Rochester General Hospital
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 152 procedure codes: 99213 at 2.2× median, 90834 at 2.4× 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:
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 $151.39 per claim for 99283 (Emergency dept visit, moderate complexity) — 3.6× the national median of $42.48.
Bills $232.41 per claim for 96361 (IV infusion, hydration, each additional hour) — 6.0× the national median of $38.92.
Bills $713.78 per claim for H2019 (Therapeutic behavioral services, per 15 min) — 8.5× the national median of $84.12.
Billing above the 90th percentile for 16 procedure codes simultaneously.
This is a statistical summary, not an accusation. See our methodology.
Compared to Dentist, General Practice Peers
Total spending distribution among 10 providers in this specialty
This provider's total spending of $227.0M is at the 99th percentile among 10 Dentist, General Practice providers.
Above 99th percentile for this specialty — higher spending than 9 of 10 peers
Total Paid
$227.0M
$226,974,802
Total Claims
3.2M
Beneficiaries
2.8M
1.1 claims/patient
Avg Cost/Claim
$70
#371 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Rochester General Hospital is a Dentist, General Practice provider based in Rochester, NY. From the 2018–2024 period, this provider received $227.0M in Medicaid payments across 3.2M claims.
Why This Matters
This provider received $227.0M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 28,371 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 10% of total spending.
$22.3M
271K claims
$82.28
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$22.3M
271K claims · 9.8%
$20.0M
224K claims
$89.16
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$20.0M
224K claims · 8.8%
Psychotherapy, 45 minutes
$16.2M
105K claims · 7.1%
$12.1M
80K claims
$151.39
$42.48
Emergency dept visit, moderate complexity
$12.1M
80K claims · 5.4%
$10.4M
45K claims
$232.41
$38.92
IV infusion, hydration, each additional hour
$10.4M
45K claims · 4.6%
$7.6M
53K claims
$141.64
$85.65
Emergency dept visit, high/urgent complexity
$7.6M
53K claims · 3.3%
$7.2M
51K claims
$141.97
$69.51
Emergency dept visit, high complexity
$7.2M
51K claims · 3.2%
$6.8M
9K claims
$713.78
$84.12
Therapeutic behavioral services, per 15 min
$6.8M
9K claims · 3.0%
Psychotherapy, 30 minutes
$6.2M
57K claims · 2.7%
Injection, pembrolizumab, 1 mg
$4.1M
365 claims · 1.8%
$4.0M
52K claims
$77.18
$60.05
COVID-19 test, nucleic acid detection, CDC lab only
$4.0M
52K claims · 1.8%
Psychiatric diagnostic evaluation
$3.8M
21K claims · 1.7%
Hospital outpatient clinic visit
$3.4M
42K claims · 1.5%
Ultrasound, pelvic, complete
$3.1M
12K claims · 1.4%
Emergency dept visit, low complexity
$2.9M
19K claims · 1.3%
CT head/brain without contrast
$2.8M
10K claims · 1.2%
CT abdomen and pelvis with contrast
$2.6M
9K claims · 1.1%
Therapeutic exercises, each 15 min
$2.5M
42K claims · 1.1%
$2.4M
952 claims · 1.0%
$2.2M
10K claims
$225.64
$77.33
Family psychotherapy with patient, 50 min
$2.2M
10K claims · 1.0%
Comprehensive metabolic panel
$2.0M
108K claims · 0.9%
Fetal non-stress test
$1.9M
11K claims · 0.8%
$1.6M
20K claims
$79.81
$69.35
Preventive medicine, established patient, infant (under 1)
$1.6M
20K claims · 0.7%
$1.6M
21K claims
$76.36
$75.18
Preventive medicine, established patient, age 1-4
$1.6M
21K claims · 0.7%
$1.5M
5K claims
$302.78
$54.68
Echocardiography, transthoracic, complete, with Doppler
$1.5M
5K claims · 0.7%
$1.5M
19K claims
$77.86
$74.82
Preventive medicine, established patient, age 5-11
$1.5M
19K claims · 0.7%
$1.5M
8K claims
$184.05
$61.57
IV infusion, hydration, initial, 31 minutes to 1 hour
$1.5M
8K claims · 0.6%
$1.3M
5K claims
$282.55
$121.16
Clinic visit/encounter, all-inclusive
$1.3M
5K claims · 0.6%
$1.3M
12K claims
$111.33
$74.09
Office/outpatient visit, high complexity
$1.3M
12K claims · 0.6%
$1.3M
24K claims
$54.72
$65.64
Influenza virus detection, reverse transcription, amplified probe
$1.3M
24K claims · 0.6%