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 Arizona 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

524

warning

574

info

6,679

Total

7,777

Outliers by Type
Severity Distribution
critical
524 (6.7%)
warning
574 (7.4%)
info
6,679 (85.9%)
5,414 results
criticalCost OutlierScore: 26.8

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

PASCUA YAQUI TRIBE (1477868396) bills $499.85/claim for D0120 (Periodic oral evaluation) vs avg $6.86 (+26.8Οƒ). $163,952 across 328 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.

PASCUA YAQUI TRIBETUCSONProvider total: $993.9K
criticalCost OutlierScore: 24.1

Cost-per-claim above average for D0140 (Limited Oral Evaluation (Problem-Focused))

PASCUA YAQUI TRIBE (1477868396) bills $505.76/claim for D0140 (Limited oral evaluation - problem focused) vs avg $8.63 (+24.1Οƒ). $333,299 across 659 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.

PASCUA YAQUI TRIBETUCSONProvider total: $993.9K
criticalCost OutlierScore: 23.4

Cost-per-claim above average for H0031

AFFIRMED WELLNESS LLC (1730804972) bills $4,214.48/claim for H0031 (Mh health assess by non-md) vs avg $147.87 (+23.5Οƒ). $324,515 across 77 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.

AFFIRMED WELLNESS LLCTEMPEProvider total: $2.3M
criticalCost OutlierScore: 20.1

Cost-per-claim above average for A0120

AMERICAN PONY EXPRESS, INC. (1902048895) bills $610.79/claim for A0120 (Noner transport mini-bus) vs avg $12.01 (+20.1Οƒ). $38,480 across 63 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.

AMERICAN PONY EXPRESS, INC.PHOENIXProvider total: $516.4K
criticalCost OutlierScore: 20.1

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

WINSLOW INDIAN HEALTH CARE CENTER, INC (1366835076) bills $719.00/claim for 99213 (Office o/p est low 20 min) vs avg $38.39 (+20.1Οƒ). $45,297 across 63 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.

WINSLOW INDIAN HEALTH CARE CENTER, INCDILKONProvider total: $45.3K
criticalCost OutlierScore: 18.9

Cost-per-claim above average for D1120 (Child Dental Prophylaxis (Teeth Cleaning))

PASCUA YAQUI TRIBE (1477868396) bills $338.39/claim for D1120 (Prophylaxis - child) vs avg $10.31 (+18.9Οƒ). $36,208 across 107 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.

PASCUA YAQUI TRIBETUCSONProvider total: $993.9K
criticalCost OutlierScore: 17.6

Cost-per-claim above average for H0002

COMMUNITY MEDICAL SERVICES MONTANA-PRIVATE, LLC (1679926745) bills $450.00/claim for H0002 (Alcohol and/or drug screenin) vs avg $21.17 (+17.6Οƒ). $15,300 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.

COMMUNITY MEDICAL SERVICES MONTANA-PRIVATE, LLCSCOTTSDALEProvider total: $43.3M
criticalCost OutlierScore: 16.9

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

DILKON MEDICAL CENTER (1306016126) bills $612.64/claim for 99213 (Office o/p est low 20 min) vs avg $38.39 (+16.9Οƒ). $14,737,003 across 24,055 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.

DILKON MEDICAL CENTERDILKONProvider total: $14.7M
criticalCost OutlierScore: 16.9

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

ESOTERIX GENETIC LABORATORIES, LLC (1467753814) bills $42.11/claim for 36415 (Coll venous bld venipuncture) vs avg $1.81 (+16.9Οƒ). $25,267 across 600 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.

ESOTERIX GENETIC LABORATORIES, LLCPHOENIXProvider total: $819.7K
criticalCost OutlierScore: 16.8

Cost-per-claim above average for 99173

THE FORT DEFIANCE INDIAN HOSPITAL BOARD, INCORPORATION (1477876639) bills $439.92/claim for 99173 (Visual acuity screen) vs avg $2.52 (+16.8Οƒ). $11,438 across 26 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 FORT DEFIANCE INDIAN HOSPITAL BOARD, INCORPORATIONFORT DEFIANCEProvider total: $13.0M
criticalCost OutlierScore: 16.7

Cost-per-claim above average for 85025 (Complete Blood Count (CBC) with Differential)

LAMIA BORIC (1689881898) bills $1,663.88/claim for 85025 (Complete cbc w/auto diff wbc) vs avg $6.95 (+16.7Οƒ). $46,589 across 28 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.

