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

Children's Hospital

General Acute Care Hospital Children·Washington, DC·NPI: 1912939703SharePrint Report
View on Risk Watchlist →

Red Flags Explained

▼

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.

Risk Assessment

•

Bills $219.60 per claim for 99212 (Office/outpatient visit, low complexity) — 8.8× the national median of $25.06.

•

Bills $265.06 per claim for 99283 (Emergency dept visit, moderate complexity) — 6.2× the national median of $42.48.

•

Bills $262.22 per claim for 99284 (Emergency dept visit, high complexity) — 3.8× the national median of $69.51.

•

Billing in the top 1% nationally for 12 procedure codes: 99212, 96361, 94640.

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

P25MedianP75P90

This provider's total spending of $243.0M is at the 50th percentile among 16 General Acute Care Hospital Children providers.

Active Billing Period:2018-01→2024-12(84 months)
Sharp billing drop in final month

Total Paid

$243.0M

$242,963,811

Total Claims

2.2M

Beneficiaries

1.9M

1.1 claims/patient

Avg Cost/Claim

$111

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

🔍 Analysis

Provider Overview

Children's Hospital is a General Acute Care Hospital Children provider based in Washington, DC. From the 2018–2024 period, this provider received $243.0M in Medicaid payments across 2.2M claims.

Why This Matters

This provider received $243.0M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 30,370 Medicaid beneficiaries for a full year at average per-enrollee costs.

↑ 34% growthsince first billing year

Monthly Spending Trend

Yearly Spending

2018
$34.2M
-8%
2019
$31.7M
-42%
2020
$18.3M
+80%
2021
$32.9M
+27%
2022
$41.7M
-8%
2023
$38.2M
+20%
2024
$46.0M

Procedure Breakdown

Cost per claim compared to national benchmarks

This provider bills for 30 distinct procedure codes. The top code (99212 (Office/outpatient visit, low complexity)) accounts for 24% of total spending.

99212Top 1%

Office/outpatient visit, low complexity

$58.1M

264K claims · 23.9%

Your Cost: $219.60/claim|Median: $25.06
8.8× median
99283Top 5%

Emergency dept visit, moderate complexity

$41.1M

155K claims · 16.9%

Your Cost: $265.06/claim|Median: $42.48
6.2× median
99284Top 5%

Emergency dept visit, high complexity

$16.2M

62K claims · 6.7%

Your Cost: $262.22/claim|Median: $69.51
3.8× median
99281Top 5%

Emergency dept visit, minimal complexity

$8.4M

35K claims · 3.5%

Your Cost: $237.36/claim|Median: $52.03
4.6× median
99282Top 5%

Emergency dept visit, low complexity

$6.5M

34K claims · 2.7%

Your Cost: $191.58/claim|Median: $37.72
5.1× median
42820Top 10%

Tonsillectomy and adenoidectomy, under age 12

$6.5M

2K claims · 2.7%

Your Cost: $2,697.68/claim|Median: $331.68
8.1× median
96361Top 1%

IV infusion, hydration, each additional hour

$6.0M

8K claims · 2.5%

Your Cost: $731.26/claim|Median: $38.92
18.8× median
94640Top 1%

Pressurized or nonpressurized inhalation treatment

$5.0M

15K claims · 2.1%

Your Cost: $330.03/claim|Median: $10.88
30.3× median
G0378Normal range

Hospital observation service, per hour

$4.9M

20K claims · 2.0%

Your Cost: $248.88/claim|Median: $99.39
2.5× median
99213Top 1%

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

$4.3M

12K claims · 1.8%

Your Cost: $347.79/claim|Median: $37.81
9.2× median
99285Top 10%

Emergency dept visit, high/urgent complexity

$3.5M

14K claims · 1.4%

Your Cost: $247.17/claim|Median: $85.65
2.9× median
99392Top 5%

Preventive medicine, established patient, age 1-4

$3.4M

18K claims · 1.4%

Your Cost: $192.60/claim|Median: $75.18
2.6× median
99393Top 5%

Preventive medicine, established patient, age 5-11

$3.4M

17K claims · 1.4%

Your Cost: $196.54/claim|Median: $74.82
2.6× median
93303Top 5%

Echocardiography, transthoracic, limited

$3.4M

6K claims · 1.4%

Your Cost: $611.54/claim|Median: $112.83
5.4× median
99391Top 5%

Preventive medicine, established patient, infant (under 1)

