Statistical Outliers

Single-test outliers in Florida Medicaid data. These are individual statistical flags — 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 — 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

1,211

warning

1,703

info

16,456

Total

19,370

Outliers by Type

Severity Distribution

critical

1,211 (6.3%)

warning

1,703 (8.8%)

info

16,456 (85.0%)

13,882 results

criticalCost OutlierScore: 34.7

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

FRANK J. MAYE, DMD, PA (1902174360) bills $1,396.42/claim for D0220 (Intraoral - periapical first image) vs avg $4.40 (+34.7σ). $343,520 across 246 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.

FRANK J. MAYE, DMD, PABOCA RATONProvider total: $364.8K

criticalCost OutlierScore: 29.3

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

HIALEAH DENTAL SPECIALTY ASSOCIATES, P.L. (1649375254) bills $384.97/claim for D0230 (Intraoral - periapical each addl image) vs avg $3.37 (+29.3σ). $21,558 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.

HIALEAH DENTAL SPECIALTY ASSOCIATES, P.L.HIALEAHProvider total: $33.6K

criticalCost OutlierScore: 24.6

Cost-per-claim above average for 81025

1265165124 (1265165124) bills $688.36/claim for 81025 (Urine pregnancy test) vs avg $5.08 (+24.7σ). $14,456 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.

1265165124Provider total: $209.9K

criticalCost OutlierScore: 23.7

Cost-per-claim above average for 1159F

FLORIDA DEPARTMENT OF HEALTH (1548236623) bills $40.29/claim for 1159F vs avg $0.19 (+23.7σ). $36,547 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.

FLORIDA DEPARTMENT OF HEALTHMACCLENNYProvider total: $970.3K

criticalCost OutlierScore: 22.1

Cost-per-claim above average for H0032

MY MENTAL HEALTH SOLUTIONS (1487247409) bills $1,037.95/claim for H0032 (Mh svc plan dev by non-md) vs avg $68.53 (+22.1σ). $31,139 across 30 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.

MY MENTAL HEALTH SOLUTIONSMIAMIProvider total: $5.1M

criticalCost OutlierScore: 21.3

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

1457361024 (1457361024) bills $284.98/claim for 81001 (Urinalysis auto w/scope) vs avg $2.75 (+21.3σ). $11,969 across 42 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.

1457361024Provider total: $103.2K

criticalCost OutlierScore: 21.0

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

STEPHEN GOLDFADEN (1417014457) bills $770.02/claim for D0140 (Limited oral evaluation - problem focused) vs avg $19.58 (+21.0σ). $50,821 across 66 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.

STEPHEN GOLDFADENGAINESVILLEProvider total: $51.1K

criticalCost OutlierScore: 20.9

Cost-per-claim above average for G8417

MELI ORTHOPEDIC CENTERS OF EXCELLENCE,LLC. (1568581502) bills $17.71/claim for G8417 (Calc bmi abv up param f/u) vs avg $0.09 (+20.9σ). $13,283 across 750 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.

MELI ORTHOPEDIC CENTERS OF EXCELLENCE,LLC.FT LAUDERDALEProvider total: $140.6K

criticalCost OutlierScore: 19.5

Cost-per-claim above average for H0031

CLAUDIA IGLESIAS (1497061568) bills $2,340.00/claim for H0031 (Mh health assess by non-md) vs avg $52.28 (+19.5σ). $37,440 across 16 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.

CLAUDIA IGLESIASMIAMIProvider total: $39.2K

criticalCost OutlierScore: 19.2

Cost-per-claim above average for 92507 (Speech-Language Therapy (Individual))

MARSHALL THERAPY SERVICES, LLC (1437412525) bills $538.14/claim for 92507 (Tx sp lang voice comm indiv) vs avg $48.37 (+19.2σ). $397,147 across 738 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.

MARSHALL THERAPY SERVICES, LLCNORTH MIAMI BEACHProvider total: $397.1K

criticalCost OutlierScore: 18.5

Cost-per-claim above average for D2391 (Dental Filling, Composite/Resin (One Surface, Posterior))

PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA (1225033020) bills $974.71/claim for D2391 (Resin composite - one surface posterior) vs avg $38.82 (+18.5σ). $19,494 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.

PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDAMIAMIProvider total: $78.8M

criticalCost OutlierScore: 17.6

Cost-per-claim above average for 86900

SOUTHERN BAPTIST HOSPITAL OF FLORIDA, INC (1700553856) bills $1,768.87/claim for 86900 (Blood typing serologic abo) vs avg $9.82 (+17.6σ). $26,533 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.