LAMIA BORICGLENDALEProvider total: $46.6K
criticalCost OutlierScore: 16.0

Cost-per-claim above average for H0025

RESILIENT COMMUNITY CARE LLC (1942894761) bills $4,394.37/claim for H0025 (Behavioral health prevention education service (delivery of services with) vs avg $60.04 (+16.0Οƒ). $281,240 across 64 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.

RESILIENT COMMUNITY CARE LLCGLENDALEProvider total: $2.1M
criticalCost OutlierScore: 15.8

Cost-per-claim above average for H0004 (Behavioral Health Counseling and Therapy (per 15 min))

GOOD NEIGHBOR COMMUNITY SERVICES (1013511674) bills $11,798.98/claim for H0004 (Behavioral health counseling and therapy, per 15 minutes) vs avg $219.37 (+15.8Οƒ). $873,124 across 74 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.

GOOD NEIGHBOR COMMUNITY SERVICESGILBERTProvider total: $2.3M
criticalCost OutlierScore: 14.7

Cost-per-claim above average for 96160

CHP CARE, PC (1821444894) bills $461.24/claim for 96160 (Pt-focused hlth risk assmt) vs avg $4.59 (+14.7Οƒ). $178,500 across 387 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.

CHP CARE, PCPEORIAProvider total: $302.0K
criticalCost OutlierScore: 14.5

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

WINSLOW INDIAN HEALTH CARE CENTER, INC (1184729493) bills $531.60/claim for 99213 (Office o/p est low 20 min) vs avg $38.39 (+14.5Οƒ). $120,770,374 across 227,182 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.

WINSLOW INDIAN HEALTH CARE CENTER, INCWINSLOWProvider total: $121.2M
criticalCost OutlierScore: 14.5

Cost-per-claim above average for H0038

GOOD NEIGHBOR COMMUNITY SERVICES (1013511674) bills $8,874.80/claim for H0038 (Self-help/peer svc per 15min) vs avg $190.53 (+14.5Οƒ). $496,989 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.

GOOD NEIGHBOR COMMUNITY SERVICESGILBERTProvider total: $2.3M
criticalCost OutlierScore: 14.3

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

WINSLOW INDIAN HEALTH CARE CENTER, INC (1649511569) bills $524.10/claim for 99213 (Office o/p est low 20 min) vs avg $38.39 (+14.3Οƒ). $2,271,453 across 4,334 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.

WINSLOW INDIAN HEALTH CARE CENTER, INCWINSLOWProvider total: $2.3M
criticalCost OutlierScore: 13.8

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

WINSLOW INDIAN HEALTH CARE CENTER, INC (1760652580) bills $507.32/claim for 99213 (Office o/p est low 20 min) vs avg $38.39 (+13.8Οƒ). $4,450,730 across 8,773 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.

WINSLOW INDIAN HEALTH CARE CENTER, INCLEUPPProvider total: $4.5M
criticalCost OutlierScore: 13.7

Cost-per-claim above average for T1016 (Case Management (per 15 min))

IOB WELLNESS CENTER LLC (1497360978) bills $6,667.91/claim for T1016 (Case management) vs avg $168.65 (+13.6Οƒ). $906,836 across 136 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.

IOB WELLNESS CENTER LLCPHOENIXProvider total: $2.0M
criticalCost OutlierScore: 13.2

Cost-per-claim above average for 99212 (Office Visit, Established Patient (10 min, Straightforward))

KAYENTA ALTERNATIVE RURAL HOSPITAL (1174692529) bills $625.59/claim for 99212 (Office o/p est sf 10 min) vs avg $28.03 (+13.2Οƒ). $9,074,854 across 14,506 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.

