Single-test outliers in Colorado 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
414
warning
600
info
7,508
Total
8,522
PEDIATRIC SERVICES OF AMERICA, LLC (1992731848): 56.3 claims/beneficiary (avg 2.5). 40,900 claims, 726 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.
LOVING CARE AGENCY, INC. (1467869214): 55.7 claims/beneficiary (avg 2.5). 28,951 claims, 520 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.
GRAND RIVER HOSPITAL DISTRICT (1851347223) bills $273.64/claim for 96127 (Brief emotional/behav assmt) vs avg $9.66 (+15.3Ο). $188,813 across 690 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.
IFEANYICHUKWU NWOBODO MD LLC (1831510536) bills $1,080.55/claim for 99233 (Sbsq hosp ip/obs high 50) vs avg $57.67 (+14.5Ο). $144,794 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.
UPPER SAN JUAN HEALTH SERVICE DISTRICT (1245401561) bills $26.94/claim for 91300 (Code 91300) vs avg $0.21 (+13.5Ο). $10,130 across 376 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.
DOLORES COUNTY HEALTH ASSOCIATION (1710954433) bills $90.34/claim for 36415 (Coll venous bld venipuncture) vs avg $2.53 (+13.3Ο). $13,642 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.
MARK BAKER (1811242340) bills $116.83/claim for D0120 (Periodic oral evaluation) vs avg $24.02 (+13.2Ο). $78,861 across 675 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.
SOUTHERN UTE INDIAN TRIBE (1407883309) bills $548.00/claim for 92014 (Compre oph exam est pt 1/>) vs avg $84.89 (+13.2Ο). $51,512 across 94 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.
ATLAS HOME HEALTH, INC. (1831401975): 45.6 claims/beneficiary (avg 2.5). 74,452 claims, 1,631 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.
CHILDREN'S HOSPITAL COLORADO (1336245828) bills $80.41/claim for 81025 (Urine pregnancy test) vs avg $5.17 (+12.6Ο). $358,161 across 4,454 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.
ROBERT HAMBLIN (1407922651) bills $54.93/claim for D0220 (Intraoral - periapical first image) vs avg $11.99 (+12.5Ο). $11,754 across 214 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.
COLORADO'S HELPING HAND LLC (1063995546): 43.2 claims/beneficiary (avg 2.5). 59,161 claims, 1,369 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.
APRIL GOGGANS (1780922864): 42.7 claims/beneficiary (avg 2.5). 14,521 claims, 340 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.
AURORA COMPREHENSIVE COMMUNITY MENTAL HEALTH CENTER, INC. (1962846840) bills $252.35/claim for 96372 (Ther/proph/diag inj sc/im) vs avg $13.81 (+11.8Ο). $33,058 across 131 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.
ANIMAS SURGICAL HOSPITAL, LLC (1508842964) bills $978.70/claim for D2930 (Prefabricated stainless steel crown primary) vs avg $134.95 (+11.7Ο). $63,616 across 65 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.
GRAND RIVER HOSPITAL DISTRICT (1124074042) bills $399.93/claim for 99173 (Visual acuity screen) vs avg $9.55 (+11.4Ο). $33,594 across 84 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.
GRAND JUNCTION REGIONAL CENTER (1275200164): 40.6 claims/beneficiary (avg 2.5). 1,625 claims, 40 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.
SUMMIT COMMUNITY CARE CLINIC, INC. (1639595986) bills $73.57/claim for G8510 (Scr dep neg, no plan reqd) vs avg $5.01 (+11.3Ο). $18,320 across 249 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.
ANGELS OF CARE PEDIATRIC HOME HEALTH COLORADO, LLC. (1184164436): 40.3 claims/beneficiary (avg 2.5). 30,316 claims, 753 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.
WESTPEAK MOBILITY LLC (1003359704) bills $3,895.25/claim for E1399 (Durable medical equipment, miscellaneous) vs avg $131.40 (+10.8Ο). $58,429 across 15 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.
SOUTHWEST HEALTH SYSTEM INC (1649241571) bills $28.25/claim for 81003 (Urinalysis auto w/o scope) vs avg $1.40 (+10.4Ο). $45,171 across 1,599 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.
LENDING HANDS HOME CARE (1811465453): 36.7 claims/beneficiary (avg 2.5). 5,317 claims, 145 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.
GRAND RIVER HOSPITAL DISTRICT (1124074042) bills $184.62/claim for 96127 (Brief emotional/behav assmt) vs avg $9.66 (+10.1Ο). $495,892 across 2,686 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.
MEDIC TRANSPORTATION LLC (1083302566) bills $2,472.32/claim for A0425 (Ground mileage) vs avg $100.86 (+9.9Ο). $187,896 across 76 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.
