Cambridge Public Health Commission
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 66 procedure codes: 99213 at 2.5× median, 96361 at 9.2× 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 $131.30 per claim for 99283 (Emergency dept visit, moderate complexity) — 3.1× the national median of $42.48.
Bills $356.23 per claim for 96361 (IV infusion, hydration, each additional hour) — 9.2× the national median of $38.92.
Bills $114.70 per claim for 99212 (Office/outpatient visit, low complexity) — 4.6× the national median of $25.06.
Billing in the top 1% nationally for 1 procedure code: 96110.
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 $352.6M is at the 75th percentile among 156 General Acute Care Hospital providers.
Total Paid
$352.6M
$352,571,667
Total Claims
7.9M
Beneficiaries
6.8M
1.2 claims/patient
Avg Cost/Claim
$45
#192 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Cambridge Public Health Commission is a General Acute Care Hospital provider based in Cambridge, MA. From the 2018–2024 period, this provider received $352.6M in Medicaid payments across 7.9M claims.
Why This Matters
This provider received $352.6M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 44,071 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 (99213 (Office/outpatient visit, est. patient, low-mod complexity)) accounts for 14% of total spending.
$47.7M
495K claims
$96.34
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$47.7M
495K claims · 13.5%
$40.8M
445K claims
$91.54
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$40.8M
445K claims · 11.6%
$24.9M
190K claims
$131.30
$42.48
Emergency dept visit, moderate complexity
$24.9M
190K claims · 7.1%
$18.8M
127K claims
$147.74
$85.65
Emergency dept visit, high/urgent complexity
$18.8M
127K claims · 5.3%
$17.9M
148K claims
$121.14
$69.51
Emergency dept visit, high complexity
$17.9M
148K claims · 5.1%
$16.6M
47K claims
$356.23
$38.92
IV infusion, hydration, each additional hour
$16.6M
47K claims · 4.7%
$8.3M
287K claims
$28.91
$26.41
Hospital outpatient clinic visit
$8.3M
287K claims · 2.4%
$6.9M
60K claims
$114.70
$25.06
Office/outpatient visit, low complexity
$6.9M
60K claims · 2.0%
$6.2M
66K claims
$94.22
$74.09
Office/outpatient visit, high complexity
$6.2M
66K claims · 1.8%
$4.8M
52K claims
$93.40
$12.93
Office/outpatient visit, minimal complexity
$4.8M
52K claims · 1.4%
$4.6M
70K claims
$65.11
$63.08
Infectious disease detection (COVID-19)
$4.6M
70K claims · 1.3%
Therapeutic exercises, each 15 min
$4.1M
91K claims · 1.2%
$4.0M
54K claims
$74.81
$47.08
Ophthalmological exam, comprehensive, established patient
$4.0M
54K claims · 1.1%
Emergency dept visit, low complexity
$3.4M
27K claims · 1.0%
$3.4M
38K claims
$89.90
$69.35
Preventive medicine, established patient, infant (under 1)
$3.4M
38K claims · 1.0%
$3.3M
30K claims
$110.59
$100.62
Respiratory virus detection, 3-5 targets, nucleic acid
$3.3M
30K claims · 1.0%
$3.2M
23K claims
$139.60
$65.76
CT abdomen and pelvis with contrast
$3.2M
23K claims · 0.9%
Upper GI endoscopy with biopsy
$3.2M
8K claims · 0.9%
Colonoscopy with biopsy
$3.0M
6K claims · 0.9%
$3.0M
15K claims
$200.90
$9.10
Developmental screening, per standardized instrument
$3.0M
15K claims · 0.8%
$2.6M
30K claims
$85.01
$79.28
Duplex scan of arterial inflow and venous outflow, complete
$2.6M
30K claims · 0.7%
CT head/brain without contrast
$2.5M
29K claims · 0.7%
Psychotherapy, 45 minutes
$2.4M
94K claims · 0.7%
$2.2M
7K claims
$316.04
$169.17
Respiratory virus detection, 12-25 targets, nucleic acid
$2.2M
7K claims · 0.6%
Speech/hearing/language treatment
$2.2M
15K claims · 0.6%
$2.1M
25K claims
$84.86
$75.18
Preventive medicine, established patient, age 1-4
$2.1M
25K claims · 0.6%
$2.1M
17K claims
$126.73
$54.77
IV infusion, therapeutic/prophylactic/diagnostic, initial, up to 1 hour
$2.1M
17K claims · 0.6%
Fetal non-stress test
$2.1M
8K claims · 0.6%
$2.0M
19K claims
$106.83
$29.03
Arthrocentesis, aspiration/injection, major joint
$2.0M
19K claims · 0.6%
Ultrasound, pelvic, complete
$2.0M
25K claims · 0.6%
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