Single-test outliers in Connecticut 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
330
warning
368
info
8,150
Total
8,848
SOUTHWESTERN CONNECTICUT AGENCY ON AGING (1225163876): 42.2 claims/beneficiary (avg 2.5). 9,306,109 claims, 220,675 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.
SOUTHWESTERN CONNECTICUT AGENCY ON AGING (1225163876): 42.2 claims/beneficiary (avg 2.5). 9,306,109 claims, 220,675 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.
STATE OF CONNECTICUT (1669466561) bills $232.06/claim for 96372 (Ther/proph/diag inj sc/im) vs avg $9.47 (+13.4Ο). $6,672,062 across 28,751 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.
STATE OF CONNECTICUT (1669466561) bills $232.06/claim for 96372 (Ther/proph/diag inj sc/im) vs avg $9.47 (+13.4Ο). $6,672,062 across 28,751 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.
LDO, LLC (1114154929) bills $24.15/claim for 85018 (Hemoglobin) vs avg $0.47 (+11.6Ο). $211,641 across 8,764 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.
LDO, LLC (1114154929) bills $24.15/claim for 85018 (Hemoglobin) vs avg $0.47 (+11.6Ο). $211,641 across 8,764 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.
STATE OF CONNECTICUT (1841225489) bills $312.70/claim for 90837 (Psytx w pt 60 minutes) vs avg $82.97 (+11.1Ο). $313,952 across 1,004 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.
STATE OF CONNECTICUT (1841225489) bills $312.70/claim for 90837 (Psytx w pt 60 minutes) vs avg $82.97 (+11.1Ο). $313,952 across 1,004 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.
UTOPIA ASSISTED LIVING SERVICES (1912056805): 29.6 claims/beneficiary (avg 2.5). 256,154 claims, 8,652 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.
UTOPIA ASSISTED LIVING SERVICES (1912056805): 29.6 claims/beneficiary (avg 2.5). 256,154 claims, 8,652 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.
CAREGIVER HOMES OF CONNECTICUT, INC (1265867394): 29.5 claims/beneficiary (avg 2.5). 1,216,445 claims, 41,186 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.
CAREGIVER HOMES OF CONNECTICUT, INC (1265867394): 29.5 claims/beneficiary (avg 2.5). 1,216,445 claims, 41,186 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.
AGENCY ON AGING OF SOUTH CENTRAL CT, INC. (1174635650): 29.1 claims/beneficiary (avg 2.5). 545,017 claims, 18,735 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.
HARTFORD HOSPITAL (1770696643) bills $121.21/claim for 90734 (Menacwyd/menacwycrm vacc im) vs avg $1.76 (+9.4Ο). $15,878 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.
STATE OF CONNECTICUT (1881629434) bills $271.24/claim for 90837 (Psytx w pt 60 minutes) vs avg $82.97 (+9.1Ο). $969,949 across 3,576 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.
STATE OF CONNECTICUT (1881629434) bills $271.24/claim for 90837 (Psytx w pt 60 minutes) vs avg $82.97 (+9.1Ο). $969,949 across 3,576 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.
STATE OF CONNECTICUT (1720013360) bills $267.44/claim for 90837 (Psytx w pt 60 minutes) vs avg $82.97 (+8.9Ο). $636,514 across 2,380 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.
STATE OF CONNECTICUT (1720013360) bills $267.44/claim for 90837 (Psytx w pt 60 minutes) vs avg $82.97 (+8.9Ο). $636,514 across 2,380 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.
GORGEOUS SMILES DENTAL HARTFORD (1548026685) bills $1,424.52/claim for D8670 (Periodic orthodontic treatment visit) vs avg $75.26 (+8.9Ο). $18,519 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.
NEW ERA REHABILITATION CENTER, INC (1255372108): 26.0 claims/beneficiary (avg 2.5). 901,197 claims, 34,619 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.
FAMILY STRONG CT (1487034641) bills $741.91/claim for 90791 (Psych diagnostic evaluation) vs avg $86.57 (+8.6Ο). $3,800,829 across 5,123 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.
EMINENCE CT, LLC (1144094392): 25.8 claims/beneficiary (avg 2.5). 2,788 claims, 108 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.
EMINENCE CT, LLC (1144094392): 25.8 claims/beneficiary (avg 2.5). 2,788 claims, 108 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 VILLAGE FOR FAMILIES & CHILDREN, INC. (1245304096): 25.7 claims/beneficiary (avg 2.5). 47,393 claims, 1,847 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 VILLAGE FOR FAMILIES & CHILDREN, INC. (1245304096): 25.7 claims/beneficiary (avg 2.5). 47,393 claims, 1,847 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.
