Baltimore Medical System INC
Billing Swing
Experienced over 200% change in year-over-year billing with >$1M absolute change.
Billing changed from $1.9M (2019) to $22.8M (2020) — a 1104% swing with $20.9M absolute change.
Explosive Growth
Billing increased over 500% year-over-year — far beyond normal growth patterns.
Billing grew 1104% from 2019 to 2020.
High Cost Per Claim
Average payment per claim is much higher than peers billing the same procedures.
Spending Spike
Experienced a dramatic increase in billing over a short period.
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:
Billing Swing
Billing Swing means this provider's total billing changed dramatically from one year to the next — increasing or decreasing by more than 200% with over $1M in absolute change. This could indicate a change in practice scope, a billing scheme ramping up, or legitimate growth.
Explosive Growth
Explosive Growth means this provider's billing increased by more than 500% year-over-year. While rapid expansion can be legitimate, this pattern has been observed in fraud schemes that ramp up billing quickly before detection.
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.
Spending Spike
Spending Spike means this provider experienced a dramatic, sudden increase in billing over a short period. Legitimate causes include new contracts or expanded services, but this pattern also appears in billing fraud ramp-ups.
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 $213.92 per claim for 99213 (Office/outpatient visit, est. patient, low-mod complexity) — 5.7× the national median of $37.81.
Bills $204.97 per claim for 99214 (Office/outpatient visit, est. patient, mod-high complexity) — 3.8× the national median of $53.41.
Bills $214.66 per claim for 99212 (Office/outpatient visit, low complexity) — 8.6× the national median of $25.06.
Billing in the top 1% nationally for 11 procedure codes: 99213, 99214, 99212.
This is a statistical summary, not an accusation. See our methodology.
Compared to Clinic/Center Federally Qualified Health Center (FQHC) Peers
Total spending distribution among 24 providers in this specialty
This provider's total spending of $121.2M is at the 25th percentile among 24 Clinic/Center Federally Qualified Health Center (FQHC) providers.
Total Paid
$121.2M
$121,188,457
Total Claims
958K
Beneficiaries
794K
1.2 claims/patient
Avg Cost/Claim
$127
#988 of 618K providers by total spending(top 0.2%)
🔍 Analysis
Provider Overview
Baltimore Medical System INC is a Clinic/Center Federally Qualified Health Center (FQHC) provider based in Baltimore, MD. From the 2018–2024 period, this provider received $121.2M in Medicaid payments across 958K claims.
Why This Matters
This provider received $121.2M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 15,148 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 39% of total spending.
$47.8M
223K claims
$213.92
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$47.8M
223K claims · 39.4%
$24.1M
117K claims
$204.97
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$24.1M
117K claims · 19.8%
$15.5M
170K claims
$91.18
$121.16
Clinic visit/encounter, all-inclusive
$15.5M
170K claims · 12.8%
$8.9M
41K claims
$214.66
$25.06
Office/outpatient visit, low complexity
$8.9M
41K claims · 7.3%
$6.3M
29K claims
$219.66
$69.35
Preventive medicine, established patient, infant (under 1)
$6.3M
29K claims · 5.2%
$6.2M
27K claims
$229.67
$75.18
Preventive medicine, established patient, age 1-4
$6.2M
27K claims · 5.1%
$4.5M
20K claims
$229.13
$74.82
Preventive medicine, established patient, age 5-11
$4.5M
20K claims · 3.7%
$3.0M
13K claims
$223.23
$80.15
Preventive medicine, established patient, age 12-17
$3.0M
13K claims · 2.5%
$1.7M
8K claims
$213.41
$74.09
Office/outpatient visit, high complexity
$1.7M
8K claims · 1.4%
$1.1M
6K claims
$192.92
$72.71
Preventive medicine, established patient, age 18-39
$1.1M
6K claims · 0.9%
$382K
2K claims
$202.00
$73.46
Preventive visit, new patient, infant (<1 yr)
$382K
2K claims · 0.3%
$306K
3K claims
$91.35
$74.63
Behavioral health counseling & therapy, per 15 min
$306K
3K claims · 0.3%
$283K
1K claims
$198.70
$12.93
Office/outpatient visit, minimal complexity
$283K
1K claims · 0.2%
$189K
975 claims
$193.78
$76.22
Preventive visit, new patient, 18-39 yr
$189K
975 claims · 0.2%
$129K
741 claims
$173.90
$57.85
Office/outpatient visit, new patient, low-mod complexity
$129K
741 claims · 0.1%
$129K
604 claims
$213.01
$76.06
Preventive medicine, established patient, age 40-64
$129K
604 claims · 0.1%
$116K
531 claims
$218.63
$35.89
Diabetes self-management training, individual
$116K
531 claims · 0.1%
$52K
2K claims
$33.54
$25.93
COVID-19 vaccine admin, Moderna, 1st dose
$52K
2K claims · 0.0%
$50K
237 claims
$209.07
$83.63
Preventive visit, new patient, adolescent (12-17 yr)
$50K
237 claims · 0.0%
$45K
34K claims
$1.31
$7.18
Influenza virus vaccine, quadrivalent, preservative-free, IM
$45K
34K claims · 0.0%
$39K
1K claims
$34.36
$33.85
COVID-19 vaccine admin, Moderna, 2nd dose
$39K
1K claims · 0.0%
$39K
195 claims
$198.13
$81.92
Preventive visit, new patient, late childhood (5-11 yr)
$39K
195 claims · 0.0%
$38K
247 claims
$153.83
$40.11
Office/outpatient visit, new patient, low complexity
$38K
247 claims · 0.0%
$34K
173 claims
$194.35
$84.03
Office/outpatient visit, new patient, mod-high complexity
$34K
173 claims · 0.0%
Vaginal delivery only
$29K
40 claims · 0.0%
$24K
2K claims · 0.0%
Tdap vaccine
$18K
2K claims · 0.0%
Preventive visit, new patient, 40-64 yr
$18K
87 claims · 0.0%
$16K
81 claims
$198.06
$111.09
Office/outpatient visit, new patient, high complexity
$16K
81 claims · 0.0%
Urine pregnancy test
$15K
12K claims · 0.0%
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