Concourse Sentinel

Medicaid Integrity Analytics

πŸ“ŠOverviewπŸ₯ProvidersπŸ’ŠProcedures🚨WatchlistπŸ”Statistical Outliersβš–οΈCompareπŸ“ˆTrendsπŸ—ΊοΈGeography

Cross-Dataset

πŸ•ΈοΈEntity Networks🏠Home Healthβ›”Exclusions (LEIE)πŸ“‹Context & Disclaimers
πŸ‡ΊπŸ‡ΈAll States
by Concourse

Data: CMS T-MSIS 2018-2024

Source: opendata.hhs.gov

Statistical Outliers

Single-test outliers in Arkansas Medicaid data. These are individual statistical flags β€” most are informational.

Important context: These findings identify statistically unusual billing patterns, not determinations of wrongdoing. Cost-per-claim comparisons may flag hospital outpatient departments whose reimbursements include facility fees, bundled services, or all-inclusive rates. High claims-per-beneficiary ratios may reflect legitimate care patterns at behavioral health facilities, pediatric specialty centers, or residential care programs. Additional investigation and clinical context are required before drawing any conclusions.

For provider level analytics using multiple independent tests, see the Watchlist β€” which flags providers only when 2+ different detection methods agree. These single-test outliers below are primarily informational; only Cost Outliers and Overutilization are flagged as critical/warning.

critical

194

warning

269

info

4,147

Total

4,610

Outliers by Type
Severity Distribution
critical
194 (4.2%)
warning
269 (5.8%)
info
4,147 (90.0%)
3,506 results
criticalCost OutlierScore: 19.3

Cost-per-claim above average for 99214 (Office Visit, Established Patient (30 min, Moderate Complexi)

CHARLES TODD (1275619876) bills $507.99/claim for 99214 (Office o/p est mod 30 min) vs avg $40.65 (+19.3Οƒ). $28,447 across 56 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

CHARLES TODDCONWAYProvider total: $115.4K
criticalCost OutlierScore: 15.9

Cost-per-claim above average for 87880 (Rapid Strep A Test (Optical/Immunoassay))

SGOH ACQUISITION INC (1568643005) bills $117.27/claim for 87880 (Strep a assay w/optic) vs avg $8.24 (+16.0Οƒ). $157,734 across 1,345 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

SGOH ACQUISITION INCGRAVETTEProvider total: $10.8M
criticalOverutilizationScore: 15.7

Unusually high claims-per-beneficiary ratio

A-LIST HOME CARE, LLC (1265909303): 45.5 claims/beneficiary (avg 2.3). 14,514 claims, 319 beneficiaries.

The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.

A-LIST HOME CARE, LLCROGERSProvider total: $849.0K
criticalCost OutlierScore: 14.5

Cost-per-claim above average for 99214 (Office Visit, Established Patient (30 min, Moderate Complexi)

CHARLES TODD, PA (1033295639) bills $393.25/claim for 99214 (Office o/p est mod 30 min) vs avg $40.65 (+14.5Οƒ). $13,371 across 34 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

CHARLES TODD, PACONWAYProvider total: $25.5K
criticalOverutilizationScore: 12.3

Unusually high claims-per-beneficiary ratio

THE GREGORY KISTLER TREATMENT CENTER, INC. (1841823200): 36.3 claims/beneficiary (avg 2.3). 116,549 claims, 3,213 beneficiaries.

The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.

THE GREGORY KISTLER TREATMENT CENTER, INC.FORT SMITHProvider total: $28.3M
criticalCost OutlierScore: 12.1

Cost-per-claim above average for 87804 (Rapid Influenza Test (Optical/Immunoassay))

SGOH ACQUISITION INC (1568643005) bills $120.57/claim for 87804 (Influenza assay w/optic) vs avg $11.07 (+12.1Οƒ). $36,775 across 305 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

SGOH ACQUISITION INCGRAVETTEProvider total: $10.8M
criticalCost OutlierScore: 11.3

Cost-per-claim above average for 92014

CHARLES TODD (1275619876) bills $251.87/claim for 92014 (Compre oph exam est pt 1/>) vs avg $46.03 (+11.3Οƒ). $27,958 across 111 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

