Long Island Jewish Medical Center
Billing Swing
Experienced over 200% change in year-over-year billing with >$1M absolute change.
Billing changed from $3.4M (2018) to $21.5M (2019) — a 531% swing with $18.1M absolute change.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 181 procedure codes: J9271 at 2.6× median, 99283 at 5.0× median.
Explosive Growth
Billing increased over 500% year-over-year — far beyond normal growth patterns.
Billing grew 531% from 2018 to 2019.
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.
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.
Explosive Growth
Explosive Growth means this provider's billing increased by more than 500% year-over-year. While rapid expansion can be legitimate, this pattern has been observed in fraud schemes that ramp up billing quickly before detection.
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 $213.71 per claim for 99283 (Emergency dept visit, moderate complexity) — 5.0× the national median of $42.48.
Bills $7,758.08 per claim for J1745 (Injection, infliximab, excludes biosimilar, 10 mg) — 4.9× the national median of $1,587.53.
Bills $133.90 per claim for 99213 (Office/outpatient visit, est. patient, low-mod complexity) — 3.5× the national median of $37.81.
Billing in the top 1% nationally for 3 procedure codes: 36430, J0897, 36416.
This is a statistical summary, not an accusation. See our methodology.
Compared to General Acute Care Hospital Peers
Total spending distribution among 156 providers in this specialty
This provider's total spending of $370.9M is at the 75th percentile among 156 General Acute Care Hospital providers.
Total Paid
$370.9M
$370,910,466
Total Claims
4.0M
Beneficiaries
3.2M
1.2 claims/patient
Avg Cost/Claim
$93
#177 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Long Island Jewish Medical Center is a General Acute Care Hospital provider based in New Hyde Park, NY. From the 2018–2024 period, this provider received $370.9M in Medicaid payments across 4.0M claims.
Why This Matters
This provider received $370.9M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 46,363 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 (J9271 (Injection, pembrolizumab, 1 mg)) accounts for 8% of total spending.
Injection, pembrolizumab, 1 mg
$30.2M
2K claims · 8.1%
$26.5M
1K claims
$24,734.76
$23,418.64
Emicizumab-kxwh (Hemlibra) injection, 0.5 mg
$26.5M
1K claims · 7.1%
$24.6M
115K claims
$213.71
$42.48
Emergency dept visit, moderate complexity
$24.6M
115K claims · 6.6%
$23.3M
118K claims
$197.84
$69.51
Emergency dept visit, high complexity
$23.3M
118K claims · 6.3%
$18.1M
2K claims
$7,758.08
$1,587.53
Injection, infliximab, excludes biosimilar, 10 mg
$18.1M
2K claims · 4.9%
$17.4M
125K claims
$139.25
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$17.4M
125K claims · 4.7%
Psychotherapy, 45 minutes
$11.0M
63K claims · 3.0%
$9.9M
74K claims
$133.90
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$9.9M
74K claims · 2.7%
Psychotherapy, 30 minutes
$8.6M
62K claims · 2.3%
$8.3M
43K claims
$195.55
$85.65
Emergency dept visit, high/urgent complexity
$8.3M
43K claims · 2.2%
Emergency dept visit, low complexity
$7.4M
36K claims · 2.0%
$6.3M
52K claims
$121.94
$47.35
Alcohol and/or drug services, group counseling
$6.3M
52K claims · 1.7%
$4.8M
449 claims
$10,666.22
$3,562.28
Nivolumab (Opdivo) injection, 1 mg
$4.8M
449 claims · 1.3%
Transfusion of whole blood
$4.6M
7K claims · 1.2%
$4.4M
25K claims
$177.01
$75.28
Chemotherapy administration, IV infusion, up to 1 hour
$4.4M
25K claims · 1.2%
$4.0M
7K claims
$581.46
$99.39
Hospital observation service, per hour
$4.0M
7K claims · 1.1%
CT abdomen and pelvis with contrast
$3.8M
15K claims · 1.0%
$3.3M
754 claims · 0.9%
Therapeutic exercises, each 15 min
$3.2M
29K claims · 0.9%
CT head/brain without contrast
$3.1M
14K claims · 0.8%
$3.1M
2K claims
$1,853.20
$123.40
Anchor or screw for tissue to bone fixation
$3.1M
2K claims · 0.8%
$3.1M
75K claims
$41.16
$18.95
Alcohol/drug services; methadone administration
$3.1M
75K claims · 0.8%
$3.0M
6K claims · 0.8%
Injection, denosumab, one milligram
$2.9M
1K claims · 0.8%
$2.9M
17K claims
$172.01
$74.09
Office/outpatient visit, high complexity
$2.9M
17K claims · 0.8%
$2.8M
896 claims · 0.8%
Comprehensive metabolic panel
$2.8M
160K claims · 0.8%
$2.8M
639 claims · 0.8%
$2.8M
59K claims · 0.8%
Group psychotherapy
$2.8M
41K claims · 0.7%
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