KAYENTA ALTERNATIVE RURAL HOSPITALKAYENTAProvider total: $9.8M
criticalCost OutlierScore: 12.8

Cost-per-claim above average for D0230 (Dental X-ray (Periapical, Each Additional))

JEREMY LIDDIARD (1003269358) bills $51.67/claim for D0230 (Intraoral - periapical each addl image) vs avg $2.21 (+12.9Οƒ). $22,581 across 437 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.

JEREMY LIDDIARDPHOENIXProvider total: $164.5K
criticalOverutilizationScore: 12.8

Unusually high claims-per-beneficiary ratio

FIRST CHOICE TRANSPORTATION LLC (1063293496): 43.6 claims/beneficiary (avg 2.6). 12,775 claims, 293 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.

FIRST CHOICE TRANSPORTATION LLCPHOENIXProvider total: $2.8M
criticalCost OutlierScore: 12.3

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

SAN CARLOS APACHE HEALTHCARE CORPORATION (1265813075) bills $429.84/claim for 99214 (Office o/p est mod 30 min) vs avg $53.96 (+12.3Οƒ). $61,038 across 142 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.

SAN CARLOS APACHE HEALTHCARE CORPORATIONPERIDOTProvider total: $4.5M
criticalCost OutlierScore: 12.3

Cost-per-claim above average for 97530 (Therapeutic Activities (per 15 min))

THE CARING HOUSE (1912909391) bills $562.91/claim for 97530 (Therapeutic activities) vs avg $53.05 (+12.3Οƒ). $73,179 across 130 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 CARING HOUSESACATONProvider total: $380.0K
criticalCost OutlierScore: 11.8

Cost-per-claim above average for J3490

ORTHOPEDIC SPECIALISTS OF NORTH AMERICA, PLLC (1770805590) bills $991.32/claim for J3490 (Drugs unclassified injection) vs avg $11.10 (+11.8Οƒ). $22,800 across 23 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.

ORTHOPEDIC SPECIALISTS OF NORTH AMERICA, PLLCAVONDALEProvider total: $864.1K
criticalCost OutlierScore: 11.6

Cost-per-claim above average for S5150

ULU CARE, LLC (1790443216) bills $2,997.37/claim for S5150 (Unskilled respite care /15m) vs avg $173.31 (+11.6Οƒ). $92,918 across 31 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.

ULU CARE, LLCTEMPEProvider total: $33.2M
criticalCost OutlierScore: 11.5

Cost-per-claim above average for 0011A

THE FORT DEFIANCE INDIAN HOSPITAL BOARD, INCORPORATION (1477876639) bills $519.00/claim for 0011A vs avg $18.30 (+11.5Οƒ). $16,089 across 31 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 FORT DEFIANCE INDIAN HOSPITAL BOARD, INCORPORATIONFORT DEFIANCEProvider total: $13.0M
criticalCost OutlierScore: 11.5

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

FORT MCDOWELL YAVAPAI NATION (1053418533) bills $427.00/claim for 99213 (Office o/p est low 20 min) vs avg $38.39 (+11.5Οƒ). $26,474 across 62 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.

FORT MCDOWELL YAVAPAI NATIONFORT MCDOWELLProvider total: $26.5K
criticalCost OutlierScore: 11.3

Cost-per-claim above average for S0215

SAGUARO FOUNDATION (1992998348) bills $873.88/claim for S0215 (Nonemerg transp mileage) vs avg $43.17 (+11.3Οƒ). $81,270 across 93 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.

SAGUARO FOUNDATIONYUMAProvider total: $73.5M
criticalCost OutlierScore: 11.2

Cost-per-claim above average for J1644

RENAL CARE GROUP ARIZONA, INC. (1760594568) bills $804.04/claim for J1644 (Inj heparin sodium per 1000u) vs avg $8.10 (+11.2Οƒ). $20,905 across 26 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.

RENAL CARE GROUP ARIZONA, INC.PHOENIXProvider total: $354.5K
criticalCost OutlierScore: 11.1

Cost-per-claim above average for 97110 (Therapeutic Exercise (per 15 min))

HAVEN OF GLOBE, LLC (1467868075) bills $567.05/claim for 97110 (Therapeutic exercises) vs avg $39.59 (+11.1Οƒ). $13,609 across 24 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.

