Medical University Hospital Authority
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 233 procedure codes: 80053 at 13.4× median, 99211 at 5.1× 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 $96.94 per claim for 80053 (Comprehensive metabolic panel) — 13.4× the national median of $7.24.
Bills $66.28 per claim for 99211 (Office/outpatient visit, minimal complexity) — 5.1× the national median of $12.93.
Bills $53.43 per claim for 36415 (Collection of venous blood by venipuncture) — 34.0× the national median of $1.57.
Billing in the top 1% nationally for 5 procedure codes: 36415, 96372, A9585.
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 $241.4M is at the 50th percentile among 156 General Acute Care Hospital providers.
Total Paid
$241.4M
$241,430,553
Total Claims
5.9M
Beneficiaries
4.8M
1.2 claims/patient
Avg Cost/Claim
$41
#345 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Medical University Hospital Authority is a General Acute Care Hospital provider based in Charleston, SC. From the 2018–2024 period, this provider received $241.4M in Medicaid payments across 5.9M claims.
Why This Matters
This provider received $241.4M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 30,178 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 (99212 (Office/outpatient visit, low complexity)) accounts for 7% of total spending.
$17.6M
372K claims
$47.25
$25.06
Office/outpatient visit, low complexity
$17.6M
372K claims · 7.3%
Comprehensive metabolic panel
$16.5M
170K claims · 6.8%
$15.5M
233K claims
$66.28
$12.93
Office/outpatient visit, minimal complexity
$15.5M
233K claims · 6.4%
$13.2M
247K claims
$53.43
$1.57
Collection of venous blood by venipuncture
$13.2M
247K claims · 5.5%
$9.5M
53K claims
$181.47
$3.42
Low osmolar contrast material, 300-399 mg iodine/ml, per ml
$9.5M
53K claims · 4.0%
$6.8M
31K claims
$217.91
$9.56
Therapeutic injection, subcutaneous/intramuscular
$6.8M
31K claims · 2.8%
Basic metabolic panel
$5.1M
75K claims · 2.1%
$4.9M
6K claims · 2.0%
$4.4M
35K claims
$127.48
$63.08
Infectious disease detection (COVID-19)
$4.4M
35K claims · 1.8%
$4.2M
52K claims
$81.04
$24.95
Chlamydia detection, nucleic acid, amplified probe
$4.2M
52K claims · 1.8%
$4.0M
4K claims · 1.6%
Emergency dept visit, low complexity
$3.9M
27K claims · 1.6%
$3.8M
38K claims · 1.6%
$3.3M
25K claims
$129.38
$35.80
Surgical pathology, gross and microscopic examination
$3.3M
25K claims · 1.3%
$3.1M
8K claims
$385.16
$133.68
MRI brain without contrast, then with contrast
$3.1M
8K claims · 1.3%
$3.1M
80K claims
$38.60
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$3.1M
80K claims · 1.3%
Therapeutic exercises, each 15 min
$2.9M
47K claims · 1.2%
$2.6M
23K claims
$109.44
$54.77
IV infusion, therapeutic/prophylactic/diagnostic, initial, up to 1 hour
$2.6M
23K claims · 1.1%
$2.5M
29K claims
$86.25
$14.92
Therapeutic/prophylactic/diagnostic IV push, each additional substance
$2.5M
29K claims · 1.0%
MRI brain without contrast
$2.4M
9K claims · 1.0%
$2.2M
2K claims · 0.9%
$2.2M
20K claims
$108.78
$47.08
Ophthalmological exam, comprehensive, established patient
$2.2M
20K claims · 0.9%
Therapeutic activities, each 15 min
$2.1M
35K claims · 0.9%
$2.1M
19K claims
$107.64
$38.23
Ophthalmological exam, intermediate, established patient
$2.1M
19K claims · 0.9%
$2.1M
20K claims
$102.17
$100.62
Respiratory virus detection, 3-5 targets, nucleic acid
$2.1M
20K claims · 0.9%
$2.0M
8K claims
$257.45
$144.30
Proprietary lab analysis, human genomic sequencing
$2.0M
8K claims · 0.8%
$1.8M
14K claims · 0.7%
Speech/hearing/language treatment
$1.7M
23K claims · 0.7%
$1.7M
3K claims
$509.81
$233.73
Polysomnography, sleep study, 6+ hours
$1.7M
3K claims · 0.7%
$1.7M
16K claims
$103.35
$54.68
Echocardiography, transthoracic, complete, with Doppler
$1.7M
16K claims · 0.7%
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