Single-test outliers in Georgia 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
139
warning
139
info
1,635
Total
1,913
NAMSARA HOMECARE SERVICES LLC (1669927380): 29.4 claims/beneficiary (avg 2.0). 6,546 claims, 223 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.
AU MEDICAL CENTER, INC (1437135902) bills $88.65/claim for 81003 (Urinalysis auto w/o scope) vs avg $2.42 (+11.7Ο). $764,123 across 8,620 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.
AU MEDICAL CENTER, INC (1437135902) bills $109.22/claim for 81002 (Urinalysis nonauto w/o scope) vs avg $3.32 (+11.6Ο). $18,895 across 173 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.
DOCTORS HOSPITAL OF AUGUSTA LLC (1912951963) bills $126.98/claim for 36415 (Coll venous bld venipuncture) vs avg $2.75 (+10.8Ο). $141,206 across 1,112 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.
AU MEDICAL CENTER, INC (1437135902) bills $70.13/claim for 90686 (Iiv4 vacc no prsv 0.5 ml im) vs avg $2.67 (+10.4Ο). $107,088 across 1,527 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.
ARUANA EMERGENCY PHYSICIANS LLC (1497151872) bills $1,089.00/claim for 99284 (Emergency dept visit mod mdm) vs avg $89.98 (+10.3Ο). $27,225 across 25 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.
LOUIS LEE (1053409797) bills $301.26/claim for 99212 (Office o/p est sf 10 min) vs avg $36.71 (+10.0Ο). $48,803 across 162 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.
SCOTTISH RITE CHILDREN'S MEDICAL CENTER (1184779332) bills $433.64/claim for D0274 (Bitewings - four radiographic images) vs avg $27.01 (+9.9Ο). $511,264 across 1,179 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.
METRO TREATMENT OF GEORGIA, LP (1982819595): 23.8 claims/beneficiary (avg 2.0). 26,298 claims, 1,104 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 TREATMENT OF GEORGIA, LP (1225447188): 23.7 claims/beneficiary (avg 2.0). 23,720 claims, 1,000 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.
FLOYD HEALTHCARE MANAGEMENT INC (1356444814) bills $412.95/claim for D1208 (Topical fluoride excluding varnish) vs avg $20.36 (+9.4Ο). $111,497 across 270 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 PARTNERSHIPS LLC (1932541729): 23.1 claims/beneficiary (avg 2.0). 6,692,783 claims, 289,131 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.
ACCESS HOME CARE, LLC (1831674563): 22.6 claims/beneficiary (avg 2.0). 12,726 claims, 562 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 TREATMENT OF GEORGIA, LP (1124235262): 22.4 claims/beneficiary (avg 2.0). 14,554 claims, 651 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 TREATMENT OF GEORGIA, LP (1144437286): 20.9 claims/beneficiary (avg 2.0). 110,087 claims, 5,259 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.
GEORGIA EM-I MEDICAL SERVICES PC (1912304932) bills $731.00/claim for 99283 (Emergency dept visit low mdm) vs avg $68.29 (+8.3Ο). $13,889 across 19 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.
ARUANA EMERGENCY PHYSICIANS LLC (1497151872) bills $715.02/claim for 99283 (Emergency dept visit low mdm) vs avg $68.29 (+8.1Ο). $168,744 across 236 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 HOME CARE SERVICES, INC. (1043488034): 20.3 claims/beneficiary (avg 2.0). 3,024,851 claims, 149,119 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.
RESCARE GEORGIA (1518135599): 20.2 claims/beneficiary (avg 2.0). 487,267 claims, 24,154 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.
HAMILTON MILL MEDICAL SERVICES, INC. (1770990012): 19.9 claims/beneficiary (avg 2.0). 22,578 claims, 1,132 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.
NORMAL LIFE OF GEORGIA (1851569834): 19.9 claims/beneficiary (avg 2.0). 948,518 claims, 47,622 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.
FLOYD HEALTHCARE MANAGEMENT INC (1356444814) bills $222.05/claim for D1120 (Prophylaxis - child) vs avg $34.50 (+7.8Ο). $109,913 across 495 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.
HEALTHSOURCE AGENCY INC (1629202874): 19.8 claims/beneficiary (avg 2.0). 34,737 claims, 1,750 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.
