Topcare Medical Group INC
Billing Swing
Experienced over 200% change in year-over-year billing with >$1M absolute change.
Billing changed from $6.3M (2020) to $32.6M (2021) — a 417% swing with $26.3M absolute change.
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:
Billing Swing
Billing Swing means this provider's total billing changed dramatically from one year to the next — increasing or decreasing by more than 200% with over $1M in absolute change. This could indicate a change in practice scope, a billing scheme ramping up, or legitimate growth.
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 $100.26 per claim for 99499 (Unlisted evaluation and management service) — 3.3× the national median of $30.88.
Bills $6.37 per claim for G8510 — 3.3× the national median of $1.96.
This is a statistical summary, not an accusation. See our methodology.
Compared to Pediatrics Peers
Total spending distribution among 14 providers in this specialty
This provider's total spending of $160.4M is at the 50th percentile among 14 Pediatrics providers.
Total Paid
$160.4M
$160,363,652
Total Claims
8.4M
Beneficiaries
6.9M
1.2 claims/patient
Avg Cost/Claim
$19
#647 of 618K providers by total spending(top 0.1%)
🔍 Analysis
Provider Overview
Topcare Medical Group INC is a Pediatrics provider based in Dallas, TX. From the 2018–2024 period, this provider received $160.4M in Medicaid payments across 8.4M claims.
Why This Matters
This provider received $160.4M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 20,045 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 (99214 (Office/outpatient visit, est. patient, mod-high complexity)) accounts for 20% of total spending.
$31.4M
849K claims
$37.04
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$31.4M
849K claims · 19.6%
$23.0M
854K claims
$26.94
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$23.0M
854K claims · 14.3%
$17.4M
536K claims
$32.56
$30.04
SARS-CoV-2 COVID-19 antigen detection, immunoassay
$17.4M
536K claims · 10.9%
$15.3M
235K claims
$65.19
$74.82
Preventive medicine, established patient, age 5-11
$15.3M
235K claims · 9.6%
$13.8M
227K claims
$60.86
$75.18
Preventive medicine, established patient, age 1-4
$13.8M
227K claims · 8.6%
$11.3M
1.3M claims
$8.89
$17.85
Immunization administration, first vaccine/toxoid, with counseling
$11.3M
1.3M claims · 7.1%
$10.9M
160K claims
$68.29
$80.15
Preventive medicine, established patient, age 12-17
$10.9M
160K claims · 6.8%
$9.9M
162K claims
$61.08
$69.35
Preventive medicine, established patient, infant (under 1)
$9.9M
162K claims · 6.2%
$4.8M
656K claims · 3.0%
$4.0M
162K claims · 2.5%
$3.8M
311K claims
$12.13
$12.59
Influenza virus detection, rapid test
$3.8M
311K claims · 2.4%
$3.1M
319K claims
$9.81
$11.48
Streptococcus, Group A, rapid antigen detection
$3.1M
319K claims · 1.9%
$1.6M
258K claims
$6.28
$9.10
Developmental screening, per standardized instrument
$1.6M
258K claims · 1.0%
$1.1M
16K claims
$67.87
$73.46
Preventive visit, new patient, infant (<1 yr)
$1.1M
16K claims · 0.7%
$855K
305K claims
$2.80
$6.93
Immunization admin, additional vaccine, counseling
$855K
305K claims · 0.5%
$853K
9K claims
$100.26
$30.88
Unlisted evaluation and management service
$853K
9K claims · 0.5%
$842K
107K claims · 0.5%
$835K
17K claims
$48.10
$34.62
COVID-19 lab test, non-CDC, nucleic acid
$835K
17K claims · 0.5%
$723K
9K claims
$80.23
$81.92
Preventive visit, new patient, late childhood (5-11 yr)
$723K
9K claims · 0.5%
$547K
9K claims
$63.48
$84.03
Office/outpatient visit, new patient, mod-high complexity
$547K
9K claims · 0.3%
$537K
27K claims
$19.88
$25.06
Office/outpatient visit, low complexity
$537K
27K claims · 0.3%
$419K
5K claims
$80.68
$79.89
Preventive visit, new patient, early childhood (1-4 yr)
$419K
5K claims · 0.3%
$368K
10K claims
$37.64
$57.85
Office/outpatient visit, new patient, low-mod complexity
$368K
10K claims · 0.2%
$351K
4K claims
$88.77
$83.63
Preventive visit, new patient, adolescent (12-17 yr)
$351K
4K claims · 0.2%
$259K
43K claims · 0.2%
$252K
173K claims
$1.46
$2.10
Patient-focused health risk assessment
$252K
173K claims · 0.2%
$223K
7K claims · 0.1%
$191K
30K claims · 0.1%
$180K
5K claims · 0.1%
$174K
24K claims · 0.1%
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