Children's Health System of Texas
General Acute Care Hospital Children
Dallas, Texas
NPI: 1194743013
Risk Tier
Critical
Total Paid
$263.8M
$263,765,033
Total Claims
1.4M
Beneficiaries
1.3M
Avg Cost/Claim
$193.28
Active billing period: 84 months (2018-01 to 2024-12)
Statistical Fraud Flags (5)
Billing Swing
Experienced over 200% change in year-over-year billing with >$1M absolute change.
Billing changed from $10.4M (2020) to $74.9M (2021) — a 619% swing with $64.5M absolute change.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 320 procedure codes: 99283 at 10.5× median, 99284 at 13.0× median.
Explosive Growth
Billing increased over 500% year-over-year — far beyond normal growth patterns.
Billing grew 619% from 2020 to 2021.
High Cost Per Claim
Average payment per claim is much higher than peers billing the same procedures.
Spending Spike
Experienced a dramatic increase in billing over a short period.
Advanced Detection Signals
CUSUM Change Point
Billing shifted 44.2x in 2020-10 — a statistically significant structural change in billing behavior was detected.
Disclaimer: Statistical flags indicate unusual billing patterns — they are not proof of fraud or wrongdoing. Some entities (government agencies, home care programs, hospitals) may legitimately bill at higher rates due to patient acuity, overhead costs, or specialized services. This report is generated from public HHS data and statistical analysis only. No clinical or investigative review has been performed.
Generated by OpenMedicaid | openmedicaid.org | Data: HHS 2018-2024