SOUTHERN BAPTIST HOSPITAL OF FLORIDA, INCJACKSONVILLEProvider total: $29.1M

criticalCost OutlierScore: 17.3

Cost-per-claim above average for 99173

ZULLY AMBROISE (1316167083) bills $61.96/claim for 99173 (Visual acuity screen) vs avg $0.58 (+17.3σ). $50,060 across 808 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.

ZULLY AMBROISEWINTER PARKProvider total: $742.2K

criticalCost OutlierScore: 17.1

Cost-per-claim above average for 90648

HARPREET KAHLON (1700807070) bills $54.06/claim for 90648 (Hib prp-t vaccine 4 dose im) vs avg $0.71 (+17.2σ). $10,650 across 197 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.

HARPREET KAHLONDAVENPORTProvider total: $1.6M

criticalCost OutlierScore: 16.9

Cost-per-claim above average for V2020

AMIR CUKIERMAN (1336351543) bills $438.10/claim for V2020 (Vision svcs frames purchases) vs avg $16.70 (+16.9σ). $1,192,063 across 2,721 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.

AMIR CUKIERMANFT LAUDERDALEProvider total: $1.6M

criticalCost OutlierScore: 16.8

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

ANTONY G SANKOORIKAL MD PA (1982620597) bills $496.85/claim for 99213 (Office o/p est low 20 min) vs avg $30.65 (+16.7σ). $728,377 across 1,466 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.

ANTONY G SANKOORIKAL MD PACLEARWATERProvider total: $1.1M

criticalCost OutlierScore: 16.7

Cost-per-claim above average for 2000F

HYDERABAD MEDICAL SERVICES PLLC (1972756112) bills $25.52/claim for 2000F vs avg $0.09 (+16.7σ). $21,617 across 847 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.

HYDERABAD MEDICAL SERVICES PLLCKISSIMMEEProvider total: $92.4K

criticalCost OutlierScore: 16.2

Cost-per-claim above average for D0272 (Dental X-rays (Bitewings, 2 Films))

NORTHWEST FLORIDA HEALTHCARE, INC (1336163708) bills $210.97/claim for D0272 (Bitewings - two radiographic images) vs avg $4.53 (+16.2σ). $64,978 across 308 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.

NORTHWEST FLORIDA HEALTHCARE, INCCHIPLEYProvider total: $12.9M

criticalCost OutlierScore: 16.2

Cost-per-claim above average for 3079F

ACEVEDO MEDICAL CARE GROUP INC (1588756001) bills $10.03/claim for 3079F vs avg $0.07 (+16.2σ). $50,340 across 5,018 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.

ACEVEDO MEDICAL CARE GROUP INCMIAMIProvider total: $1.7M

criticalCost OutlierScore: 16.1

Cost-per-claim above average for 82550

LIVE OAK HMA, LLC (1255430757) bills $298.18/claim for 82550 (Assay of ck (cpk)) vs avg $2.82 (+16.1σ). $22,662 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.

LIVE OAK HMA, LLCLIVE OAKProvider total: $6.5M

criticalCost OutlierScore: 15.9

Cost-per-claim above average for 71045 (Chest X-ray (Single View))

LIVE OAK HMA, LLC (1255430757) bills $127.45/claim for 71045 (X-ray exam chest 1 view) vs avg $4.32 (+15.9σ). $210,415 across 1,651 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.

LIVE OAK HMA, LLCLIVE OAKProvider total: $6.5M

criticalCost OutlierScore: 15.7

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

VITAS HEALTHCARE CORPORATION OF FLORIDA (1528113792) bills $314.18/claim for 99232 (Sbsq hosp ip/obs moderate 35) vs avg $17.27 (+15.7σ). $280,245 across 892 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.

VITAS HEALTHCARE CORPORATION OF FLORIDAMIAMI LAKESProvider total: $36.9M

criticalCost OutlierScore: 15.4

Cost-per-claim above average for 99291 (Critical Care, First 30-74 min)

SOUTHERN BAPTIST HOSPITAL OF FLORIDA, INC (1700553856) bills $1,592.05/claim for 99291 (Critical care first hour) vs avg $90.14 (+15.4σ). $97,115 across 61 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 BAPTIST HOSPITAL OF FLORIDA, INCJACKSONVILLEProvider total: $29.1M

criticalCost OutlierScore: 15.4

Cost-per-claim above average for 82962

STARKE HMA, LLC (1285733790) bills $209.81/claim for 82962 (Glucose blood test) vs avg $3.93 (+15.4σ). $49,306 across 235 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.

STARKE HMA, LLCSTARKEProvider total: $5.3M

criticalCost OutlierScore: 15.2

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

INSTITUTE FOR RHEUMATOLOGY & INTEGRATIVE MEDICINE (1457442451) bills $467.75/claim for 99212 (Office o/p est sf 10 min) vs avg $29.12 (+15.2σ). $82,792 across 177 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.