CHARLES TODDCONWAYProvider total: $115.4K
criticalCost OutlierScore: 9.6

Cost-per-claim above average for 90853 (Group Psychotherapy)

CHICOT MEMORIAL MEDICAL CENTER (1235453192) bills $216.00/claim for 90853 (Group psychotherapy) vs avg $38.95 (+9.6Οƒ). $41,255 across 191 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

CHICOT MEMORIAL MEDICAL CENTERLAKE VILLAGEProvider total: $1.5M
criticalOverutilizationScore: 9.3

Unusually high claims-per-beneficiary ratio

INDEPENDENT CASE MANAGEMENT, INC. (1962547745): 28.0 claims/beneficiary (avg 2.3). 299,732 claims, 10,692 beneficiaries.

The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.

INDEPENDENT CASE MANAGEMENT, INC.LITTLE ROCKProvider total: $58.8M
criticalCost OutlierScore: 9.1

Cost-per-claim above average for 80053 (Comprehensive Metabolic Panel (14 tests))

NORTHEAST ARKANSAS CLINIC CHARITABLE FOUNDATION, INC (1447581673) bills $210.54/claim for 80053 (Comprehen metabolic panel) vs avg $12.95 (+9.1Οƒ). $129,482 across 615 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

NORTHEAST ARKANSAS CLINIC CHARITABLE FOUNDATION, INCJONESBOROProvider total: $387.8K
criticalOverutilizationScore: 8.9

Unusually high claims-per-beneficiary ratio

ARKANSAS FAMILY SUPPORTS, INC. (1124489695): 26.8 claims/beneficiary (avg 2.3). 52,194 claims, 1,945 beneficiaries.

The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.

ARKANSAS FAMILY SUPPORTS, INC.FORT SMITHProvider total: $15.6M
criticalCost OutlierScore: 8.4

Cost-per-claim above average for H2015

PALCO, INC. (1801276738) bills $234.30/claim for H2015 (Comp comm supp svc, 15 min) vs avg $70.50 (+8.4Οƒ). $906,493 across 3,869 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

PALCO, INC.MAUMELLEProvider total: $435.6M
criticalOverutilizationScore: 8.0

Unusually high claims-per-beneficiary ratio

NEW LIFE POME LIVING INC (1497408074): 24.4 claims/beneficiary (avg 2.3). 3,495 claims, 143 beneficiaries.

The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.

NEW LIFE POME LIVING INCLITTLE ROCKProvider total: $1.3M
criticalCost OutlierScore: 8.0

Cost-per-claim above average for D1206 (Topical Fluoride Varnish Application)

BRYAN DARLING (1679788426) bills $45.57/claim for D1206 (Topical fluoride varnish) vs avg $18.36 (+8.0Οƒ). $14,765 across 324 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

BRYAN DARLINGJONESBOROProvider total: $82.9K
criticalCost OutlierScore: 7.9

Cost-per-claim above average for Q5001

ST BERNARDS HOSPITAL, INC. (1538197389) bills $122.72/claim for Q5001 (Hospice or home hlth in home) vs avg $3.20 (+7.9Οƒ). $165,913 across 1,352 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

ST BERNARDS HOSPITAL, INC.JONESBOROProvider total: $165.9K
criticalOverutilizationScore: 7.7

Unusually high claims-per-beneficiary ratio

BIRCH TREE COMMUNITIES, INC. (1306416128): 23.4 claims/beneficiary (avg 2.3). 11,589 claims, 495 beneficiaries.

The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.

BIRCH TREE COMMUNITIES, INC.CLARKSVILLEProvider total: $3.4M
criticalOverutilizationScore: 7.6

Unusually high claims-per-beneficiary ratio

WEST HAVEN VILLAGE, LLC (1811697782): 23.4 claims/beneficiary (avg 2.3). 1,169 claims, 50 beneficiaries.

The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.

WEST HAVEN VILLAGE, LLCDE WITTProvider total: $106.9K
criticalOverutilizationScore: 7.5

Unusually high claims-per-beneficiary ratio

UNITED CEREBRAL PALSY OF ARKANSAS (1427616119): 23.0 claims/beneficiary (avg 2.3). 428,254 claims, 18,598 beneficiaries.

