Norton Hospitals, INC
Billing Swing
Experienced over 200% change in year-over-year billing with >$1M absolute change.
Billing changed from $1.3M (2021) to $25.7M (2022) — a 1845% swing with $24.4M absolute change.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 295 procedure codes: 99284 at 4.4× median, 99283 at 6.5× median.
Explosive Growth
Billing increased over 500% year-over-year — far beyond normal growth patterns.
Billing grew 1845% from 2021 to 2022.
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.
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.
Explosive Growth
Explosive Growth means this provider's billing increased by more than 500% year-over-year. While rapid expansion can be legitimate, this pattern has been observed in fraud schemes that ramp up billing quickly before detection.
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 $308.27 per claim for 99284 (Emergency dept visit, high complexity) — 4.4× the national median of $69.51.
Bills $275.04 per claim for 99283 (Emergency dept visit, moderate complexity) — 6.5× the national median of $42.48.
Bills $658.87 per claim for 74177 (CT abdomen and pelvis with contrast) — 10.0× the national median of $65.76.
Billing in the top 1% nationally for 3 procedure codes: 93306, 72148, 72141.
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 $299.0M is at the 75th percentile among 156 General Acute Care Hospital providers.
Total Paid
$299.0M
$299,002,604
Total Claims
3.2M
Beneficiaries
2.2M
1.4 claims/patient
Avg Cost/Claim
$94
#246 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Norton Hospitals, INC is a General Acute Care Hospital provider based in Louisville, KY. From the 2018–2024 period, this provider received $299.0M in Medicaid payments across 3.2M claims.
Why This Matters
This provider received $299.0M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 37,375 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 9% of total spending.
$25.5M
83K claims
$308.27
$69.51
Emergency dept visit, high complexity
$25.5M
83K claims · 8.5%
$24.8M
90K claims
$275.04
$42.48
Emergency dept visit, moderate complexity
$24.8M
90K claims · 8.3%
CT abdomen and pelvis with contrast
$11.5M
17K claims · 3.8%
$9.8M
34K claims
$287.76
$85.65
Emergency dept visit, high/urgent complexity
$9.8M
34K claims · 3.3%
Injection, pembrolizumab, 1 mg
$9.5M
1K claims · 3.2%
Emergency dept visit, low complexity
$8.8M
37K claims · 2.9%
$8.2M
880 claims · 2.8%
CT head/brain without contrast
$6.4M
20K claims · 2.1%
$6.2M
11K claims
$562.27
$54.68
Echocardiography, transthoracic, complete, with Doppler
$6.2M
11K claims · 2.1%
$5.9M
4K claims
$1,528.16
$123.40
Anchor or screw for tissue to bone fixation
$5.9M
4K claims · 2.0%
$5.8M
49K claims
$117.79
$100.62
Respiratory virus detection, 3-5 targets, nucleic acid
$5.8M
49K claims · 1.9%
Unclassified drugs
$5.4M
100K claims · 1.8%
MRI brain without contrast
$4.1M
6K claims · 1.4%
$3.9M
6K claims
$632.64
$133.68
MRI brain without contrast, then with contrast
$3.9M
6K claims · 1.3%
MRI lumbar spine without contrast
$3.4M
5K claims · 1.1%
$3.4M
6K claims
$603.64
$470.36
Injection, onabotulinumtoxinA, 1 unit
$3.4M
6K claims · 1.1%
$3.2M
29K claims
$110.62
$14.92
Therapeutic/prophylactic/diagnostic IV push, each additional substance
$3.2M
29K claims · 1.1%
CT abdomen and pelvis without contrast
$3.1M
7K claims · 1.0%
CT angiography, chest, with contrast
$3.1M
6K claims · 1.0%
$2.5M
55K claims
$45.20
$21.76
Therapeutic/prophylactic/diagnostic IV push, single substance
$2.5M
55K claims · 0.8%
$2.4M
29K claims
$81.66
$54.77
IV infusion, therapeutic/prophylactic/diagnostic, initial, up to 1 hour
$2.4M
29K claims · 0.8%
$2.3M
46K claims
$50.75
$7.50
Electrocardiogram, tracing only, without interpretation
$2.3M
46K claims · 0.8%
$2.2M
7K claims
$307.72
$169.17
Respiratory virus detection, 12-25 targets, nucleic acid
$2.2M
7K claims · 0.7%
Upper GI endoscopy with biopsy
$2.1M
5K claims · 0.7%
$2.0M
5K claims
$445.81
$260.56
Intensity modulated radiation treatment delivery, complex
$2.0M
5K claims · 0.7%
$2.0M
3K claims
$702.77
$112.68
MRI of cervical spine without contrast
$2.0M
3K claims · 0.7%
$2.0M
5K claims
$396.53
$106.14
Myocardial perfusion imaging, SPECT, multiple studies
$2.0M
5K claims · 0.7%
CT cervical spine without contrast
$2.0M
5K claims · 0.7%
$1.8M
31K claims
$59.57
$38.92
IV infusion, hydration, each additional hour
$1.8M
31K claims · 0.6%
$1.8M
8K claims
$213.43
$52.03
Emergency dept visit, minimal complexity
$1.8M
8K claims · 0.6%
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