INSTITUTE FOR RHEUMATOLOGY & INTEGRATIVE MEDICINEPEMBROKE PINESProvider total: $579.3K

criticalCost OutlierScore: 15.2

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

WAVE THERAPY (1497243661) bills $448.00/claim for 97110 (Therapeutic exercises) vs avg $33.18 (+15.2σ). $37,184 across 83 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.

WAVE THERAPYGULF BREEZEProvider total: $37.2K

criticalCost OutlierScore: 14.8

Cost-per-claim above average for 3075F

ST LUCIE MEDICAL SPECIALISTS LLC (1548447535) bills $18.02/claim for 3075F vs avg $0.23 (+14.8σ). $28,990 across 1,609 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 LUCIE MEDICAL SPECIALISTS LLCPORT ST LUCIEProvider total: $1.3M

criticalCost OutlierScore: 14.7

Cost-per-claim above average for 83036 (Hemoglobin A1c (Diabetes Monitoring))

ST. MARY'S MEDICAL CENTER, INC (1952333205) bills $93.40/claim for 83036 (Hemoglobin glycosylated a1c) vs avg $2.41 (+14.7σ). $114,605 across 1,227 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. MARY'S MEDICAL CENTER, INCWEST PALM BEACHProvider total: $61.5M

criticalCost OutlierScore: 14.4

Cost-per-claim above average for G0439 (Annual Wellness Visit (Subsequent))

DONALD DIXON (1720138878) bills $154.89/claim for G0439 (Ppps, subseq visit) vs avg $1.79 (+14.4σ). $52,507 across 339 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.

DONALD DIXONHOLLYWOODProvider total: $559.7K

criticalCost OutlierScore: 14.3

Cost-per-claim above average for 99231 (Subsequent Hospital Care (Low Complexity))

H2 HOSPITALIST GROUP, LLC (1346759768) bills $314.45/claim for 99231 (Sbsq hosp ip/obs sf/low 25) vs avg $12.99 (+14.3σ). $1,449,000 across 4,608 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.

H2 HOSPITALIST GROUP, LLCMIAMIProvider total: $3.5M

criticalCost OutlierScore: 14.2

Cost-per-claim above average for D0272 (Dental X-rays (Bitewings, 2 Films))

TAMPA CHILDRENS SURGERY CENTER LLC (1215421540) bills $185.06/claim for D0272 (Bitewings - two radiographic images) vs avg $4.53 (+14.2σ). $10,919 across 59 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.

TAMPA CHILDRENS SURGERY CENTER LLCTAMPAProvider total: $30.7M

criticalCost OutlierScore: 13.9

Cost-per-claim above average for S9451

FLORIDA PEDIATRIC GROUP PA (1396962734) bills $13.94/claim for S9451 (Exercise class) vs avg $0.13 (+13.9σ). $249,656 across 17,911 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.

FLORIDA PEDIATRIC GROUP PAW MELBOURNEProvider total: $7.7M

criticalCost OutlierScore: 13.8

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

NORTH CENTRAL FLORIDA ENDODONTICS,PLLC (1699326603) bills $512.26/claim for D0140 (Limited oral evaluation - problem focused) vs avg $19.58 (+13.8σ). $224,882 across 439 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.

NORTH CENTRAL FLORIDA ENDODONTICS,PLLCOCALAProvider total: $313.4K

criticalCost OutlierScore: 13.8

Cost-per-claim above average for 84484

LIVE OAK HMA, LLC (1255430757) bills $180.15/claim for 84484 (Assay of troponin quant) vs avg $3.24 (+13.8σ). $249,332 across 1,384 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.

LIVE OAK HMA, LLCLIVE OAKProvider total: $6.5M

criticalCost OutlierScore: 13.7

Cost-per-claim above average for G0151

ONE NURSING CARE LLC (1295157790) bills $22.93/claim for G0151 (Hhcp-serv of pt,ea 15 min) vs avg $0.12 (+13.7σ). $90,265 across 3,936 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.

ONE NURSING CARE LLCMIRAMARProvider total: $4.0M

criticalCost OutlierScore: 13.7

Cost-per-claim above average for T1027

BLAIRE TAYLOR (1437401452) bills $221.35/claim for T1027 (Family training & counseling) vs avg $45.58 (+13.7σ). $970,602 across 4,385 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.

BLAIRE TAYLORNEPTUNE BEACHProvider total: $970.6K

criticalCost OutlierScore: 13.7

Cost-per-claim above average for 99283 (Emergency Dept Visit (Moderate Complexity))

1326447939 (1326447939) bills $616.32/claim for 99283 (Emergency dept visit low mdm) vs avg $58.15 (+13.7σ). $75,191 across 122 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.

