Texas Children's Physician Group
Billing Swing
Experienced over 200% change in year-over-year billing with >$1M absolute change.
Billing changed from $7.2M (2020) to $37.0M (2021) — a 412% swing with $29.8M absolute change.
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:
Billing Swing
Billing Swing means this provider's total billing changed dramatically from one year to the next — increasing or decreasing by more than 200% with over $1M in absolute change. This could indicate a change in practice scope, a billing scheme ramping up, or legitimate growth.
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
Billing above the 90th percentile for 9 procedure codes simultaneously.
This is a statistical summary, not an accusation. See our methodology.
Compared to Pediatrics Peers
Total spending distribution among 14 providers in this specialty
This provider's total spending of $160.8M is at the 50th percentile among 14 Pediatrics providers.
Total Paid
$160.8M
$160,810,791
Total Claims
2.5M
Beneficiaries
2.2M
1.1 claims/patient
Avg Cost/Claim
$64
#642 of 618K providers by total spending(top 0.1%)
🔍 Analysis
Provider Overview
Texas Children's Physician Group is a Pediatrics provider based in Houston, TX. From the 2018–2024 period, this provider received $160.8M in Medicaid payments across 2.5M claims.
Why This Matters
This provider received $160.8M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 20,101 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 (99284 (Emergency dept visit, high complexity)) accounts for 12% of total spending.
$19.9M
182K claims
$109.32
$69.51
Emergency dept visit, high complexity
$19.9M
182K claims · 12.4%
$15.7M
262K claims
$59.93
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$15.7M
262K claims · 9.8%
$10.1M
63K claims
$161.06
$121.58
Office or other outpatient consultation, moderate complexity
$10.1M
63K claims · 6.3%
$9.5M
106K claims
$89.45
$74.09
Office/outpatient visit, high complexity
$9.5M
106K claims · 5.9%
$8.7M
207K claims
$41.88
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$8.7M
207K claims · 5.4%
$6.0M
52K claims
$115.03
$82.43
Office or other outpatient consultation, low complexity
$6.0M
52K claims · 3.8%
$6.0M
14K claims
$421.78
$307.98
Subsequent pediatric critical care, per day, age 2-5
$6.0M
14K claims · 3.7%
$5.8M
72K claims
$80.38
$35.30
Subsequent hospital care, per day, high complexity
$5.8M
72K claims · 3.6%
Anesthesia for intraoral procedures
$5.3M
20K claims · 3.3%
$4.3M
68K claims
$62.19
$42.48
Emergency dept visit, moderate complexity
$4.3M
68K claims · 2.6%
Critical care, first 30-74 minutes
$4.2M
18K claims · 2.6%
$3.9M
28K claims
$136.43
$85.65
Emergency dept visit, high/urgent complexity
$3.9M
28K claims · 2.4%
$3.4M
53K claims
$65.40
$57.85
Office/outpatient visit, new patient, low-mod complexity
$3.4M
53K claims · 2.1%
$2.7M
45K claims
$59.16
$23.99
Subsequent hospital care, per day, moderate complexity
$2.7M
45K claims · 1.6%
$2.5M
34K claims
$73.21
$37.22
Hospital discharge day management, 30 minutes or less
$2.5M
34K claims · 1.6%
$2.4M
5K claims
$449.58
$293.45
Subsequent intensive care, very low birth weight infant
$2.4M
5K claims · 1.5%
$2.2M
15K claims
$146.55
$98.15
Subsequent intensive care, very low birth weight infant
$2.2M
15K claims · 1.4%
$2.2M
22K claims
$98.88
$62.48
Initial hospital or birthing center care, newborn, per day
$2.2M
22K claims · 1.4%
$2.1M
16K claims
$126.12
$205.50
Tympanostomy, general anesthesia
$2.1M
16K claims · 1.3%
$2.0M
21K claims
$95.09
$84.03
Office/outpatient visit, new patient, mod-high complexity
$2.0M
21K claims · 1.2%
$1.8M
21K claims
$82.46
$112.83
Echocardiography, transthoracic, limited
$1.8M
21K claims · 1.1%
$1.8M
16K claims
$106.47
$54.68
Echocardiography, transthoracic, complete, with Doppler
$1.8M
16K claims · 1.1%
$1.6M
9K claims · 1.0%
$1.6M
19K claims
$85.41
$47.08
Ophthalmological exam, comprehensive, established patient
$1.6M
19K claims · 1.0%
$1.5M
31K claims
$47.49
$58.55
Ultrasound, pregnant uterus, follow-up
$1.5M
31K claims · 0.9%
Ultrasound, abdominal, limited
$1.3M
44K claims · 0.8%
$1.3M
4K claims
$300.82
$331.68
Tonsillectomy and adenoidectomy, under age 12
$1.3M
4K claims · 0.8%
$1.2M
11K claims
$108.97
$133.68
MRI brain without contrast, then with contrast
$1.2M
11K claims · 0.8%
$1.2M
102K claims
$11.54
$5.60
Electrocardiogram, interpretation and report only
$1.2M
102K claims · 0.7%
Chest X-ray, single view
$1.1M
141K claims · 0.7%
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