The New York and Presbyterian Hospital
General Acute Care Hospital
New York, New York
NPI: 1194832477
Risk Tier
Critical
Total Paid
$454.9M
$454,946,329
Total Claims
7.1M
Beneficiaries
6.2M
Avg Cost/Claim
$63.98
Active billing period: 84 months (2018-01 to 2024-12)
Statistical Fraud Flags (3)
Cost Outlier
Billing over 3× the national median for specific procedure codes.
Bills $189.62 per claim for 99213 (Office/outpatient visit, est. patient, low-mod complexity), which is 5.0× the national median of $37.81.
Billing Swing
Experienced over 200% change in year-over-year billing with >$1M absolute change.
Billing changed from $10.3M (2018) to $32.6M (2019) — a 217% swing with $22.3M absolute change.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 212 procedure codes: 99213 at 5.0× median, 99283 at 4.3× median.
Advanced Detection Signals
Billing Velocity
3847.6 claims per working day — may exceed physically possible volume for a single provider.
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