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 California 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

3,706

warning

3,444

info

32,955

Total

40,105

Outliers by Type
Severity Distribution
critical
3,706 (9.2%)
warning
3,444 (8.6%)
info
32,955 (82.2%)
26,822 results
criticalCost OutlierScore: 80.2

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

HILLSIDE HOUSE, INC. (1467653303) bills $8,083.73/claim for 99213 (Office o/p est low 20 min) vs avg $29.29 (+80.2Οƒ). $541,610 across 67 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.

HILLSIDE HOUSE, INC.SANTA BARBARAProvider total: $35.6M
criticalCost OutlierScore: 53.5

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

VISITING NURSE AND HOSPICE CARE OF SANTA BARBARA (1275662405) bills $5,402.51/claim for 99213 (Office o/p est low 20 min) vs avg $29.29 (+53.5Οƒ). $118,855 across 22 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.

VISITING NURSE AND HOSPICE CARE OF SANTA BARBARASANTA BARBARAProvider total: $1.8M
criticalCost OutlierScore: 44.0

Cost-per-claim above average for D7140 (Tooth Extraction (Erupted Tooth, Simple))

KAISER FOUNDATION HOSPITALS (1073811378) bills $4,141.73/claim for D7140 (Extraction erupted tooth or exposed root) vs avg $56.00 (+44.0Οƒ). $53,842 across 13 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.

KAISER FOUNDATION HOSPITALSROSEVILLEProvider total: $90.7M
criticalCost OutlierScore: 39.4

Cost-per-claim above average for 90471 (Immunization Administration (Injection))

GOOD SHEPHERD MEDICAL CLINIC, INC (1427336791) bills $308.44/claim for 90471 (Immunization admin) vs avg $2.94 (+39.4Οƒ). $278,524 across 903 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 SHEPHERD MEDICAL CLINIC, INCTUSTINProvider total: $5.9M
criticalCost OutlierScore: 36.8

Cost-per-claim above average for 90734

CITY OF HOPE NATIONAL MEDICAL CENTER (1750358297) bills $1,146.24/claim for 90734 (Menacwyd/menacwycrm vacc im) vs avg $5.91 (+36.8Οƒ). $29,802 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.

CITY OF HOPE NATIONAL MEDICAL CENTERDUARTEProvider total: $175.7M
criticalCost OutlierScore: 36.5

Cost-per-claim above average for 3077F

SHINGLE SPRINGS RANCHERIA (1245356674) bills $82.73/claim for 3077F vs avg $0.16 (+36.5Οƒ). $35,573 across 430 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.

SHINGLE SPRINGS RANCHERIAPLACERVILLEProvider total: $69.0M
criticalCost OutlierScore: 32.3

Cost-per-claim above average for T1015 (Clinic Service)

DHHS IHS CAO DESERT SAGE YOUTH WELLNESS CENTER (1780057521) bills $7,079.77/claim for T1015 (Clinic service) vs avg $182.15 (+32.3Οƒ). $304,430 across 43 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 CAO DESERT SAGE YOUTH WELLNESS CENTERHEMETProvider total: $304.4K
criticalCost OutlierScore: 30.4

Cost-per-claim above average for 99211 (Office Visit, Established Patient (May not require physician)

DON GARCIA (1669574968) bills $710.61/claim for 99211 (Off/op est may x req phy/qhp) vs avg $10.91 (+30.4Οƒ). $103,749 across 146 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.

DON GARCIALA HABRAProvider total: $1.0M
criticalCost OutlierScore: 28.9

Cost-per-claim above average for 99000

RACHEL STEWARD (1619119328) bills $97.12/claim for 99000 (Specimen handling office-lab) vs avg $1.95 (+29.0Οƒ). $18,647 across 192 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.

RACHEL STEWARDSAN BERNARDINOProvider total: $32.1K
criticalCost OutlierScore: 28.2

Cost-per-claim above average for J1885

PALOMAR HEALTH (1376513754) bills $306.81/claim for J1885 (Ketorolac tromethamine inj) vs avg $3.87 (+28.2Οƒ). $1,912,328 across 6,233 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.

