Unm Hospital
General Acute Care Hospital
Albuquerque, New Mexico
NPI: 1689747552
Risk Tier
High
Total Paid
$463.3M
$463,287,047
Total Claims
7.0M
Beneficiaries
6.0M
Avg Cost/Claim
$66.21
Active billing period: 84 months (2018-01 to 2024-12)
Statistical Fraud Flags (2)
Cost Outlier
Billing over 3× the national median for specific procedure codes.
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.
Advanced Detection Signals
Billing Velocity
3786.2 claims per working day — may exceed physically possible volume for a single provider.
Disclaimer: Statistical flags indicate unusual billing patterns — they are not proof of fraud or wrongdoing. Some entities (government agencies, home care programs, hospitals) may legitimately bill at higher rates due to patient acuity, overhead costs, or specialized services. This report is generated from public HHS data and statistical analysis only. No clinical or investigative review has been performed.
Generated by OpenMedicaid | openmedicaid.org | Data: HHS 2018-2024