$2.8M

14K claims · 1.1%

Your Cost: $195.51/claim|Median: $69.35
2.8× median
93306Top 1%

Echocardiography, transthoracic, complete, with Doppler

$2.8M

4K claims · 1.1%

Your Cost: $656.28/claim|Median: $54.68
12.0× median
69436Top 1%

Tympanostomy, general anesthesia

$2.6M

1K claims · 1.1%

Your Cost: $2,076.17/claim|Median: $205.50
10.1× median
96366Top 1%

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

$2.3M

4K claims · 1.0%

Your Cost: $572.37/claim|Median: $40.12
14.3× median
99394Top 5%

Preventive medicine, established patient, age 12-17

$2.1M

10K claims · 0.9%

Your Cost: $207.80/claim|Median: $80.15
2.6× median
0241UTop 5%

Proprietary lab analysis, genomic sequencing

$1.9M

9K claims · 0.8%

Your Cost: $204.16/claim|Median: $91.47
2.2× median
41899Top 10%

Unlisted procedure, dentoalveolar structures

$1.8M

932 claims · 0.8%

Your Cost: $1,958.03/claim|Median: $763.43
2.6× median
92550Top 1%

$1.8M

8K claims · 0.7%

Your Cost: $209.05/claim|Median: $14.15
14.8× median
92507Top 1%

Speech/hearing/language treatment

$1.8M

9K claims · 0.7%

Your Cost: $201.00/claim|Median: $49.45
4.1× median
97110Top 1%

Therapeutic exercises, each 15 min

$1.6M

8K claims · 0.7%

Your Cost: $193.42/claim|Median: $24.49
7.9× median
97530Top 5%

Therapeutic activities, each 15 min

$1.5M

11K claims · 0.6%

Your Cost: $133.10/claim|Median: $33.11
4.0× median
95810Top 5%

Polysomnography, sleep study, 6+ hours

$1.5M

1K claims · 0.6%

Your Cost: $1,239.06/claim|Median: $233.73
5.3× median
94644Top 1%

$1.3M

9K claims · 0.5%

Your Cost: $139.41/claim|Median: $17.35
8.0× median
70450Top 1%

CT head/brain without contrast

$1.3M

3K claims · 0.5%

Your Cost: $450.85/claim|Median: $45.53
9.9× median
96360Top 5%

IV infusion, hydration, initial, 31 minutes to 1 hour

$1.3M

5K claims · 0.5%

Your Cost: $256.17/claim|Median: $61.57
4.2× median
70551Top 5%

MRI brain without contrast

$1.2M

3K claims · 0.5%

Your Cost: $406.56/claim|Median: $85.39
4.8× median

Other Top Providers in District of Columbia

View all →

Mbi Health Services LLC

Case Management

$270.1M

Medstar Washington Hospital Center

General Acute Care Hospital

$239.1M

Government of the District of Columbia Office of Tax and Revenue

Ambulance Land Transport

$213.4M

Integrated Community Services, Inc.

Clinic/Center, Developmental Disabilities

$145.7M

District Hospital Partners L P

Nurse Practitioner, Family

$136.3M

Similar Providers

Other top providers in General Acute Care Hospital Children

Children's Hospital Medical Center of Akron

Akron, OH

$556.6M

Phoenix Children's Hospital

Phoenix, AZ

$555.7M

Childrens Hospital of Philadelphia

Philadelphia, PA

$286.9M

Cook Children's Medical Center

Fort Worth, TX

$286.7M

Texas Children's Hospital

Houston, TX

$277.3M

← All providersRisk Watchlist →All providers in District of Columbia →How we detect fraud →