HAVEN OF GLOBE, LLCGLOBEProvider total: $66.6K
criticalCost OutlierScore: 11.1

Cost-per-claim above average for 99212 (Office Visit, Established Patient (10 min, Straightforward))

WINSLOW INDIAN HEALTH CARE CENTER, INC. (1205006020) bills $528.47/claim for 99212 (Office o/p est sf 10 min) vs avg $28.03 (+11.0Οƒ). $1,627,152 across 3,079 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.

WINSLOW INDIAN HEALTH CARE CENTER, INC.DILKONProvider total: $1.6M
criticalCost OutlierScore: 10.9

Cost-per-claim above average for 96127 (Brief Emotional/Behavioral Assessment)

EBONY WALKER (1922604727) bills $36.23/claim for 96127 (Brief emotional/behav assmt) vs avg $2.95 (+10.9Οƒ). $23,041 across 636 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.

EBONY WALKERSCOTTSDALEProvider total: $153.4K
criticalCost OutlierScore: 10.7

Cost-per-claim above average for H0004 (Behavioral Health Counseling and Therapy (per 15 min))

BRIGHTER TOMORROW'S COUNSELING FACILITY (1790359537) bills $8,051.84/claim for H0004 (Behavioral health counseling and therapy, per 15 minutes) vs avg $219.37 (+10.7Οƒ). $281,814 across 35 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.

BRIGHTER TOMORROW'S COUNSELING FACILITYMESAProvider total: $754.3K
criticalCost OutlierScore: 10.7

Cost-per-claim above average for 99232 (Subsequent Hospital Care (Moderate Complexity))

ARIZONA PEDIATRIC PULMONARY & ASTHMA ASSOCIATES, P.L.C. (1841263704) bills $250.82/claim for 99232 (Sbsq hosp ip/obs moderate 35) vs avg $42.20 (+10.7Οƒ). $15,802 across 63 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.

ARIZONA PEDIATRIC PULMONARY & ASTHMA ASSOCIATES, P.L.C.PHOENIXProvider total: $1.9M
criticalCost OutlierScore: 10.6

Cost-per-claim above average for 99212 (Office Visit, Established Patient (10 min, Straightforward))

WINSLOW INDIAN HEALTH CARE CENTER, INC (1497925218) bills $508.78/claim for 99212 (Office o/p est sf 10 min) vs avg $28.03 (+10.6Οƒ). $1,163,081 across 2,286 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.

WINSLOW INDIAN HEALTH CARE CENTER, INCLEUPPProvider total: $1.2M
criticalCost OutlierScore: 10.6

Cost-per-claim above average for 87635

KAYENTA ALTERNATIVE RURAL HOSPITAL (1174692529) bills $349.25/claim for 87635 (Sars-cov-2 covid-19 amp prb) vs avg $20.31 (+10.6Οƒ). $109,314 across 313 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.

KAYENTA ALTERNATIVE RURAL HOSPITALKAYENTAProvider total: $9.8M
criticalCost OutlierScore: 10.3

Cost-per-claim above average for H2011

2 BE DIFFERENT LLC (1982356549) bills $13,105.60/claim for H2011 (Crisis interven svc, 15 min) vs avg $536.47 (+10.4Οƒ). $1,795,467 across 137 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.

2 BE DIFFERENT LLCMARICOPAProvider total: $2.1M
criticalCost OutlierScore: 10.3

Cost-per-claim above average for 99441 (Telephone E&M (5-10 min))

DHHS IHS PHOENIX AREA (1356628028) bills $518.92/claim for 99441 (Code 99441) vs avg $23.14 (+10.3Οƒ). $4,165,352 across 8,027 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.

DHHS IHS PHOENIX AREAPOLACCAProvider total: $29.9M
criticalCost OutlierScore: 10.3

Cost-per-claim above average for J0696

TWELFTH ONE, LLC (1457872632) bills $25.00/claim for J0696 (Ceftriaxone sodium injection) vs avg $0.85 (+10.3Οƒ). $15,249 across 610 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.

