Children's Hospital Medical Center of Akron
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $148.27 per claim for 99213 (Office/outpatient visit, est. patient, low-mod complexity), which is 3.9× the national median of $37.81.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 221 procedure codes: 99213 at 3.9× median, 99214 at 3.0× 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.
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 $148.27 per claim for 99213 (Office/outpatient visit, est. patient, low-mod complexity) — 3.9× the national median of $37.81.
Bills $162.46 per claim for 99214 (Office/outpatient visit, est. patient, mod-high complexity) — 3.0× the national median of $53.41.
Bills $151.33 per claim for 99283 (Emergency dept visit, moderate complexity) — 3.6× the national median of $42.48.
Billing in the top 1% nationally for 4 procedure codes: 92551, U0003, 96361.
This is a statistical summary, not an accusation. See our methodology.
Compared to General Acute Care Hospital Children Peers
Total spending distribution among 16 providers in this specialty
This provider's total spending of $556.6M is at the 99th percentile among 16 General Acute Care Hospital Children providers.
Above 99th percentile for this specialty — higher spending than 15 of 16 peers
Total Paid
$556.6M
$556,646,907
Total Claims
6.6M
Beneficiaries
5.6M
1.2 claims/patient
Avg Cost/Claim
$84
#101 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Children's Hospital Medical Center of Akron is a General Acute Care Hospital Children provider based in Akron, OH. From the 2018–2024 period, this provider received $556.6M in Medicaid payments across 6.6M claims.
Why This Matters
This provider received $556.6M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 69,580 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 (99213 (Office/outpatient visit, est. patient, low-mod complexity)) accounts for 26% of total spending.
$147.0M
991K claims
$148.27
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$147.0M
991K claims · 26.4%
$56.7M
349K claims
$162.46
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$56.7M
349K claims · 10.2%
$30.2M
217K claims
$139.08
$75.18
Preventive medicine, established patient, age 1-4
$30.2M
217K claims · 5.4%
$28.9M
216K claims
$134.26
$69.35
Preventive medicine, established patient, infant (under 1)
$28.9M
216K claims · 5.2%
$27.5M
162K claims
$169.82
$69.51
Emergency dept visit, high complexity
$27.5M
162K claims · 4.9%
$24.3M
161K claims
$151.33
$42.48
Emergency dept visit, moderate complexity
$24.3M
161K claims · 4.4%
$16.6M
121K claims
$137.27
$74.82
Preventive medicine, established patient, age 5-11
$16.6M
121K claims · 3.0%
$13.0M
142K claims
$91.19
$6.61
Screening audiometry, pure tone, air only
$13.0M
142K claims · 2.3%
Tympanostomy, general anesthesia
$10.6M
6K claims · 1.9%
$10.1M
62K claims
$164.29
$74.09
Office/outpatient visit, high complexity
$10.1M
62K claims · 1.8%
$9.4M
48K claims
$196.92
$85.65
Emergency dept visit, high/urgent complexity
$9.4M
48K claims · 1.7%
$8.6M
60K claims
$141.75
$25.06
Office/outpatient visit, low complexity
$8.6M
60K claims · 1.5%
$7.4M
54K claims
$137.86
$80.15
Preventive medicine, established patient, age 12-17
$7.4M
54K claims · 1.3%
Therapeutic activities, each 15 min
$6.1M
58K claims · 1.1%
Therapeutic exercises, each 15 min
$5.5M
45K claims · 1.0%
$5.3M
22K claims
$247.18
$63.08
Infectious disease detection (COVID-19)
$5.3M
22K claims · 1.0%
Psychotherapy, 45 minutes
$5.2M
26K claims · 0.9%
$5.2M
3K claims
$1,548.01
$331.68
Tonsillectomy and adenoidectomy, under age 12
$5.2M
3K claims · 0.9%
$4.8M
33K claims
$144.79
$10.88
Pressurized or nonpressurized inhalation treatment
$4.8M
33K claims · 0.9%
$4.8M
9K claims
$558.25
$38.92
IV infusion, hydration, each additional hour
$4.8M
9K claims · 0.9%
$3.9M
22K claims
$176.71
$169.17
Respiratory virus detection, 12-25 targets, nucleic acid
$3.9M
22K claims · 0.7%
Speech/hearing/language treatment
$3.7M
34K claims · 0.7%
$3.6M
5K claims
$742.03
$120.85
Prefabricated stainless steel crown, primary tooth
$3.6M
5K claims · 0.7%
$2.9M
2K claims
$1,801.72
$470.36
Injection, onabotulinumtoxinA, 1 unit
$2.9M
2K claims · 0.5%
$2.8M
28K claims
$100.20
$99.39
Hospital observation service, per hour
$2.8M
28K claims · 0.5%
Emergency dept visit, low complexity
$2.8M
19K claims · 0.5%
$2.6M
6K claims
$439.44
$54.68
Echocardiography, transthoracic, complete, with Doppler
$2.6M
6K claims · 0.5%
$2.6M
808 claims · 0.5%
$2.5M
335K claims
$7.53
$9.80
Immunization administration, 1 vaccine, percutaneous/ID/SC/IM
$2.5M
335K claims · 0.5%
$2.5M
14K claims
$178.88
$58.55
Ultrasound, pregnant uterus, follow-up
$2.5M
14K claims · 0.5%
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