Bronxcare Health System
General Acute Care Hospital
Bronx, New York
NPI: 1417027558
Risk Tier
High
Total Paid
$348.4M
$348,432,639
Total Claims
5.7M
Beneficiaries
4.4M
Avg Cost/Claim
$60.65
Active billing period: 84 months (2018-01 to 2024-12)
Statistical Fraud Flags (2)
Cost Outlier
Billing over 3× the national median for specific procedure codes.
Bills $122.78 per claim for 99213 (Office/outpatient visit, est. patient, low-mod complexity), which is 3.2× the national median of $37.81.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 150 procedure codes: 99213 at 3.2× median, 99214 at 2.6× median.
Advanced Detection Signals
CUSUM Change Point
Billing shifted 3.6x in 2019-09 — a statistically significant structural change in billing behavior was detected.
Disclaimer: Statistical flags indicate unusual billing patterns — they are not proof of fraud or wrongdoing. Some entities (government agencies, home care programs, hospitals) may legitimately bill at higher rates due to patient acuity, overhead costs, or specialized services. This report is generated from public HHS data and statistical analysis only. No clinical or investigative review has been performed.
Generated by OpenMedicaid | openmedicaid.org | Data: HHS 2018-2024