TWELFTH ONE, LLCCHANDLERProvider total: $14.3M
criticalCost OutlierScore: 10.3

Cost-per-claim above average for 0012A

THE FORT DEFIANCE INDIAN HOSPITAL BOARD, INCORPORATION (1477876639) bills $508.19/claim for 0012A vs avg $21.85 (+10.3Οƒ). $24,393 across 48 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 FORT DEFIANCE INDIAN HOSPITAL BOARD, INCORPORATIONFORT DEFIANCEProvider total: $13.0M
criticalCost OutlierScore: 10.2

Cost-per-claim above average for 87340

KINGMAN HEALTHCARE, INC (1265423917) bills $76.27/claim for 87340 (Hepatitis b surface ag ia) vs avg $1.26 (+10.2Οƒ). $126,761 across 1,662 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.

KINGMAN HEALTHCARE, INCKINGMANProvider total: $86.2M
criticalCost OutlierScore: 10.2

Cost-per-claim above average for S5110

RESILIENT COMMUNITY CARE LLC (1942894761) bills $1,843.84/claim for S5110 (Family homecare training 15m) vs avg $80.17 (+10.2Οƒ). $38,721 across 21 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.

RESILIENT COMMUNITY CARE LLCGLENDALEProvider total: $2.1M
criticalCost OutlierScore: 10.1

Cost-per-claim above average for 97110 (Therapeutic Exercise (per 15 min))

THE CARING HOUSE (1912909391) bills $521.85/claim for 97110 (Therapeutic exercises) vs avg $39.59 (+10.1Οƒ). $62,100 across 119 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 CARING HOUSESACATONProvider total: $380.0K
criticalCost OutlierScore: 10.0

Cost-per-claim above average for H2027

TAYLORD LLC (1093340606) bills $14,214.78/claim for H2027 (Psychoed svc, per 15 min) vs avg $508.96 (+10.0Οƒ). $5,970,209 across 420 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.

TAYLORD LLCPHOENIXProvider total: $10.6M
criticalCost OutlierScore: 9.9

Cost-per-claim above average for H0004 (Behavioral Health Counseling and Therapy (per 15 min))

BRIDGE OF HOPE FAMILY SERVICES LLC (1235881103) bills $7,477.73/claim for H0004 (Behavioral health counseling and therapy, per 15 minutes) vs avg $219.37 (+9.9Οƒ). $1,517,980 across 203 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.

BRIDGE OF HOPE FAMILY SERVICES LLCMESAProvider total: $3.0M
criticalCost OutlierScore: 9.9

Cost-per-claim above average for D0220 (Dental X-ray (Periapical, First Film))

YUKTI GARG (1619346970) bills $44.00/claim for D0220 (Intraoral - periapical first image) vs avg $2.69 (+9.9Οƒ). $87,828 across 1,996 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.

YUKTI GARGMESAProvider total: $337.6K
criticalCost OutlierScore: 9.8

Cost-per-claim above average for 99212 (Office Visit, Established Patient (10 min, Straightforward))

DHHS, PHS, NAIHS, SHIPROCK HOSPITAL (1477615789) bills $474.08/claim for 99212 (Office o/p est sf 10 min) vs avg $28.03 (+9.8Οƒ). $10,349,532 across 21,831 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.

DHHS, PHS, NAIHS, SHIPROCK HOSPITALTEECNOSPOSProvider total: $12.8M
criticalCost OutlierScore: 9.8

Cost-per-claim above average for 99203 (Office Visit, New Patient (30 min, Low Complexity))

SMITHS FOOD & DRUG CENTERS INC (1689618993) bills $335.79/claim for 99203 (Office o/p new low 30 min) vs avg $55.04 (+9.8Οƒ). $12,424 across 37 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.

SMITHS FOOD & DRUG CENTERS INCPRESCOTTProvider total: $1.6M
criticalCost OutlierScore: 9.6

Cost-per-claim above average for H0004 (Behavioral Health Counseling and Therapy (per 15 min))

SAFE KEEPINGS COUNSELING LLC (1902434236) bills $7,244.38/claim for H0004 (Behavioral health counseling and therapy, per 15 minutes) vs avg $219.37 (+9.6Οƒ). $6,121,499 across 845 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.

SAFE KEEPINGS COUNSELING LLCPHOENIXProvider total: $19.4M
Page 1 of 109