Hennepin Healthcare System INC
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $718.32 per claim for A0427 (Ambulance, ALS emergency transport Level 1), which is 4.4× the national median of $164.22.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 149 procedure codes: G0463 at 3.5× median, A0429 at 4.8× median.
Unusually High Spending
This provider's total payments are significantly above the median for their specialty.
High Cost Per Claim
Average payment per claim is much higher than peers billing the same procedures.
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:
Cost Outlier
Cost Outlier means this provider charges significantly more per claim than other providers billing the same procedure codes. This could indicate upcoding, inflated charges, or specialized services that justify higher costs.
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.
Unusually High Spending
Unusually High Spending means this provider's total Medicaid payments are significantly above the median for their specialty. This doesn't necessarily indicate fraud — high volume practices and those serving complex populations may legitimately bill more.
High Cost Per Claim
High Cost Per Claim means each individual claim from this provider costs significantly more than what other providers charge for the same services. This could indicate upcoding (billing for more expensive services than provided) or legitimate specialized care.
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 $92.20 per claim for G0463 (Hospital outpatient clinic visit) — 3.5× the national median of $26.41.
Bills $657.82 per claim for A0429 (Ambulance, BLS emergency transport) — 4.8× the national median of $138.19.
Bills $718.32 per claim for A0427 (Ambulance, ALS emergency transport Level 1) — 4.4× the national median of $164.22.
Billing in the top 1% nationally for 2 procedure codes: 95004, A0433.
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 $708.9M is at the 90th percentile among 156 General Acute Care Hospital providers.
Above 90th percentile for this specialty — higher spending than 140 of 156 peers
Total Paid
$708.9M
$708,859,553
Total Claims
10.0M
Beneficiaries
7.4M
1.4 claims/patient
Avg Cost/Claim
$71
#68 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Hennepin Healthcare System INC is a General Acute Care Hospital provider based in Minneapolis, MN. From the 2018–2024 period, this provider received $708.9M in Medicaid payments across 10.0M claims.
Why This Matters
This provider received $708.9M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 88,607 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 (G0463 (Hospital outpatient clinic visit)) accounts for 15% of total spending.
Hospital outpatient clinic visit
$105.1M
1.1M claims · 14.8%
Ambulance, BLS emergency transport
$78.1M
119K claims · 11.0%
$67.7M
94K claims
$718.32
$164.22
Ambulance, ALS emergency transport Level 1
$67.7M
94K claims · 9.6%
$53.3M
262K claims
$203.43
$69.51
Emergency dept visit, high complexity
$53.3M
262K claims · 7.5%
$49.6M
203K claims
$244.75
$85.65
Emergency dept visit, high/urgent complexity
$49.6M
203K claims · 7.0%
$32.7M
461K claims
$70.94
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$32.7M
461K claims · 4.6%
$32.4M
190K claims
$170.45
$42.48
Emergency dept visit, moderate complexity
$32.4M
190K claims · 4.6%
$14.6M
298K claims
$49.01
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$14.6M
298K claims · 2.1%
Ground mileage, per statute mile
$14.0M
219K claims · 2.0%
$13.5M
261K claims
$51.88
$23.99
Subsequent hospital care, per day, moderate complexity
$13.5M
261K claims · 1.9%
Critical care, first 30-74 minutes
$13.5M
69K claims · 1.9%
$13.0M
807K claims
$16.09
$18.95
Alcohol/drug services; methadone administration
$13.0M
807K claims · 1.8%
$10.1M
146K claims
$69.13
$35.30
Subsequent hospital care, per day, high complexity
$10.1M
146K claims · 1.4%
$9.2M
93K claims
$98.81
$74.09
Office/outpatient visit, high complexity
$9.2M
93K claims · 1.3%
$7.1M
34K claims · 1.0%
$4.8M
3K claims
$1,834.14
$134.97
Percutaneous allergy skin tests, each
$4.8M
3K claims · 0.7%
$4.7M
228K claims
$20.56
$17.67
Sign language or oral interpretive services, per 15 minutes
$4.7M
228K claims · 0.7%
$4.6M
355K claims
$13.01
$1.57
Collection of venous blood by venipuncture
$4.6M
355K claims · 0.7%
$4.3M
60K claims
$72.37
$60.05
COVID-19 test, nucleic acid detection, CDC lab only
$4.3M
60K claims · 0.6%
$4.2M
37K claims
$114.80
$67.32
Initial hospital care, per day, high complexity
$4.2M
37K claims · 0.6%
$3.4M
77K claims · 0.5%
Psychotherapy, 45 minutes
$3.3M
39K claims · 0.5%
Injection, omalizumab, 5 mg
$3.3M
4K claims · 0.5%
$3.2M
38K claims
$85.05
$65.76
CT abdomen and pelvis with contrast
$3.2M
38K claims · 0.5%
$3.2M
39K claims
$81.73
$69.35
Preventive medicine, established patient, infant (under 1)
$3.2M
39K claims · 0.4%
$2.8M
58K claims · 0.4%
CT head/brain without contrast
$2.8M
61K claims · 0.4%
$2.6M
30K claims
$88.29
$75.18
Preventive medicine, established patient, age 1-4
$2.6M
30K claims · 0.4%
$2.6M
2K claims · 0.4%
$2.5M
33K claims
$77.32
$43.85
Hospital discharge day management, more than 30 minutes
$2.5M
33K claims · 0.4%
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