Baystate Medical Center INC
General Acute Care Hospital
Springfield, Massachusetts
NPI: 1487655064
Risk Tier
High
Total Paid
$374.5M
$374,467,034
Total Claims
7.8M
Beneficiaries
6.8M
Avg Cost/Claim
$47.97
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 $146.05 per claim for 99211 (Office/outpatient visit, minimal complexity), which is 11.3× the national median of $12.93.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 123 procedure codes: 99211 at 11.3× median, 99283 at 3.7× median.
Advanced Detection Signals
Billing Velocity
4223.8 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