Unm Hospital
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $79.45 per claim for G0463 (Hospital outpatient clinic visit), which is 3.0× the national median of $26.41.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 423 procedure codes: 99283 at 3.4× median, 95004 at 31.5× 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.
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 $79.45 per claim for G0463 (Hospital outpatient clinic visit) — 3.0× the national median of $26.41.
Bills $345.43 per claim for G9001 — 6.4× the national median of $53.98.
Bills $143.97 per claim for 99283 (Emergency dept visit, moderate complexity) — 3.4× the national median of $42.48.
Billing in the top 1% nationally for 1 procedure code: 95004.
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 $463.3M 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
$463.3M
$463,287,047
Total Claims
7.0M
Beneficiaries
6.0M
1.2 claims/patient
Avg Cost/Claim
$66
#133 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Unm Hospital is a General Acute Care Hospital provider based in Albuquerque, NM. From the 2018–2024 period, this provider received $463.3M in Medicaid payments across 7.0M claims.
Why This Matters
This provider received $463.3M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 57,910 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 16% of total spending.
Hospital outpatient clinic visit
$72.3M
910K claims · 15.6%
$31.6M
92K claims · 6.8%
$16.6M
115K claims
$143.97
$42.48
Emergency dept visit, moderate complexity
$16.6M
115K claims · 3.6%
$12.1M
3K claims
$4,256.48
$134.97
Percutaneous allergy skin tests, each
$12.1M
3K claims · 2.6%
$10.5M
41K claims
$259.58
$85.65
Emergency dept visit, high/urgent complexity
$10.5M
41K claims · 2.3%
$10.5M
91K claims
$115.38
$5.42
Annual wellness visit, subsequent visit
$10.5M
91K claims · 2.3%
$10.2M
24K claims
$422.64
$99.39
Hospital observation service, per hour
$10.2M
24K claims · 2.2%
$8.7M
50K claims
$174.85
$69.51
Emergency dept visit, high complexity
$8.7M
50K claims · 1.9%
$6.5M
3K claims
$2,012.04
$1,588.22
ALS mileage, per mile, fixed wing
$6.5M
3K claims · 1.4%
$6.4M
2K claims
$3,087.25
$1,587.53
Injection, infliximab, excludes biosimilar, 10 mg
$6.4M
2K claims · 1.4%
Injection, pembrolizumab, 1 mg
$6.4M
817 claims · 1.4%
CT abdomen and pelvis with contrast
$5.8M
22K claims · 1.3%
CT head/brain without contrast
$5.2M
27K claims · 1.1%
$5.0M
3K claims
$1,551.80
$1,235.61
ALS mileage, per mile, fixed wing, level 2
$5.0M
3K claims · 1.1%
$4.1M
81K claims
$50.84
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$4.1M
81K claims · 0.9%
$4.0M
70K claims
$57.53
$7.50
Electrocardiogram, tracing only, without interpretation
$4.0M
70K claims · 0.9%
$3.9M
784 claims · 0.8%
Basic metabolic panel
$3.5M
230K claims · 0.8%
$3.4M
36K claims
$94.69
$91.63
Psychosocial rehabilitation services, per 15 min
$3.4M
36K claims · 0.7%
$3.3M
6K claims
$571.11
$470.36
Injection, onabotulinumtoxinA, 1 unit
$3.3M
6K claims · 0.7%
$3.1M
76K claims
$40.28
$35.43
Drug test, presumptive, by chemistry analyzers
$3.1M
76K claims · 0.7%
$3.0M
6K claims
$528.08
$112.83
Echocardiography, transthoracic, limited
$3.0M
6K claims · 0.7%
$3.0M
18K claims
$162.95
$132.62
Assertive community treatment, per diem
$3.0M
18K claims · 0.6%
CT chest with contrast
$3.0M
12K claims · 0.6%
Therapeutic exercises, each 15 min
$2.9M
55K claims · 0.6%
$2.8M
7K claims
$405.73
$54.68
Echocardiography, transthoracic, complete, with Doppler
$2.8M
7K claims · 0.6%
$2.8M
11K claims
$261.67
$227.82
Multisystemic therapy for juveniles, per 15 minutes
$2.8M
11K claims · 0.6%
$2.7M
6K claims
$439.28
$133.68
MRI brain without contrast, then with contrast
$2.7M
6K claims · 0.6%
Therapeutic activities, each 15 min
$2.4M
30K claims · 0.5%
$2.3M
27K claims
$86.83
$37.72
Emergency dept visit, low complexity
$2.3M
27K claims · 0.5%
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