Spectrum Health Hospitals
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 31 procedure codes: 99284 at 3.0× median, 99285 at 4.3× 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:
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 $371.16 per claim for 99285 (Emergency dept visit, high/urgent complexity) — 4.3× the national median of $85.65.
Bills $127.97 per claim for 99283 (Emergency dept visit, moderate complexity) — 3.0× the national median of $42.48.
Bills $2,623.72 per claim for 42820 (Tonsillectomy and adenoidectomy, under age 12) — 7.9× the national median of $331.68.
Billing above the 90th percentile for 6 procedure codes simultaneously.
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 $243.2M is at the 50th percentile among 156 General Acute Care Hospital providers.
Total Paid
$243.2M
$243,224,156
Total Claims
7.0M
Beneficiaries
6.1M
1.1 claims/patient
Avg Cost/Claim
$35
#341 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Spectrum Health Hospitals is a General Acute Care Hospital provider based in Grand Rapids, MI. From the 2018–2024 period, this provider received $243.2M in Medicaid payments across 7.0M claims.
Why This Matters
This provider received $243.2M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 30,403 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.
$30.1M
146K claims
$206.70
$69.51
Emergency dept visit, high complexity
$30.1M
146K claims · 12.4%
$27.3M
74K claims
$371.16
$85.65
Emergency dept visit, high/urgent complexity
$27.3M
74K claims · 11.2%
$19.8M
155K claims
$127.97
$42.48
Emergency dept visit, moderate complexity
$19.8M
155K claims · 8.1%
Hospital outpatient clinic visit
$14.7M
242K claims · 6.0%
$8.4M
3K claims
$2,623.72
$331.68
Tonsillectomy and adenoidectomy, under age 12
$8.4M
3K claims · 3.5%
$7.7M
83K claims
$92.90
$21.76
Therapeutic/prophylactic/diagnostic IV push, single substance
$7.7M
83K claims · 3.2%
$5.4M
90K claims
$59.88
$60.05
COVID-19 test, nucleic acid detection, CDC lab only
$5.4M
90K claims · 2.2%
$3.9M
143K claims
$27.50
$24.49
Therapeutic exercises, each 15 min
$3.9M
143K claims · 1.6%
$3.9M
38K claims
$103.44
$99.39
Hospital observation service, per hour
$3.9M
38K claims · 1.6%
$3.6M
3K claims · 1.5%
$3.3M
25K claims
$134.81
$65.76
CT abdomen and pelvis with contrast
$3.3M
25K claims · 1.4%
Upper GI endoscopy with biopsy
$3.1M
10K claims · 1.3%
$2.9M
12K claims
$237.39
$54.68
Echocardiography, transthoracic, complete, with Doppler
$2.9M
12K claims · 1.2%
$2.6M
27K claims
$99.17
$100.62
Respiratory virus detection, 3-5 targets, nucleic acid
$2.6M
27K claims · 1.1%
$2.4M
33K claims
$73.04
$37.72
Emergency dept visit, low complexity
$2.4M
33K claims · 1.0%
$2.1M
4K claims
$504.24
$763.43
Unlisted procedure, dentoalveolar structures
$2.1M
4K claims · 0.9%
$2.1M
748 claims · 0.9%
$2.0M
8K claims
$260.34
$112.83
Echocardiography, transthoracic, limited
$2.0M
8K claims · 0.8%
$1.8M
58K claims
$31.80
$38.92
IV infusion, hydration, each additional hour
$1.8M
58K claims · 0.8%
$1.8M
10K claims
$190.59
$133.68
MRI brain without contrast, then with contrast
$1.8M
10K claims · 0.7%
$1.8M
4K claims
$447.68
$255.17
Colonoscopy with polyp removal, snare technique
$1.8M
4K claims · 0.7%
$1.7M
4K claims
$425.14
$233.73
Polysomnography, sleep study, 6+ hours
$1.7M
4K claims · 0.7%
$1.7M
596 claims · 0.7%
Chest X-ray, 2 views
$1.7M
44K claims · 0.7%
$1.7M
10K claims
$163.02
$75.28
Chemotherapy administration, IV infusion, up to 1 hour
$1.7M
10K claims · 0.7%
Colonoscopy with biopsy
$1.6M
4K claims · 0.7%
$1.5M
17K claims
$89.80
$54.77
IV infusion, therapeutic/prophylactic/diagnostic, initial, up to 1 hour
$1.5M
17K claims · 0.6%
$1.5M
3K claims
$462.36
$205.50
Tympanostomy, general anesthesia
$1.5M
3K claims · 0.6%
$1.5M
15K claims
$100.36
$61.57
IV infusion, hydration, initial, 31 minutes to 1 hour
$1.5M
15K claims · 0.6%
$1.5M
2K claims
$767.17
$48.25
Direct admission to hospital observation
$1.5M
2K claims · 0.6%
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