Statistical flags indicate unusual patterns — not proof of fraud or wrongdoing. Read our methodology

Egleston Children's Hospital at Emory University Inc.

Pediatrics Pediatric Emergency Medicine·Atlanta, GA·NPI: 1558416701SharePrint Report
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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:

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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.

Risk Assessment

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Bills $669.22 per claim for 99285 (Emergency dept visit, high/urgent complexity) — 7.8× the national median of $85.65.

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Bills $166.72 per claim for 99283 (Emergency dept visit, moderate complexity) — 3.9× the national median of $42.48.

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Bills $355.36 per claim for 99284 (Emergency dept visit, high complexity) — 5.1× the national median of $69.51.

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Billing in the top 1% nationally for 6 procedure codes: 99285, 70551, 70553.

This is a statistical summary, not an accusation. See our methodology.

Active Billing Period:2018-01→2024-12(84 months)

Total Paid

$222.6M

$222,593,125

Total Claims

1.9M

Beneficiaries

1.6M

1.2 claims/patient

Avg Cost/Claim

$115

#382 of 618K providers by total spending(top <0.1%)

🔍 Analysis

Provider Overview

Egleston Children's Hospital at Emory University Inc. is a Pediatrics Pediatric Emergency Medicine provider based in Atlanta, GA. From the 2018–2024 period, this provider received $222.6M in Medicaid payments across 1.9M claims.

Why This Matters

This provider received $222.6M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 27,824 Medicaid beneficiaries for a full year at average per-enrollee costs.

↓ 43% growthsince first billing year

Monthly Spending Trend

Yearly Spending

2018
$45.5M
-1%
2019
$45.2M
-35%
2020
$29.5M
-2%
2021
$28.9M
-21%
2022
$22.9M
+6%
2023
$24.4M
+7%
2024
$26.2M

Procedure Breakdown

Cost per claim compared to national benchmarks

This provider bills for 30 distinct procedure codes. The top code (99285 (Emergency dept visit, high/urgent complexity)) accounts for 20% of total spending.

99285Top 1%

Emergency dept visit, high/urgent complexity

$45.5M

68K claims · 20.5%

Your Cost: $669.22/claim|Median: $85.65
7.8× median
99283Top 10%

Emergency dept visit, moderate complexity

$28.6M

172K claims · 12.8%

Your Cost: $166.72/claim|Median: $42.48
3.9× median
99284Top 5%

Emergency dept visit, high complexity

$26.5M

75K claims · 11.9%

Your Cost: $355.36/claim|Median: $69.51
5.1× median
G0378Top 25%

Hospital observation service, per hour

$6.1M

17K claims · 2.7%

Your Cost: $354.89/claim|Median: $99.39
3.6× median
J1569Top 25%

$5.4M

2K claims · 2.4%

Your Cost: $2,498.05/claim|Median: $1,387.65
1.8× median
J1745Top 25%

Injection, infliximab, excludes biosimilar, 10 mg

$5.2M

2K claims · 2.3%

Your Cost: $3,198.30/claim|Median: $1,587.53
2.0× median
70551Top 1%

MRI brain without contrast

$4.2M

4K claims · 1.9%

Your Cost: $946.86/claim|Median: $85.39
11.1× median
70553Top 1%

MRI brain without contrast, then with contrast

$3.8M

2K claims · 1.7%

Your Cost: $1,781.73/claim|Median: $133.68
13.3× median
43239Top 1%

Upper GI endoscopy with biopsy

$3.1M

2K claims · 1.4%

Your Cost: $1,470.81/claim|Median: $151.68
9.7× median
99213Top 5%

Office/outpatient visit, est. patient, low-mod complexity

$2.9M

30K claims · 1.3%

Your Cost: $95.68/claim|Median: $37.81
2.5× median
95810Top 5%

Polysomnography, sleep study, 6+ hours

$2.9M

2K claims · 1.3%

Your Cost: $1,634.76/claim|Median: $233.73
7.0× median
96413Top 5%

Chemotherapy administration, IV infusion, up to 1 hour

$2.8M

8K claims · 1.3%

Your Cost: $345.91/claim|Median: $75.28
4.6× median
P9016Top 5%

$2.7M

3K claims · 1.2%

Your Cost: $998.81/claim|Median: $122.26
8.2× median
95782Top 5%

$2.4M

1K claims · 1.1%

Your Cost: $1,674.59/claim|Median: $216.35
7.7× median
42820Top 25%

Tonsillectomy and adenoidectomy, under age 12

$2.2M

1K claims · 1.0%

Your Cost: $1,602.34/claim|Median: $331.68
4.8× median
99282Normal range

Emergency dept visit, low complexity

$2.0M

23K claims · 0.9%

Your Cost: $84.31/claim|Median: $37.72
2.2× median
93325Top 5%

$1.8M

10K claims · 0.8%

Your Cost: $182.17/claim|Median: $14.61
12.5× median
J0585Top 25%

Injection, onabotulinumtoxinA, 1 unit

$1.7M

2K claims · 0.8%

Your Cost: $1,021.83/claim|Median: $470.36
2.2× median
J9312Top 5%

$1.6M

255 claims · 0.7%

Your Cost: $6,401.27/claim|Median: $2,705.30
2.4× median
92611Top 5%

$1.6M

4K claims · 0.7%

Your Cost: $394.93/claim|Median: $47.58
8.3× median
74230Top 1%

$1.6M

4K claims · 0.7%

Your Cost: $391.72/claim|Median: $19.67
19.9× median
71046Top 5%

Chest X-ray, 2 views

$1.6M

24K claims · 0.7%

Your Cost: $66.79/claim|Median: $8.92
7.5× median
74183Top 1%

$1.6M

948 claims · 0.7%

Your Cost: $1,641.51/claim|Median: $151.91
10.8× median
70543Top 5%

$1.5M

816 claims · 0.7%

Your Cost: $1,828.21/claim|Median: $247.27
7.4× median
96365Normal range

IV infusion, therapeutic/prophylactic/diagnostic, initial, up to 1 hour

$1.4M

15K claims · 0.6%

Your Cost: $94.49/claim|Median: $54.77
1.7× median
70450Top 5%

CT head/brain without contrast

$1.4M

4K claims · 0.6%

Your Cost: $325.16/claim|Median: $45.53
7.1× median
94776Normal range

$1.3M

3K claims · 0.6%

Your Cost: $387.59/claim|Median: $313.90
1.2× median
93975Top 5%

Duplex scan of arterial inflow and venous outflow, complete

$1.3M

3K claims · 0.6%

Your Cost: $456.94/claim|Median: $79.28
5.8× median
69436Top 25%

Tympanostomy, general anesthesia

$1.2M

2K claims · 0.6%

Your Cost: $693.51/claim|Median: $205.50
3.4× median
37241Normal range

$1.2M

367 claims · 0.5%

Your Cost: $3,187.47/claim|Median: $4,600.28
0.7× median

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