ACTUALIZE BEHAVIOR ALTERNATIVES (1902251705) bills $2,633.36/claim for 97155 (Adapt behavior tx phys/qhp) vs avg $183.65 (+9.9Ο). $2,064,558 across 784 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.
SOUTHWEST COLORADO MENTAL HEALTH CENTER, INC (1447630504) bills $141.86/claim for 90471 (Immunization admin) vs avg $14.69 (+9.9Ο). $14,612 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.
DENVER INDIAN HEALTH AND FAMILY SERVICES INC. (1073561270) bills $195.91/claim for 0064A vs avg $31.96 (+9.5Ο). $18,416 across 94 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.
ANGELS OF CARE PEDIATRIC HOME HEALTH COLORADO, LLC. (1366032732): 34.0 claims/beneficiary (avg 2.5). 8,627 claims, 254 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.
METRO COMMUNITY PROVIDER NETWORK INC (1396510947) bills $253.39/claim for 90460 (Im admin 1st/only component) vs avg $32.82 (+9.3Ο). $32,687 across 129 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.
MOSAIC (1518182120): 33.5 claims/beneficiary (avg 2.5). 170,655 claims, 5,089 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.
MARILLAC CLINIC, INC. (1518239219) bills $120.80/claim for 99406 (Behav chng smoking 3-10 min) vs avg $9.45 (+9.1Ο). $1,191,832 across 9,866 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.
VAXCARE COLORADO LLC (1164800082) bills $189.63/claim for 90670 (Pcv13 vaccine im) vs avg $7.11 (+9.0Ο). $15,549 across 82 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.
PUEBLO REGIONAL CENTER (1760921274): 32.7 claims/beneficiary (avg 2.5). 425 claims, 13 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.
COMMUNITY LIVING ALTERNATIVES, INC. (1144497975): 32.7 claims/beneficiary (avg 2.5). 93,442 claims, 2,861 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.
TLC CONNECTION (1659928604): 32.6 claims/beneficiary (avg 2.5). 92,243 claims, 2,830 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.
SOUTHERN UTE INDIAN TRIBE (1407883309) bills $490.20/claim for 99213 (Office o/p est low 20 min) vs avg $62.56 (+8.9Ο). $1,663,261 across 3,393 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.
AHOD SERVICES LLC (1912461179) bills $1,315.74/claim for T1017 (Targeted case management) vs avg $99.16 (+8.9Ο). $482,876 across 367 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.
ARIEL CLINICAL SERVICES (1154876209): 32.4 claims/beneficiary (avg 2.5). 31,062 claims, 960 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.
MARK BAKER (1811242340) bills $131.66/claim for D0150 (Comprehensive oral evaluation) vs avg $38.68 (+8.8Ο). $51,085 across 388 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.
TEAMSELECT HOME CARE OF COLORADO, LLC (1871198952): 31.8 claims/beneficiary (avg 2.5). 347,538 claims, 10,912 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.
HUMAN TOUCH UNSKILLED SERVICES, INC. (1336158906): 31.5 claims/beneficiary (avg 2.5). 12,872 claims, 408 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.
COTTONWOOD COMMUNITY ALTERNATIVES, INC. (1033577853): 31.5 claims/beneficiary (avg 2.5). 442,180 claims, 14,031 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.
GRAND RIVER HOSPITAL DISTRICT (1649218991) bills $78.96/claim for Q9967 (Locm 300-399mg/ml iodine,1ml) vs avg $4.14 (+8.7Ο). $31,899 across 404 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.
ELEOS SERVICES LLC (1467908004): 31.4 claims/beneficiary (avg 2.5). 45,407 claims, 1,446 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.
AMAZING CARE HOME HEALTH SERVICES, LLC (1407965122): 31.3 claims/beneficiary (avg 2.5). 59,893 claims, 1,914 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.
APEX PHYSICAL MEDICINE AND REHABILITATION PROFESSIONAL LLC (1326229287) bills $207.98/claim for J3490 (Drugs unclassified injection) vs avg $4.30 (+8.6Ο). $114,389 across 550 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.
MARILLAC CLINIC, INC. (1518239219) bills $10.38/claim for 1160F vs avg $0.18 (+8.5Ο). $76,552 across 7,376 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.
TEAMSELECT HOME CARE OF COLORADO, LLC (1710582184): 30.6 claims/beneficiary (avg 2.5). 366,989 claims, 11,989 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.
ARAPAHOE MENTAL HEALTH CENTER, INC (1568078517) bills $326.85/claim for 90853 (Group psychotherapy) vs avg $36.56 (+8.3Ο). $23,206 across 71 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.
PERSONAL ASSISTANCE SERVICES OF COLORADO, LLC (1972954923): 30.1 claims/beneficiary (avg 2.5). 2,492,970 claims, 82,877 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.