The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.

UNITED CEREBRAL PALSY OF ARKANSASLITTLE ROCKProvider total: $108.3M
criticalOverutilizationScore: 7.4

Unusually high claims-per-beneficiary ratio

HOLIDAY ISLAND OPERATIONS, LLC (1497481832): 22.8 claims/beneficiary (avg 2.3). 1,776 claims, 78 beneficiaries.

The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.

HOLIDAY ISLAND OPERATIONS, LLCHOLIDAY ISLANDProvider total: $1.2M
criticalOverutilizationScore: 7.4

Unusually high claims-per-beneficiary ratio

BIRCH TREE COMMUNITIES, INC. (1578133294): 22.7 claims/beneficiary (avg 2.3). 36,520 claims, 1,606 beneficiaries.

The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.

BIRCH TREE COMMUNITIES, INC.CONWAYProvider total: $11.0M
criticalOverutilizationScore: 7.4

Unusually high claims-per-beneficiary ratio

MCT, INC. (1245015841): 22.6 claims/beneficiary (avg 2.3). 27,494 claims, 1,214 beneficiaries.

The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.

MCT, INC.LITTLE ROCKProvider total: $3.6M
criticalOverutilizationScore: 7.3

Unusually high claims-per-beneficiary ratio

PALCO, INC. (1972369346): 22.4 claims/beneficiary (avg 2.3). 8,766 claims, 392 beneficiaries.

The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.

PALCO, INC.MAUMELLEProvider total: $881.5K
criticalCost OutlierScore: 7.2

Cost-per-claim above average for D0120 (Periodic Oral Evaluation (Established Patient))

TERRI EUBANKS (1306960737) bills $48.02/claim for D0120 (Periodic oral evaluation) vs avg $24.54 (+7.2Οƒ). $86,633 across 1,804 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

TERRI EUBANKSDERMOTTProvider total: $783.9K
criticalOverutilizationScore: 7.2

Unusually high claims-per-beneficiary ratio

MYERS DAVIS LIFE COACHING, INC (1477144103): 22.1 claims/beneficiary (avg 2.3). 158,972 claims, 7,192 beneficiaries.

The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.

MYERS DAVIS LIFE COACHING, INCBATESVILLEProvider total: $37.1M
criticalCost OutlierScore: 7.0

Cost-per-claim above average for 80053 (Comprehensive Metabolic Panel (14 tests))

NORTHEAST ARKANSAS CLINIC CHARITABLE FOUNDATION, INC. (1033491519) bills $164.57/claim for 80053 (Comprehen metabolic panel) vs avg $12.95 (+7.0Οƒ). $97,753 across 594 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

NORTHEAST ARKANSAS CLINIC CHARITABLE FOUNDATION, INC.JONESBOROProvider total: $397.1K
criticalOverutilizationScore: 6.9

Unusually high claims-per-beneficiary ratio

BIRCH TREE COMMUNITIES, INC. (1487224101): 21.5 claims/beneficiary (avg 2.3). 13,775 claims, 642 beneficiaries.

The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.

BIRCH TREE COMMUNITIES, INC.CLARKSVILLEProvider total: $4.1M
criticalOverutilizationScore: 6.9

Unusually high claims-per-beneficiary ratio

BIRCH TREE COMMUNITIES, INC. (1386214187): 21.3 claims/beneficiary (avg 2.3). 35,171 claims, 1,653 beneficiaries.

The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.

BIRCH TREE COMMUNITIES, INC.BENTONProvider total: $10.5M
criticalOverutilizationScore: 6.9

Unusually high claims-per-beneficiary ratio

BIRCH TREE COMMUNITIES, INC. (1558931360): 21.2 claims/beneficiary (avg 2.3). 13,366 claims, 629 beneficiaries.

The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.

BIRCH TREE COMMUNITIES, INC.NEWPORTProvider total: $4.1M
criticalOverutilizationScore: 6.8

Unusually high claims-per-beneficiary ratio

BIRCH TREE COMMUNITIES, INC. (1619547429): 21.2 claims/beneficiary (avg 2.3). 39,931 claims, 1,884 beneficiaries.

The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.

