridement, subcutaneous tissue, first 20 sq cm

$2.7M

27K claims · 1.4%

Your Cost: $101.98/claim|Median: $36.13
2.8× median
J9271Normal range

Injection, pembrolizumab, 1 mg

$2.5M

434 claims · 1.3%

Your Cost: $5,802.46/claim|Median: $5,391.55
1.1× median
G0463Normal range

Hospital outpatient clinic visit

$2.5M

49K claims · 1.2%

Your Cost: $49.95/claim|Median: $26.41
1.9× median
11045Top 10%

$2.4M

6K claims · 1.2%

Your Cost: $389.18/claim|Median: $27.04
14.4× median
93306Top 10%

Echocardiography, transthoracic, complete, with Doppler

$2.3M

10K claims · 1.1%

Your Cost: $226.82/claim|Median: $54.68
4.2× median
99281Top 1%

Emergency dept visit, minimal complexity

$2.1M

6K claims · 1.1%

Your Cost: $332.10/claim|Median: $52.03
6.4× median
45380Top 25%

Colonoscopy with biopsy

$1.9M

3K claims · 0.9%

Your Cost: $537.91/claim|Median: $200.68
2.7× median
45385Top 5%

Colonoscopy with polyp removal, snare technique

$1.8M

2K claims · 0.9%

Your Cost: $776.58/claim|Median: $255.17
3.0× median
78452Top 5%

Myocardial perfusion imaging, SPECT, multiple studies

$1.4M

2K claims · 0.7%

Your Cost: $622.59/claim|Median: $106.14
5.9× median
70498Top 1%

$1.1M

1K claims · 0.5%

Your Cost: $742.28/claim|Median: $58.88
12.6× median
S9480Normal range

Intensive outpatient psychiatric services, per diem

$1.1M

9K claims · 0.5%

Your Cost: $122.73/claim|Median: $135.70
0.9× median
43239Top 25%

Upper GI endoscopy with biopsy

$1.1M

3K claims · 0.5%

Your Cost: $317.50/claim|Median: $151.68
2.1× median
70553Top 10%

MRI brain without contrast, then with contrast

$1.1M

2K claims · 0.5%

Your Cost: $458.02/claim|Median: $133.68
3.4× median
77386Top 25%

Intensity modulated radiation treatment delivery, complex

$906K

2K claims · 0.5%

Your Cost: $436.75/claim|Median: $260.56
1.7× median
74183Top 5%

$880K

2K claims · 0.4%

Your Cost: $570.95/claim|Median: $151.91
3.8× median
99218Top 25%

$853K

10K claims · 0.4%

Your Cost: $82.91/claim|Median: $51.50
1.6× median
74174Top 1%

$819K

635 claims · 0.4%

Your Cost: $1,289.53/claim|Median: $89.41
14.4× median
77067Top 25%

Screening mammography, bilateral, including CAD

$797K

9K claims · 0.4%

Your Cost: $89.96/claim|Median: $39.33
2.3× median
G0390Top 5%

$694K

279 claims · 0.3%

Your Cost: $2,489.19/claim|Median: $357.22
7.0× median
90853Top 25%

Group psychotherapy

$649K

11K claims · 0.3%

Your Cost: $60.75/claim|Median: $25.02
2.4× median
80307Normal range

Drug test, presumptive, by chemistry analyzers

$631K

23K claims · 0.3%

Your Cost: $27.98/claim|Median: $35.43
0.8× median