The New York and Presbyterian Hospital
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 166 procedure codes: 99213 at 5.2× median, 99214 at 3.6× 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 $198.30 per claim for 99213 (Office/outpatient visit, est. patient, low-mod complexity) — 5.2× the national median of $37.81.
Bills $190.38 per claim for 99214 (Office/outpatient visit, est. patient, mod-high complexity) — 3.6× the national median of $53.41.
Bills $183.35 per claim for 99283 (Emergency dept visit, moderate complexity) — 4.3× the national median of $42.48.
Billing in the top 1% nationally for 4 procedure codes: 99213, 99214, 99391.
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 $207.4M is at the 50th percentile among 156 General Acute Care Hospital providers.
Total Paid
$207.4M
$207,366,640
Total Claims
3.1M
Beneficiaries
2.7M
1.2 claims/patient
Avg Cost/Claim
$66
#430 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
The New York and Presbyterian Hospital is a General Acute Care Hospital provider based in New York, NY. From the 2018–2024 period, this provider received $207.4M in Medicaid payments across 3.1M claims.
Why This Matters
This provider received $207.4M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 25,920 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 10% of total spending.
$19.8M
100K claims
$198.30
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$19.8M
100K claims · 9.5%
$16.0M
84K claims
$190.38
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$16.0M
84K claims · 7.7%
$13.7M
75K claims
$183.35
$42.48
Emergency dept visit, moderate complexity
$13.7M
75K claims · 6.6%
$10.4M
59K claims
$177.70
$69.51
Emergency dept visit, high complexity
$10.4M
59K claims · 5.0%
Injection, pembrolizumab, 1 mg
$8.2M
942 claims · 3.9%
$7.3M
39K claims
$184.74
$25.06
Office/outpatient visit, low complexity
$7.3M
39K claims · 3.5%
$6.9M
42K claims
$163.84
$85.65
Emergency dept visit, high/urgent complexity
$6.9M
42K claims · 3.3%
$6.2M
21K claims
$289.86
$38.92
IV infusion, hydration, each additional hour
$6.2M
21K claims · 3.0%
$4.4M
23K claims
$196.25
$74.09
Office/outpatient visit, high complexity
$4.4M
23K claims · 2.1%
$4.1M
1K claims
$3,519.98
$1,587.53
Injection, infliximab, excludes biosimilar, 10 mg
$4.1M
1K claims · 2.0%
CT head/brain without contrast
$3.7M
13K claims · 1.8%
Upper GI endoscopy with biopsy
$3.4M
6K claims · 1.6%
$3.3M
819 claims
$4,010.46
$4,027.41
Injection, vedolizumab, one milligram
$3.3M
819 claims · 1.6%
Emergency dept visit, low complexity
$3.2M
18K claims · 1.6%
Colonoscopy with biopsy
$3.2M
4K claims · 1.5%
$3.1M
104 claims
$30,055.18
$23,418.64
Emicizumab-kxwh (Hemlibra) injection, 0.5 mg
$3.1M
104 claims · 1.5%
Therapeutic exercises, each 15 min
$2.8M
26K claims · 1.3%
$2.6M
14K claims
$188.33
$75.28
Chemotherapy administration, IV infusion, up to 1 hour
$2.6M
14K claims · 1.3%
CT abdomen and pelvis with contrast
$2.5M
9K claims · 1.2%
$2.3M
11K claims
$203.54
$69.35
Preventive medicine, established patient, infant (under 1)
$2.3M
11K claims · 1.1%
Ultrasound, pelvic, complete
$2.2M
3K claims · 1.1%
$2.1M
13K claims
$161.97
$54.77
IV infusion, therapeutic/prophylactic/diagnostic, initial, up to 1 hour
$2.1M
13K claims · 1.0%
$2.1M
10K claims
$217.22
$73.29
Medication-assisted treatment, opioid use disorder, per month
$2.1M
10K claims · 1.0%
Transfusion of whole blood
$1.8M
5K claims · 0.9%
$1.8M
3K claims
$587.93
$43.68
Chemotherapy infusion, each additional hour
$1.8M
3K claims · 0.8%
$1.7M
9K claims
$201.75
$75.18
Preventive medicine, established patient, age 1-4
$1.7M
9K claims · 0.8%
Colonoscopy, diagnostic
$1.6M
2K claims · 0.8%
$1.6M
1K claims
$1,433.87
$1,442.37
Injection, leuprolide acetate, per three point seven five milligrams
$1.6M
1K claims · 0.8%
$1.6M
2K claims
$652.35
$255.17
Colonoscopy with polyp removal, snare technique
$1.6M
2K claims · 0.8%
$1.5M
24K claims
$65.11
$169.17
Respiratory virus detection, 12-25 targets, nucleic acid
$1.5M
24K claims · 0.7%
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