PALOMAR HEALTHPOWAYProvider total: $46.7M
criticalCost OutlierScore: 27.1

Cost-per-claim above average for 99308 (Subsequent Nursing Facility Care (Low Complexity))

CITY & COUNTY OF SAN FRANCISCO (1417099789) bills $703.29/claim for 99308 (Sbsq nf care low mdm 20) vs avg $14.91 (+27.1Οƒ). $167,382 across 238 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.

CITY & COUNTY OF SAN FRANCISCOSAN FRANCISCOProvider total: $1.3B
criticalCost OutlierScore: 26.8

Cost-per-claim above average for 3075F

SHINGLE SPRINGS RANCHERIA (1245356674) bills $38.40/claim for 3075F vs avg $0.13 (+26.8Οƒ). $10,789 across 281 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.

SHINGLE SPRINGS RANCHERIAPLACERVILLEProvider total: $69.0M
criticalCost OutlierScore: 25.5

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

MICHAELIAN ENDODONTIC DENTAL GROUP INC (1578012027) bills $116.00/claim for D0220 (Intraoral - periapical first image) vs avg $10.34 (+25.5Οƒ). $51,504 across 444 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.

MICHAELIAN ENDODONTIC DENTAL GROUP INCDALY CITYProvider total: $634.2K
criticalCost OutlierScore: 25.1

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

ORANGE COAST CARE, INC. (1598221863) bills $604.36/claim for 97110 (Therapeutic exercises) vs avg $21.64 (+25.1Οƒ). $19,944 across 33 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.

ORANGE COAST CARE, INC.ORANGEProvider total: $3.5M
criticalCost OutlierScore: 25.0

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

ST JOSEPH HOSPITAL OF ORANGE (1609850320) bills $558.14/claim for 80053 (Comprehen metabolic panel) vs avg $5.63 (+25.0Οƒ). $238,886 across 428 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 JOSEPH HOSPITAL OF ORANGEORANGEProvider total: $2.3M
criticalCost OutlierScore: 25.0

Cost-per-claim above average for 96372

RIVERWALK PEDIATRIC CLINIC INC (1417910886) bills $1,007.50/claim for 96372 (Ther/proph/diag inj sc/im) vs avg $17.23 (+25.0Οƒ). $13,097 across 13 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.

RIVERWALK PEDIATRIC CLINIC INCBAKERSFIELDProvider total: $7.7M
criticalCost OutlierScore: 24.1

Cost-per-claim above average for 0250

PINE STREET SNF, LLC (1972201598) bills $2,429.72/claim for 0250 vs avg $15.80 (+24.1Οƒ). $48,594 across 20 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.

PINE STREET SNF, LLCSAN FRANCISCOProvider total: $261.6K
criticalCost OutlierScore: 23.4

Cost-per-claim above average for 3074F

SHINGLE SPRINGS RANCHERIA (1245356674) bills $55.94/claim for 3074F vs avg $0.23 (+23.4Οƒ). $97,061 across 1,735 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.

SHINGLE SPRINGS RANCHERIAPLACERVILLEProvider total: $69.0M
criticalCost OutlierScore: 23.0

Cost-per-claim above average for 93010

TRIANGLE EYE INSTITUTE (1700052206) bills $168.11/claim for 93010 (Electrocardiogram report) vs avg $8.63 (+23.0Οƒ). $13,281 across 79 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.

TRIANGLE EYE INSTITUTEBAKERSFIELDProvider total: $226.6K
criticalCost OutlierScore: 23.0

Cost-per-claim above average for D2954

MICHAELIAN ENDODONTIC DENTAL GROUP INC (1578012027) bills $400.00/claim for D2954 (Prefab post and core in addition to crown) vs avg $104.13 (+23.0Οƒ). $25,200 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.