GUAM HEALTHCARE DEVELOPMENT INCORPORATEDDEDEDOProvider total: $980.4K

criticalCost OutlierScore: 13.7

Cost-per-claim above average for 2001F

HYDERABAD MEDICAL SERVICES PLLC (1972756112) bills $7.51/claim for 2001F vs avg $0.09 (+13.7σ). $14,405 across 1,919 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.

HYDERABAD MEDICAL SERVICES PLLCKISSIMMEEProvider total: $92.4K

criticalCost OutlierScore: 13.5

Cost-per-claim above average for A4657

RENAL TREATMENT CENTERS-SOUTHEAST, LP. (1336117670) bills $1,867.93/claim for A4657 (Syringe w/wo needle) vs avg $178.06 (+13.5σ). $5,411,390 across 2,897 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 TREATMENT CENTERS-SOUTHEAST, LP.PENSACOLAProvider total: $11.1M

criticalCost OutlierScore: 13.4

Cost-per-claim above average for 71045 (Chest X-ray (Single View))

STARKE HMA, LLC (1285733790) bills $107.57/claim for 71045 (X-ray exam chest 1 view) vs avg $4.32 (+13.4σ). $160,285 across 1,490 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.

STARKE HMA, LLCSTARKEProvider total: $5.3M

criticalCost OutlierScore: 13.3

Cost-per-claim above average for 4010F

ACEVEDO MEDICAL CARE GROUP INC (1588756001) bills $7.99/claim for 4010F vs avg $0.05 (+13.3σ). $10,246 across 1,283 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.

ACEVEDO MEDICAL CARE GROUP INCMIAMIProvider total: $1.7M

criticalCost OutlierScore: 13.3

Cost-per-claim above average for D1330

1437215134 (1437215134) bills $69.99/claim for D1330 (Oral hygiene instructions) vs avg $1.96 (+13.3σ). $11,058 across 158 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.

FREDERIKSTED HEALTH CARE, INC.FREDERIKSTEDProvider total: $1.6M

criticalCost OutlierScore: 13.2

Cost-per-claim above average for J3010

THE NEMOURS FOUNDATION (1245520386) bills $764.96/claim for J3010 (Fentanyl citrate injection) vs avg $9.30 (+13.2σ). $14,073,736 across 18,398 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 NEMOURS FOUNDATIONORLANDOProvider total: $105.0M

criticalCost OutlierScore: 13.2

Cost-per-claim above average for D9230

DALE SALOMON (1245333509) bills $774.99/claim for D9230 (Inhalation of nitrous oxide/analgesia) vs avg $25.78 (+13.2σ). $12,400 across 16 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.

DALE SALOMONTAMPAProvider total: $18.5K

criticalCost OutlierScore: 13.2

Cost-per-claim above average for 90633

HARPREET KAHLON (1700807070) bills $45.90/claim for 90633 (Hepa vacc ped/adol 2 dose im) vs avg $1.24 (+13.1σ). $12,486 across 272 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.

HARPREET KAHLONDAVENPORTProvider total: $1.6M

criticalCost OutlierScore: 13.0

Cost-per-claim above average for J2270

WESTCHESTER GENERAL HOSPITAL, INC. (1548284177) bills $492.46/claim for J2270 (Morphine sulfate injection) vs avg $5.45 (+13.0σ). $16,251 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.

WESTCHESTER GENERAL HOSPITAL, INC.MIAMIProvider total: $315.1K

criticalCost OutlierScore: 13.0

Cost-per-claim above average for 90461 (Immunization Administration (Each Additional Component))

JOHN ELZIE (1396734752) bills $206.75/claim for 90461 (Im admin each addl component) vs avg $9.43 (+13.0σ). $26,671 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.

JOHN ELZIETALLAHASSEEProvider total: $186.4K

criticalCost OutlierScore: 12.9

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

NICOLE EASTHAM (1699039867) bills $425.17/claim for T1015 (Clinic service) vs avg $48.44 (+13.0σ). $307,401 across 723 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.

NICOLE EASTHAMBONITA SPRINGSProvider total: $307.9K

criticalCost OutlierScore: 12.7

Cost-per-claim above average for T1019

DOUGLAS GARDENS HOME CARE, INC. (1598825127) bills $958.31/claim for T1019 (Personal care ser per 15 min) vs avg $70.00 (+12.7σ). $52,707 across 55 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.

DOUGLAS GARDENS HOME CARE, INC.MIAMIProvider total: $107.4K

criticalCost OutlierScore: 12.5

Cost-per-claim above average for 83605

STARKE HMA, LLC (1285733790) bills $167.82/claim for 83605 (Assay of lactic acid) vs avg $2.50 (+12.5σ). $50,851 across 303 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.

STARKE HMA, LLCSTARKEProvider total: $5.3M

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