The Cleveland Clinic Foundation
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $106.53 per claim for G0463 (Hospital outpatient clinic visit), which is 4.0× the national median of $26.41.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 227 procedure codes: G0463 at 4.0× median, 96361 at 9.4× median.
Unusually High Spending
This provider's total payments are significantly above the median for their specialty.
High Cost Per Claim
Average payment per claim is much higher than peers billing the same procedures.
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.
Unusually High Spending
Unusually High Spending means this provider's total Medicaid payments are significantly above the median for their specialty. This doesn't necessarily indicate fraud — high volume practices and those serving complex populations may legitimately bill more.
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.
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 $106.53 per claim for G0463 (Hospital outpatient clinic visit) — 4.0× the national median of $26.41.
Bills $365.37 per claim for 96361 (IV infusion, hydration, each additional hour) — 9.4× the national median of $38.92.
Bills $85.20 per claim for 97110 (Therapeutic exercises, each 15 min) — 3.5× the national median of $24.49.
Billing in the top 1% nationally for 2 procedure codes: 96127, 96110.
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 $863.5M is at the 90th percentile among 156 General Acute Care Hospital providers.
Above 90th percentile for this specialty — higher spending than 140 of 156 peers
Total Paid
$863.5M
$863,549,396
Total Claims
16.0M
Beneficiaries
12.9M
1.2 claims/patient
Avg Cost/Claim
$54
#46 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
The Cleveland Clinic Foundation is a General Acute Care Hospital provider based in Cleveland, OH. From the 2018–2024 period, this provider received $863.5M in Medicaid payments across 16.0M claims.
Why This Matters
This provider received $863.5M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 107,943 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 (G0463 (Hospital outpatient clinic visit)) accounts for 31% of total spending.
Hospital outpatient clinic visit
$270.0M
2.5M claims · 31.3%
$45.3M
518K claims
$87.38
$85.65
Emergency dept visit, high/urgent complexity
$45.3M
518K claims · 5.2%
$37.4M
582K claims
$64.19
$69.51
Emergency dept visit, high complexity
$37.4M
582K claims · 4.3%
$34.3M
2K claims
$19,026.92
$17,264.74
Ocrelizumab (Ocrevus) injection, 1 mg
$34.3M
2K claims · 4.0%
$21.6M
619K claims
$34.86
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$21.6M
619K claims · 2.5%
$20.3M
807K claims
$25.20
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$20.3M
807K claims · 2.4%
Injection, pembrolizumab, 1 mg
$14.6M
2K claims · 1.7%
$14.6M
239K claims
$60.97
$42.48
Emergency dept visit, moderate complexity
$14.6M
239K claims · 1.7%
$11.3M
31K claims
$365.37
$38.92
IV infusion, hydration, each additional hour
$11.3M
31K claims · 1.3%
$10.1M
14K claims
$747.17
$470.36
Injection, onabotulinumtoxinA, 1 unit
$10.1M
14K claims · 1.2%
Therapeutic exercises, each 15 min
$8.7M
102K claims · 1.0%
$7.8M
76K claims
$103.82
$54.68
Echocardiography, transthoracic, complete, with Doppler
$7.8M
76K claims · 0.9%
$7.0M
90K claims
$77.49
$69.35
Preventive medicine, established patient, infant (under 1)
$7.0M
90K claims · 0.8%
$6.7M
80K claims
$83.63
$75.18
Preventive medicine, established patient, age 1-4
$6.7M
80K claims · 0.8%
$6.3M
64K claims
$99.30
$58.55
Ultrasound, pregnant uterus, follow-up
$6.3M
64K claims · 0.7%
$6.3M
40K claims · 0.7%
$5.9M
2K claims · 0.7%
$5.5M
28K claims
$194.34
$54.77
IV infusion, therapeutic/prophylactic/diagnostic, initial, up to 1 hour
$5.5M
28K claims · 0.6%
$5.5M
58K claims
$94.56
$3.67
Brief emotional/behavioral assessment, per standardized instrument
$5.5M
58K claims · 0.6%
Upper GI endoscopy with biopsy
$5.2M
15K claims · 0.6%
$5.0M
147K claims
$34.04
$35.80
Surgical pathology, gross and microscopic examination
$5.0M
147K claims · 0.6%
$4.7M
34K claims
$138.58
$63.08
Infectious disease detection (COVID-19)
$4.7M
34K claims · 0.5%
$4.5M
34K claims
$131.35
$72.71
Preventive medicine, established patient, age 18-39
$4.5M
34K claims · 0.5%
$4.5M
22K claims
$205.43
$65.45
Respiratory virus detection, 3-5 targets, multiplex
$4.5M
22K claims · 0.5%
$4.2M
9K claims
$464.24
$233.73
Polysomnography, sleep study, 6+ hours
$4.2M
9K claims · 0.5%
$4.1M
86K claims
$47.90
$101.24
Critical care, first 30-74 minutes
$4.1M
86K claims · 0.5%
$4.1M
3K claims · 0.5%
$3.9M
16K claims
$249.99
$9.10
Developmental screening, per standardized instrument
$3.9M
16K claims · 0.5%
$3.9M
834 claims · 0.5%
Comprehensive metabolic panel
$3.8M
302K claims · 0.4%
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