MICHAELIAN ENDODONTIC DENTAL GROUP INCDALY CITYProvider total: $634.2K
criticalCost OutlierScore: 22.9

Cost-per-claim above average for 80048 (Basic Metabolic Panel (8 tests))

ST JOSEPH HOSPITAL OF ORANGE (1609850320) bills $447.64/claim for 80048 (Metabolic panel total ca) vs avg $5.67 (+22.9Οƒ). $344,233 across 769 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 JOSEPH HOSPITAL OF ORANGEORANGEProvider total: $2.3M
criticalCost OutlierScore: 21.8

Cost-per-claim above average for 99070

FREMONT AMBULATORY SURGERY CENTER, LP (1851369284) bills $3,050.66/claim for 99070 (Special supplies phys/qhp) vs avg $20.33 (+21.8Οƒ). $799,273 across 262 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.

FREMONT AMBULATORY SURGERY CENTER, LPFREMONTProvider total: $7.1M
criticalCost OutlierScore: 21.6

Cost-per-claim above average for J3420

COUNTY OF STANISLAUS (1629094891) bills $252.98/claim for J3420 (Vitamin b12 injection) vs avg $2.28 (+21.6Οƒ). $206,428 across 816 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.

COUNTY OF STANISLAUSMODESTOProvider total: $3.9M
criticalCost OutlierScore: 21.1

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

TRI-CITY HOSPITAL (1801861190) bills $207.77/claim for 87804 (Influenza assay w/optic) vs avg $4.77 (+21.1Οƒ). $41,969 across 202 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.

TRI-CITY HOSPITALOCEANSIDEProvider total: $44.7M
criticalCost OutlierScore: 21.1

Cost-per-claim above average for G8510

GOOD SHEPHERD MEDICAL CLINIC, INC (1427336791) bills $150.58/claim for G8510 (Scr dep neg, no plan reqd) vs avg $2.79 (+21.1Οƒ). $46,681 across 310 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 SHEPHERD MEDICAL CLINIC, INCTUSTINProvider total: $5.9M
criticalCost OutlierScore: 20.6

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

DIGNITY COMMUNITY CARE (1114081056) bills $223.82/claim for 36415 (Coll venous bld venipuncture) vs avg $1.80 (+20.6Οƒ). $4,120,535 across 18,410 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.

DIGNITY COMMUNITY CARELOS ANGELESProvider total: $116.4M
criticalCost OutlierScore: 20.5

Cost-per-claim above average for H2019 (Therapeutic Behavioral Services (per 15 min))

MS. G & ASSOCIATES (1407343122) bills $4,114.59/claim for H2019 (Ther behav svc, per 15 min) vs avg $149.85 (+20.5Οƒ). $9,006,840 across 2,189 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.

MS. G & ASSOCIATESRIVERSIDEProvider total: $12.1M
criticalOverutilizationScore: 20.4

Unusually high claims-per-beneficiary ratio

NATHAN O OGBATUE (1922477975): 55.3 claims/beneficiary (avg 2.1). 500,777 claims, 9,061 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.

NATHAN O OGBATUERIVERSIDEProvider total: $36.2M
criticalCost OutlierScore: 20.4

Cost-per-claim above average for 81002 (Urinalysis without Microscopy)

COUNTY OF VENTURA (1821253402) bills $63.08/claim for 81002 (Urinalysis nonauto w/o scope) vs avg $1.20 (+20.4Οƒ). $22,206 across 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.

COUNTY OF VENTURAVENTURAProvider total: $4.3M
criticalCost OutlierScore: 20.3

Cost-per-claim above average for 1126F

SHIMA HADIDCHI MD A PROFESSIONAL CORP (1225685332) bills $199.44/claim for 1126F vs avg $0.71 (+20.3Οƒ). $71,800 across 360 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.