PASSIONATE CARE SERVICES (1073727988): 25.3 claims/beneficiary (avg 2.5). 3,446 claims, 136 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.
PASSIONATE CARE SERVICES (1073727988): 25.3 claims/beneficiary (avg 2.5). 3,446 claims, 136 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.
BINA ROGINSKY (1235269721) bills $708.05/claim for 90791 (Psych diagnostic evaluation) vs avg $86.57 (+8.1Ο). $485,721 across 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.
BINA ROGINSKY (1235269721) bills $708.05/claim for 90791 (Psych diagnostic evaluation) vs avg $86.57 (+8.1Ο). $485,721 across 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.
SAINT FRANCIS HOSPITAL AND MEDICAL CENTER (1407833486) bills $15.84/claim for 36415 (Coll venous bld venipuncture) vs avg $2.01 (+7.9Ο). $22,305 across 1,408 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.
SAINT FRANCIS HOSPITAL AND MEDICAL CENTER (1407833486) bills $15.84/claim for 36415 (Coll venous bld venipuncture) vs avg $2.01 (+7.9Ο). $22,305 across 1,408 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.
CONNECTICUT CHILDREN'S MEDICAL CENTER (1134271661) bills $1,951.24/claim for 99285 (Emergency dept visit hi mdm) vs avg $174.22 (+7.8Ο). $42,759,433 across 21,914 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.
CONNECTICUT CHILDREN'S MEDICAL CENTER (1134271661) bills $1,951.24/claim for 99285 (Emergency dept visit hi mdm) vs avg $174.22 (+7.8Ο). $42,759,433 across 21,914 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.
FMCH DBA GRISWOLD HOME CARE (1083063481): 23.5 claims/beneficiary (avg 2.5). 9,018 claims, 384 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.
FMCH DBA GRISWOLD HOME CARE (1083063481): 23.5 claims/beneficiary (avg 2.5). 9,018 claims, 384 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 HOME CARE SERVICES, INC. (1629320494): 23.4 claims/beneficiary (avg 2.5). 132,576 claims, 5,671 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.
RETINA GROUP OF NEW ENGLAND PC (1316329733) bills $1,229.94/claim for J3490 (Drugs unclassified injection) vs avg $22.00 (+7.5Ο). $39,358 across 32 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.
LAWRENCE AND MEMORIAL HOSPITAL, INC. (1073530879) bills $15.18/claim for 36415 (Coll venous bld venipuncture) vs avg $2.01 (+7.5Ο). $94,753 across 6,241 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.
LAWRENCE AND MEMORIAL HOSPITAL, INC. (1073530879) bills $15.18/claim for 36415 (Coll venous bld venipuncture) vs avg $2.01 (+7.5Ο). $94,753 across 6,241 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.
SOVEREIGN HOME HEALTHCARE LLC (1710248083): 22.9 claims/beneficiary (avg 2.5). 20,136 claims, 881 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.
SOVEREIGN HOME HEALTHCARE LLC (1710248083): 22.9 claims/beneficiary (avg 2.5). 20,136 claims, 881 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.
ATHENA HOME HEALTH LLC (1063810992): 22.7 claims/beneficiary (avg 2.5). 8,230 claims, 362 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.
VICARAH, LLC (1225548332): 22.7 claims/beneficiary (avg 2.5). 8,414 claims, 371 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.
VICARAH, LLC (1225548332): 22.7 claims/beneficiary (avg 2.5). 8,414 claims, 371 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.
ABI RESOURCES LLC (1396184099): 22.3 claims/beneficiary (avg 2.5). 10,040 claims, 451 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.
ABI RESOURCES LLC (1396184099): 22.3 claims/beneficiary (avg 2.5). 10,040 claims, 451 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.
GREENWICH HOSPITAL (1609846088) bills $138.03/claim for 92012 (Intrm oph exam est patient) vs avg $22.40 (+7.2Ο). $19,600 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.
GREENWICH HOSPITAL (1609846088) bills $138.03/claim for 92012 (Intrm oph exam est patient) vs avg $22.40 (+7.2Ο). $19,600 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.
CONNECTICUT CHILDREN'S MEDICAL CENTER (1134271661) bills $65.11/claim for 92508 (Tx sp lang voice comm group) vs avg $29.35 (+7.2Ο). $120,526 across 1,851 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.
MCCALL FOUNDATION, INC. (1225180391): 22.0 claims/beneficiary (avg 2.5). 12,075 claims, 549 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.