BIRCH TREE COMMUNITIES, INC.MALVERNProvider total: $12.0M
criticalOverutilizationScore: 6.8

Unusually high claims-per-beneficiary ratio

BIRCH TREE COMMUNITIES, INC. (1730759457): 21.0 claims/beneficiary (avg 2.3). 13,689 claims, 653 beneficiaries.

The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.

BIRCH TREE COMMUNITIES, INC.BENTONProvider total: $5.7M
criticalOverutilizationScore: 6.7

Unusually high claims-per-beneficiary ratio

BIRCH TREE COMMUNITIES, INC. (1063082873): 20.9 claims/beneficiary (avg 2.3). 31,907 claims, 1,529 beneficiaries.

The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.

BIRCH TREE COMMUNITIES, INC.OXFORDProvider total: $9.5M
criticalOverutilizationScore: 6.7

Unusually high claims-per-beneficiary ratio

BIRCH TREE COMMUNITIES, INC (1124896600): 20.8 claims/beneficiary (avg 2.3). 2,292 claims, 110 beneficiaries.

The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.

BIRCH TREE COMMUNITIES, INCGREENBRIERProvider total: $1.1M
criticalCost OutlierScore: 6.7

Cost-per-claim above average for 96372

CROSSETT HEALTH FOUNDATION (1952308215) bills $110.55/claim for 96372 (Ther/proph/diag inj sc/im) vs avg $7.96 (+6.7Οƒ). $52,513 across 475 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

CROSSETT HEALTH FOUNDATIONCROSSETTProvider total: $3.4M
criticalCost OutlierScore: 6.6

Cost-per-claim above average for 99233 (Subsequent Hospital Care (High Complexity))

THE CENTER FOR PEDIATRICS AND ADOLESCENT MEDICINE (1043225709) bills $187.44/claim for 99233 (Sbsq hosp ip/obs high 50) vs avg $38.70 (+6.6Οƒ). $125,394 across 669 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

THE CENTER FOR PEDIATRICS AND ADOLESCENT MEDICINEFORT SMITHProvider total: $2.7M
criticalCost OutlierScore: 6.6

Cost-per-claim above average for 99213 (Office Visit, Established Patient (20 min, Low Complexity))

1972577104 (1972577104) bills $107.46/claim for 99213 (Office o/p est low 20 min) vs avg $24.10 (+6.6Οƒ). $37,287 across 347 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

GOVERNMENT OF GUAM DEPARTMENT OF ADMINISTRATIONDEDEDOProvider total: $43.9K
criticalOverutilizationScore: 6.6

Unusually high claims-per-beneficiary ratio

BIRCH TREE COMMUNITIES, INC. (1538102223): 20.6 claims/beneficiary (avg 2.3). 50,605 claims, 2,461 beneficiaries.

The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.

BIRCH TREE COMMUNITIES, INC.BENTONProvider total: $7.1M
criticalCost OutlierScore: 6.6

Cost-per-claim above average for 36415 (Blood Draw (Venipuncture))

VAN BUREN HMA LLC (1386687036) bills $19.47/claim for 36415 (Coll venous bld venipuncture) vs avg $1.98 (+6.6Οƒ). $14,405 across 740 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

VAN BUREN HMA LLCVAN BURENProvider total: $398.0K
criticalOverutilizationScore: 6.6

Unusually high claims-per-beneficiary ratio

BIRCH TREE COMMUNITIES, INC (1962652941): 20.4 claims/beneficiary (avg 2.3). 16,841 claims, 824 beneficiaries.

The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.

BIRCH TREE COMMUNITIES, INCCLARKSVILLEProvider total: $2.5M
criticalCost OutlierScore: 6.5

Cost-per-claim above average for 99213 (Office Visit, Established Patient (20 min, Low Complexity))

INIS BARDELLA (1124084926) bills $106.53/claim for 99213 (Office o/p est low 20 min) vs avg $24.10 (+6.6Οƒ). $18,216 across 171 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

INIS BARDELLAMAGNOLIAProvider total: $21.7K
criticalOverutilizationScore: 6.5

Unusually high claims-per-beneficiary ratio

BIRCH TREE COMMUNITIES INC (1750531745): 20.3 claims/beneficiary (avg 2.3). 38,930 claims, 1,916 beneficiaries.