SHIMA HADIDCHI MD A PROFESSIONAL CORPVICTORVILLEProvider total: $7.2M
criticalCost OutlierScore: 20.2

Cost-per-claim above average for 99238 (Hospital Discharge Day (30 min or less))

SAN MATEO COUNTY (1427242163) bills $1,114.21/claim for 99238 (Hosp ip/obs dschrg mgmt 30/<) vs avg $33.45 (+20.2Οƒ). $30,084 across 27 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 MATEO COUNTYSAN MATEOProvider total: $131.0M
criticalCost OutlierScore: 20.1

Cost-per-claim above average for 90715 (Tdap Vaccine (Tetanus, Diphtheria, Pertussis))

PALOMAR HEALTH (1376513754) bills $371.83/claim for 90715 (Tdap vaccine 7 yrs/> im) vs avg $11.98 (+20.0Οƒ). $78,456 across 211 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.

PALOMAR HEALTHPOWAYProvider total: $46.7M
criticalCost OutlierScore: 20.0

Cost-per-claim above average for 90686 (Influenza Vaccine (Quadrivalent))

KRISHNAMOORTHI MD INC A PROFESSIONAL MEDICAL CORPORATION (1285785154) bills $222.86/claim for 90686 (Iiv4 vacc no prsv 0.5 ml im) vs avg $6.56 (+20.0Οƒ). $211,046 across 947 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.

KRISHNAMOORTHI MD INC A PROFESSIONAL MEDICAL CORPORATIONESCALONProvider total: $3.3M
criticalCost OutlierScore: 19.8

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

COUNTY OF LAKE (1215140066) bills $1,440.74/claim for 99232 (Sbsq hosp ip/obs moderate 35) vs avg $31.46 (+19.8Οƒ). $106,615 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.

COUNTY OF LAKELUCERNEProvider total: $15.8M
criticalCost OutlierScore: 19.8

Cost-per-claim above average for 0551

SOTERIA HOME HEALTH AGENCY, INC. (1629371398) bills $2,031.74/claim for 0551 vs avg $19.22 (+19.8Οƒ). $10,522,382 across 5,179 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.

SOTERIA HOME HEALTH AGENCY, INC.INGLEWOODProvider total: $17.2M
criticalCost OutlierScore: 19.1

Cost-per-claim above average for 81001 (Urinalysis with Microscopy)

PALOMAR HEALTH (1588634034) bills $59.62/claim for 81001 (Urinalysis auto w/scope) vs avg $1.62 (+19.1Οƒ). $14,129 across 237 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.

PALOMAR HEALTHESCONDIDOProvider total: $1.2M
criticalCost OutlierScore: 19.1

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

DIGNITY HEALTH (1356389878) bills $208.12/claim for 36415 (Coll venous bld venipuncture) vs avg $1.80 (+19.1Οƒ). $6,051,251 across 29,076 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.

DIGNITY HEALTHFOLSOMProvider total: $45.1M
criticalCost OutlierScore: 19.1

Cost-per-claim above average for 84132 (Potassium Blood Level)

MISSION HILLS DIALYSIS, LLC (1821242470) bills $154.56/claim for 84132 (Assay of serum potassium) vs avg $2.26 (+19.0Οƒ). $20,712 across 134 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.

MISSION HILLS DIALYSIS, LLCMISSION HILLSProvider total: $6.4M
criticalCost OutlierScore: 18.8

Cost-per-claim above average for 92014

SANTA YNEZ BAND OF MISSION INDIANS (1992779417) bills $719.00/claim for 92014 (Compre oph exam est pt 1/>) vs avg $27.50 (+18.8Οƒ). $19,413 across 27 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.

SANTA YNEZ BAND OF MISSION INDIANSSANTA YNEZProvider total: $38.9M
criticalCost OutlierScore: 18.8

Cost-per-claim above average for J3301

ST. JOSEPH HEALTH NORTHERN CALIFORNIA, LLC (1891900635) bills $195.21/claim for J3301 (Triamcinolone acet inj nos) vs avg $5.75 (+18.8Οƒ). $20,107 across 103 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. JOSEPH HEALTH NORTHERN CALIFORNIA, LLCEUREKAProvider total: $8.0M
criticalCost OutlierScore: 18.7

Cost-per-claim above average for 1126F

POOM MEDICAL CLINIC INC (1831548197) bills $184.47/claim for 1126F vs avg $0.71 (+18.7Οƒ). $19,000 across 103 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.

