Virginia Commonwealth University Health System Authority
General Acute Care Hospital
Richmond, Virginia
NPI: 1437175734
Risk Tier
Critical
Total Paid
$658.5M
$658,485,314
Total Claims
8.5M
Beneficiaries
6.3M
Avg Cost/Claim
$77.73
Active billing period: 84 months (2018-01 to 2024-12)
Statistical Fraud Flags (4)
Cost Outlier
Billing over 3× the national median for specific procedure codes.
Bills $185.10 per claim for G0463 (Hospital outpatient clinic visit), which is 7.0× the national median of $26.41.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 313 procedure codes: G0463 at 7.0× median, 99283 at 5.8× 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.
Advanced Detection Signals
Billing Velocity
4584.4 claims per working day — may exceed physically possible volume for a single provider.
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