St Josephs University Medical Center Inc.
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $352.94 per claim for 99284 (Emergency dept visit, high complexity), which is 5.1× the national median of $69.51.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 97 procedure codes: 99284 at 5.1× median, 99283 at 7.0× 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:
Cost Outlier
Cost Outlier means this provider charges significantly more per claim than other providers billing the same procedure codes. This could indicate upcoding, inflated charges, or specialized services that justify higher costs.
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
Bills $352.94 per claim for 99284 (Emergency dept visit, high complexity) — 5.1× the national median of $69.51.
Bills $295.44 per claim for 99283 (Emergency dept visit, moderate complexity) — 7.0× the national median of $42.48.
Bills $497.97 per claim for 99285 (Emergency dept visit, high/urgent complexity) — 5.8× the national median of $85.65.
Billing above the 90th percentile for 14 procedure codes simultaneously.
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 $322.4M is at the 75th percentile among 156 General Acute Care Hospital providers.
Total Paid
$322.4M
$322,401,873
Total Claims
4.7M
Beneficiaries
3.9M
1.2 claims/patient
Avg Cost/Claim
$68
#222 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
St Josephs University Medical Center Inc. is a General Acute Care Hospital provider based in Paterson, NJ. From the 2018–2024 period, this provider received $322.4M in Medicaid payments across 4.7M claims.
Why This Matters
This provider received $322.4M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 40,300 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 (99284 (Emergency dept visit, high complexity)) accounts for 18% of total spending.
$59.3M
168K claims
$352.94
$69.51
Emergency dept visit, high complexity
$59.3M
168K claims · 18.4%
$53.8M
182K claims
$295.44
$42.48
Emergency dept visit, moderate complexity
$53.8M
182K claims · 16.7%
$33.4M
67K claims
$497.97
$85.65
Emergency dept visit, high/urgent complexity
$33.4M
67K claims · 10.4%
$8.0M
11K claims
$696.62
$99.39
Hospital observation service, per hour
$8.0M
11K claims · 2.5%
Emergency dept visit, low complexity
$7.0M
35K claims · 2.2%
Psychotherapy, 30 minutes
$5.6M
51K claims · 1.7%
Upper GI endoscopy with biopsy
$5.1M
9K claims · 1.6%
$4.8M
20K claims
$240.75
$148.53
Mental health partial hospitalization, treatment, per hour
$4.8M
20K claims · 1.5%
$4.6M
6K claims
$820.65
$135.70
Intensive outpatient psychiatric services, per diem
$4.6M
6K claims · 1.4%
$3.9M
11K claims
$369.13
$54.68
Echocardiography, transthoracic, complete, with Doppler
$3.9M
11K claims · 1.2%
$3.7M
29K claims
$127.98
$52.03
Emergency dept visit, minimal complexity
$3.7M
29K claims · 1.2%
CT head/brain without contrast
$3.5M
27K claims · 1.1%
$3.4M
57K claims
$58.82
$63.08
Infectious disease detection (COVID-19)
$3.4M
57K claims · 1.0%
CT abdomen and pelvis with contrast
$3.3M
19K claims · 1.0%
$3.2M
17K claims · 1.0%
$3.2M
86K claims
$37.46
$24.49
Therapeutic exercises, each 15 min
$3.2M
86K claims · 1.0%
Colonoscopy with biopsy
$2.8M
6K claims · 0.9%
$2.8M
12K claims
$237.48
$164.22
Ambulance, ALS emergency transport Level 1
$2.8M
12K claims · 0.9%
$2.7M
23K claims
$113.83
$47.65
Ultrasound, pregnant uterus, transvaginal
$2.7M
23K claims · 0.8%
$2.6M
54K claims
$47.92
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$2.6M
54K claims · 0.8%
$2.5M
38K claims
$66.26
$14.92
Therapeutic/prophylactic/diagnostic IV push, each additional substance
$2.5M
38K claims · 0.8%
$2.5M
109K claims
$22.82
$7.50
Electrocardiogram, tracing only, without interpretation
$2.5M
109K claims · 0.8%
$2.5M
40K claims
$61.99
$49.45
Speech/hearing/language treatment
$2.5M
40K claims · 0.8%
$2.4M
59K claims
$41.22
$21.76
Therapeutic/prophylactic/diagnostic IV push, single substance
$2.4M
59K claims · 0.8%
Fetal non-stress test
$2.4M
12K claims · 0.7%
$2.3M
2K claims
$1,243.87
$763.43
Unlisted procedure, dentoalveolar structures
$2.3M
2K claims · 0.7%
$2.3M
30K claims · 0.7%
$2.3M
53K claims
$42.50
$9.56
Therapeutic injection, subcutaneous/intramuscular
$2.3M
53K claims · 0.7%
Comprehensive metabolic panel
$2.2M
155K claims · 0.7%
$2.2M
41K claims
$53.54
$38.92
IV infusion, hydration, each additional hour
$2.2M
41K claims · 0.7%
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