POOM MEDICAL CLINIC INCPERRISProvider total: $224.4K
criticalCost OutlierScore: 18.6

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

GOOD SHEPHERD MEDICAL CLINIC, INC (1427336791) bills $970.38/claim for 99212 (Office o/p est sf 10 min) vs avg $22.44 (+18.6Οƒ). $4,257,074 across 4,387 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.

GOOD SHEPHERD MEDICAL CLINIC, INCTUSTINProvider total: $5.9M
criticalCost OutlierScore: 18.5

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

RAI CARE CENTERS OF SOUTHERN CALIFORNIA I, LLC (1982777686) bills $104.54/claim for 85027 (Complete cbc automated) vs avg $2.40 (+18.5Οƒ). $18,399 across 176 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.

RAI CARE CENTERS OF SOUTHERN CALIFORNIA I, LLCCOMMERCEProvider total: $9.2M
criticalCost OutlierScore: 18.4

Cost-per-claim above average for S5102

ALL SEASONS HEALTHCARE, INC. (1992935563) bills $2,498.57/claim for S5102 (Adult day care per diem) vs avg $81.64 (+18.4Οƒ). $49,971 across 20 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.

ALL SEASONS HEALTHCARE, INC.LONG BEACHProvider total: $11.3M
criticalCost OutlierScore: 18.3

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

DIGNITY HEALTH (1972541498) bills $199.29/claim for 36415 (Coll venous bld venipuncture) vs avg $1.80 (+18.3Οƒ). $13,099,098 across 65,728 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.

DIGNITY HEALTHCARMICHAELProvider total: $97.3M
criticalCost OutlierScore: 18.3

Cost-per-claim above average for 99223 (Hospital Admission (High Complexity))

COUNTY OF SANTA CLARA (1265558324) bills $2,688.01/claim for 99223 (1st hosp ip/obs high 75) vs avg $77.96 (+18.3Οƒ). $115,584 across 43 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.

COUNTY OF SANTA CLARASAN JOSEProvider total: $2.8M
criticalCost OutlierScore: 18.2

Cost-per-claim above average for 92004

UNITED INDIAN HEALTH SERVICES, INC. (1497751572) bills $610.69/claim for 92004 (Compre oph exam new pt 1/>) vs avg $28.42 (+18.2Οƒ). $92,214 across 151 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.

UNITED INDIAN HEALTH SERVICES, INC.ARCATAProvider total: $64.8M
criticalCost OutlierScore: 18.2

Cost-per-claim above average for 82040 (Albumin Blood Level)

KECK MEDICAL CENTER OF USC (1013514199) bills $297.94/claim for 82040 (Assay of serum albumin) vs avg $3.28 (+18.2Οƒ). $121,558 across 408 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.

KECK MEDICAL CENTER OF USCLOS ANGELESProvider total: $45.0M
criticalCost OutlierScore: 18.0

Cost-per-claim above average for 99204 (Office Visit, New Patient (45 min, Moderate Complexity))

COUNTY OF STANISLAUS (1831227974) bills $1,373.22/claim for 99204 (Office o/p new mod 45 min) vs avg $66.38 (+18.0Οƒ). $178,518 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.

COUNTY OF STANISLAUSMODESTOProvider total: $63.5M
criticalCost OutlierScore: 18.0

Cost-per-claim above average for J7613

ANTELOPE VALLEY HEALTH CARE DISTRICT (1366419517) bills $272.14/claim for J7613 (Albuterol non-comp unit) vs avg $1.43 (+18.0Οƒ). $23,404 across 86 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.

ANTELOPE VALLEY HEALTH CARE DISTRICTLANCASTERProvider total: $222.3M
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