Statistical flags indicate unusual patterns — not proof of fraud or wrongdoing. Read our methodology

Children's Hospital Corporation

Clinic/Center·Boston, MA·NPI: 1710087127SharePrint Report
View on Risk Watchlist →

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:

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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

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Bills $130.51 per claim for 99213 (Office/outpatient visit, est. patient, low-mod complexity) — 3.5× the national median of $37.81.

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Bills $180.31 per claim for 99283 (Emergency dept visit, moderate complexity) — 4.2× the national median of $42.48.

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Bills $939.54 per claim for 96413 (Chemotherapy administration, IV infusion, up to 1 hour) — 12.5× the national median of $75.28.

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Billing in the top 1% nationally for 4 procedure codes: 96413, 96366, 96361.

This is a statistical summary, not an accusation. See our methodology.

Compared to Clinic/Center Peers

Total spending distribution among 13 providers in this specialty

P25MedianP75P90

This provider's total spending of $330.8M is at the 99th percentile among 13 Clinic/Center providers.

Above 99th percentile for this specialty — higher spending than 12 of 13 peers

Active Billing Period:2018-01→2024-12(84 months)

Total Paid

$330.8M

$330,793,080

Total Claims

4.7M

Beneficiaries

4.3M

1.1 claims/patient

Avg Cost/Claim

$70

#216 of 618K providers by total spending(top <0.1%)

🔍 Analysis

Provider Overview

Children's Hospital Corporation is a Clinic/Center provider based in Boston, MA. From the 2018–2024 period, this provider received $330.8M in Medicaid payments across 4.7M claims.

Why This Matters

This provider received $330.8M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 41,349 Medicaid beneficiaries for a full year at average per-enrollee costs.

↑ 25% growthsince first billing year

Monthly Spending Trend

Yearly Spending

2018
$41.1M
+2%
2019
$42.2M
-9%
2020
$38.2M
+22%
2021
$46.6M
+14%
2022
$53.3M
+9%
2023
$58.0M
-11%
2024
$51.5M

Procedure Breakdown

Cost per claim compared to national benchmarks

This provider bills for 30 distinct procedure codes. The top code (99213 (Office/outpatient visit, est. patient, low-mod complexity)) accounts for 5% of total spending.

99213Top 5%

Office/outpatient visit, est. patient, low-mod complexity

$17.6M

135K claims · 5.3%

Your Cost: $130.51/claim|Median: $37.81
3.5× median
99283Top 10%

Emergency dept visit, moderate complexity

$13.5M

75K claims · 4.1%

Your Cost: $180.31/claim|Median: $42.48
4.2× median
99214Top 5%

Office/outpatient visit, est. patient, mod-high complexity

$11.7M

76K claims · 3.5%

Your Cost: $154.26/claim|Median: $53.41
2.9× median
99284Top 10%

Emergency dept visit, high complexity

$11.5M

58K claims · 3.5%

Your Cost: $199.83/claim|Median: $69.51
2.9× median
J1745Normal range

Injection, infliximab, excludes biosimilar, 10 mg

$10.4M

5K claims · 3.1%

Your Cost: $2,079.05/claim|Median: $1,587.53
1.3× median
96413Top 1%

Chemotherapy administration, IV infusion, up to 1 hour

$10.0M

11K claims · 3.0%

Your Cost: $939.54/claim|Median: $75.28
12.5× median
99285Top 10%

Emergency dept visit, high/urgent complexity

$9.7M

36K claims · 2.9%

Your Cost: $267.28/claim|Median: $85.65
3.1× median
96366Top 1%

IV infusion, therapeutic/prophylactic/diagnostic, each additional hour

$7.7M

8K claims · 2.3%

Your Cost: $916.13/claim|Median: $40.12
22.8× median
J1561Normal range

$7.6M

4K claims · 2.3%

Your Cost: $1,868.26/claim|Median: $1,482.84
1.3× median
41899Top 25%

Unlisted procedure, dentoalveolar structures

$7.2M

4K claims · 2.2%

Your Cost: $1,799.12/claim|Median: $763.43
2.4× median
69436Top 5%

Tympanostomy, general anesthesia

$7.0M

4K claims · 2.1%

Your Cost: $1,601.25/claim|Median: $205.50
7.8× median
42820Top 25%

Tonsillectomy and adenoidectomy, under age 12

$6.8M

3K claims · 2.1%

Your Cost: $2,184.32/claim|Median: $331.68
6.6× median
96361Top 1%

IV infusion, hydration, each additional hour

$5.5M

8K claims · 1.7%

Your Cost: $652.42/claim|Median: $38.92
16.8× median
43239Top 5%

Upper GI endoscopy with biopsy

$5.3M

5K claims · 1.6%

Your Cost: $966.28/claim|Median: $151.68
6.4× median
J3490Top 5%

Unclassified drugs

$4.5M

18K claims · 1.4%

Your Cost: $254.32/claim|Median: $5.70
44.6× median
70551Top 10%

MRI brain without contrast

$4.5M

12K claims · 1.4%

Your Cost: $364.57/claim|Median: $85.39
4.3× median
G0378Normal range

Hospital observation service, per hour

$4.3M

35K claims · 1.3%

Your Cost: $123.49/claim|Median: $99.39
1.2× median
93303Top 25%

Echocardiography, transthoracic, limited

$4.2M

15K claims · 1.3%

Your Cost: $288.57/claim|Median: $112.83
2.6× median
93306Top 5%

Echocardiography, transthoracic, complete, with Doppler

$3.8M

13K claims · 1.2%

Your Cost: $289.44/claim|Median: $54.68
5.3× median
96365Top 5%

IV infusion, therapeutic/prophylactic/diagnostic, initial, up to 1 hour

$3.7M

15K claims · 1.1%

Your Cost: $246.40/claim|Median: $54.77
4.5× median
99391Top 5%

Preventive medicine, established patient, infant (under 1)

$3.6M

30K claims · 1.1%

Your Cost: $120.06/claim|Median: $69.35
1.7× median
Q5103Top 25%

$3.6M

2K claims · 1.1%

Your Cost: $2,177.52/claim|Median: $1,075.28
2.0× median
90834Top 1%

Psychotherapy, 45 minutes

$3.4M

11K claims · 1.0%

Your Cost: $313.57/claim|Median: $63.65
4.9× median
87635Top 10%

COVID-19 SARS-CoV-2 amplified probe detection

$3.3M

63K claims · 1.0%

Your Cost: $51.56/claim|Median: $39.70
1.3× median
99392Top 10%

Preventive medicine, established patient, age 1-4

$3.2M

30K claims · 1.0%

Your Cost: $106.56/claim|Median: $75.18
1.4× median
99282Top 10%

Emergency dept visit, low complexity

$3.2M

19K claims · 1.0%

Your Cost: $168.92/claim|Median: $37.72
4.5× median
70553Top 5%

MRI brain without contrast, then with contrast

$3.1M

4K claims · 0.9%

Your Cost: $752.94/claim|Median: $133.68
5.6× median
76770Top 5%

Ultrasound, retroperitoneal, complete

$3.1M

16K claims · 0.9%

Your Cost: $193.00/claim|Median: $37.35
5.2× median
J0585Top 25%

Injection, onabotulinumtoxinA, 1 unit

$3.1M

3K claims · 0.9%

Your Cost: $990.45/claim|Median: $470.36
2.1× median
49452Top 5%

$2.9M

3K claims · 0.9%

Your Cost: $1,112.89/claim|Median: $279.23
4.0× median

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