University of Rochester
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 200 procedure codes: 90791 at 6.7× median, 90834 at 2.3× 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 $667.12 per claim for 90791 (Psychiatric diagnostic evaluation) — 6.7× the national median of $99.21.
Bills $132.84 per claim for 99213 (Office/outpatient visit, est. patient, low-mod complexity) — 3.5× the national median of $37.81.
Bills $140.78 per claim for 90832 (Psychotherapy, 30 minutes) — 3.4× the national median of $41.28.
Billing in the top 1% nationally for 3 procedure codes: 90791, H0005, G0396.
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 $368.3M is at the 75th percentile among 156 General Acute Care Hospital providers.
Total Paid
$368.3M
$368,317,926
Total Claims
4.9M
Beneficiaries
3.9M
1.2 claims/patient
Avg Cost/Claim
$76
#180 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
University of Rochester is a General Acute Care Hospital provider based in Rochester, NY. From the 2018–2024 period, this provider received $368.3M in Medicaid payments across 4.9M claims.
Why This Matters
This provider received $368.3M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 46,039 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 (90791 (Psychiatric diagnostic evaluation)) accounts for 5% of total spending.
Psychiatric diagnostic evaluation
$20.2M
30K claims · 5.5%
Psychotherapy, 45 minutes
$14.5M
97K claims · 3.9%
$13.8M
135K claims
$102.69
$130.29
Medicaid certified CCBHC services
$13.8M
135K claims · 3.8%
$12.8M
96K claims
$132.84
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$12.8M
96K claims · 3.5%
Psychotherapy, 30 minutes
$11.9M
85K claims · 3.2%
Injection, pembrolizumab, 1 mg
$11.2M
1K claims · 3.0%
$10.7M
57K claims
$187.82
$69.51
Emergency dept visit, high complexity
$10.7M
57K claims · 2.9%
$9.7M
72K claims
$135.49
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$9.7M
72K claims · 2.6%
$9.3M
8K claims
$1,218.25
$501.33
Crisis intervention mental health services, per diem
$9.3M
8K claims · 2.5%
$8.8M
110K claims
$80.07
$63.08
Infectious disease detection (COVID-19)
$8.8M
110K claims · 2.4%
$8.8M
52K claims
$169.74
$42.48
Emergency dept visit, moderate complexity
$8.8M
52K claims · 2.4%
$8.7M
358 claims
$24,239.99
$17,264.74
Ocrelizumab (Ocrevus) injection, 1 mg
$8.7M
358 claims · 2.4%
$8.1M
5K claims
$1,689.67
$266.41
Assertive community treatment, face-to-face, per 15 minutes
$8.1M
5K claims · 2.2%
Therapeutic exercises, each 15 min
$8.0M
96K claims · 2.2%
$7.6M
262K claims
$29.07
$18.95
Alcohol/drug services; methadone administration
$7.6M
262K claims · 2.1%
$5.2M
38K claims
$136.61
$215.80
Crisis intervention service, per 15 minutes
$5.2M
38K claims · 1.4%
$4.9M
4K claims · 1.3%
$4.6M
2K claims · 1.2%
Hospital outpatient clinic visit
$4.2M
32K claims · 1.1%
Psychotherapy, 60 minutes
$4.0M
24K claims · 1.1%
$3.8M
16K claims
$231.61
$148.53
Mental health partial hospitalization, treatment, per hour
$3.8M
16K claims · 1.0%
Emergency dept visit, low complexity
$3.6M
25K claims · 1.0%
$3.4M
1K claims
$3,245.97
$4,027.41
Injection, vedolizumab, one milligram
$3.4M
1K claims · 0.9%
$3.3M
17K claims
$193.99
$85.65
Emergency dept visit, high/urgent complexity
$3.3M
17K claims · 0.9%
$3.2M
15K claims
$214.51
$47.35
Alcohol and/or drug services, group counseling
$3.2M
15K claims · 0.9%
$3.2M
3K claims
$1,089.48
$763.43
Unlisted procedure, dentoalveolar structures
$3.2M
3K claims · 0.9%
$3.1M
6K claims
$485.03
$43.68
Chemotherapy infusion, each additional hour
$3.1M
6K claims · 0.9%
$3.1M
13K claims
$233.62
$40.58
Alcohol/substance abuse structured assessment, 15-30 minutes
$3.1M
13K claims · 0.9%
$3.0M
17K claims
$177.44
$54.77
IV infusion, therapeutic/prophylactic/diagnostic, initial, up to 1 hour
$3.0M
17K claims · 0.8%
$3.0M
85K claims
$34.99
$24.95
Chlamydia detection, nucleic acid, amplified probe
$3.0M
85K claims · 0.8%
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