The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.

BIRCH TREE COMMUNITIES INCOXFORDProvider total: $5.7M
criticalCost OutlierScore: 6.5

Cost-per-claim above average for 99213 (Office Visit, Established Patient (20 min, Low Complexity))

1629041546 (1629041546) bills $106.15/claim for 99213 (Office o/p est low 20 min) vs avg $24.10 (+6.5Οƒ). $19,000 across 179 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

GOVERNMENT OF GUAM DEPARTMENT OF ADMINISTRATIONINARAJANProvider total: $23.6K
criticalCost OutlierScore: 6.5

Cost-per-claim above average for 97532

PATHFINDER, INC. (1326004466) bills $83.47/claim for 97532 (Code 97532) vs avg $27.35 (+6.5Οƒ). $110,596 across 1,325 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

PATHFINDER, INC.JACKSONVILLEProvider total: $69.9M
criticalOverutilizationScore: 6.5

Unusually high claims-per-beneficiary ratio

BIRCH TREE COMMUNITIES, INC. (1528638335): 20.1 claims/beneficiary (avg 2.3). 282 claims, 14 beneficiaries.

The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.

BIRCH TREE COMMUNITIES, INC.CLINTONProvider total: $97.2K
criticalOverutilizationScore: 6.5

Unusually high claims-per-beneficiary ratio

DEVELOPMENTAL MILESTONES CENTER, LLC (1063076594): 20.1 claims/beneficiary (avg 2.3). 70,479 claims, 3,506 beneficiaries.

The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.

DEVELOPMENTAL MILESTONES CENTER, LLCWEST MEMPHISProvider total: $3.3M
criticalOverutilizationScore: 6.4

Unusually high claims-per-beneficiary ratio

BIRCH TREE COMMUNITIES, INC (1285884239): 20.0 claims/beneficiary (avg 2.3). 14,902 claims, 746 beneficiaries.

The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.

BIRCH TREE COMMUNITIES, INCBENTONProvider total: $3.5M
criticalOverutilizationScore: 6.4

Unusually high claims-per-beneficiary ratio

BIRCH TREE COMMUNITIES, INC. (1467022277): 19.9 claims/beneficiary (avg 2.3). 18,314 claims, 922 beneficiaries.

The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.

BIRCH TREE COMMUNITIES, INC.MOUNTAIN VIEWProvider total: $5.5M
criticalCost OutlierScore: 6.3

Cost-per-claim above average for J7030

BAPTIST MEMORIAL HOSPITAL - CRITTENDEN INC (1437634524) bills $68.81/claim for J7030 (Normal saline solution infus) vs avg $2.99 (+6.3Οƒ). $33,440 across 486 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

BAPTIST MEMORIAL HOSPITAL - CRITTENDEN INCWEST MEMPHISProvider total: $4.1M
criticalCost OutlierScore: 6.3

Cost-per-claim above average for H2016

DIVERSIFIED CHILDREN YOUTH & FAMILIES DEVELOPMENT PROGRAM (1851654909) bills $15,826.77/claim for H2016 (Comp comm supp svc, per diem) vs avg $1,269.82 (+6.3Οƒ). $14,354,879 across 907 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

DIVERSIFIED CHILDREN YOUTH & FAMILIES DEVELOPMENT PROGRAMLITTLE ROCKProvider total: $14.4M
criticalCost OutlierScore: 6.3

Cost-per-claim above average for 85027 (Complete Blood Count (CBC) without Differential)

HARRISON DIALYSIS LLC (1659522076) bills $26.43/claim for 85027 (Complete cbc automated) vs avg $5.20 (+6.3Οƒ). $10,574 across 400 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

HARRISON DIALYSIS LLCHARRISONProvider total: $346.8K
criticalOverutilizationScore: 6.3

Unusually high claims-per-beneficiary ratio

BIRCH TREE COMMUNITIES, INC. (1376113183): 19.6 claims/beneficiary (avg 2.3). 18,667 claims, 953 beneficiaries.

The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.

BIRCH TREE COMMUNITIES, INC.RUSSELLVILLEProvider total: $5.6M
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