OLIVE HOME CARE SERVICES, INC (1063896009): 19.8 claims/beneficiary (avg 2.0). 1,425 claims, 72 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.
ARTHUR M. BLANK HOSPITAL, INC. (1689744450) bills $1,211.36/claim for 99285 (Emergency dept visit hi mdm) vs avg $124.35 (+7.8Ο). $39,850,255 across 32,897 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.
COASTAL HOME CARE, LLC (1285777490): 19.7 claims/beneficiary (avg 2.0). 552,205 claims, 27,991 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.
ARTHUR M. BLANK HOSPITAL, INC. (1689744450) bills $1,375.70/claim for D7140 (Extraction erupted tooth or exposed root) vs avg $96.05 (+7.7Ο). $16,508 across 12 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.
EGLESTON CHILDREN'S HOSPITAL AT EMORY UNIVERSITY, INC. (1558416701) bills $519.20/claim for D0230 (Intraoral - periapical each addl image) vs avg $19.23 (+7.6Ο). $430,413 across 829 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.
METRO TREATMENT OF GEORGIA, LP (1083030928): 19.3 claims/beneficiary (avg 2.0). 29,070 claims, 1,504 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.
BRENDA COPELAND (1598079212) bills $235.66/claim for 90847 (Family psytx w/pt 50 min) vs avg $71.99 (+7.5Ο). $439,980 across 1,867 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.
EGLESTON CHILDREN'S HOSPITAL AT EMORY UNIVERSITY, INC. (1558416701) bills $468.03/claim for D1351 (Sealant per tooth) vs avg $42.54 (+7.4Ο). $169,426 across 362 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.
ACCESS HEALTH TREATMENT CENTER LLC (1699220475): 18.6 claims/beneficiary (avg 2.0). 4,744 claims, 255 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. (1972771962): 18.4 claims/beneficiary (avg 2.0). 80,255 claims, 4,373 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.
PUBLIC PARTNERSHIPS LLC (1871959007): 17.7 claims/beneficiary (avg 2.0). 80,473 claims, 4,556 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.
DELTA HOMECARE (1053428615): 17.2 claims/beneficiary (avg 2.0). 37,389 claims, 2,174 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.
EBENEZER HEALTHCARE SERVICES, INC. (1669874673): 17.0 claims/beneficiary (avg 2.0). 247,583 claims, 14,528 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.
GOLDEN HEART HOME SERVICES, LLC (1215611488): 16.3 claims/beneficiary (avg 2.0). 5,828 claims, 358 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.
HOPE PRIVATE IN HOME CARE LLC (1235459090): 16.1 claims/beneficiary (avg 2.0). 30,260 claims, 1,874 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.
ROYAL HANDS HEALTHCARE SERVICES, INC (1689917635): 16.1 claims/beneficiary (avg 2.0). 23,458 claims, 1,457 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.
VIDALIA HEALTH SERVICES, LLC (1790376564) bills $563.86/claim for 99283 (Emergency dept visit low mdm) vs avg $68.29 (+6.2Ο). $47,364 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.
ROSE PETAL FALLS, LLC (1306189626): 16.1 claims/beneficiary (avg 2.0). 26,604 claims, 1,656 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.
VIDALIA HEALTH SERVICES, LLC (1790376564) bills $556.82/claim for 99282 (Emergency dept visit sf mdm) vs avg $74.43 (+6.0Ο). $13,364 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.
PARTNERSHIP FOR HEALTH HEALTH CARE (1942502364): 15.5 claims/beneficiary (avg 2.0). 41,781 claims, 2,688 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.
VICTORY HEALTH SYSTEM, INC. (1982064895): 15.2 claims/beneficiary (avg 2.0). 31,490 claims, 2,066 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.
DOCTORS HOSPITAL OF AUGUSTA LLC (1912951963) bills $89.35/claim for 80053 (Comprehen metabolic panel) vs avg $8.33 (+5.7Ο). $399,821 across 4,475 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.
H-SQUARED HEALTH RESOURCES INC (1033524798): 14.8 claims/beneficiary (avg 2.0). 32,680 claims, 2,204 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 CHILDREN'S DOCTORS PC (1295724680) bills $20.49/claim for 96160 (Pt-focused hlth risk assmt) vs avg $3.43 (+5.6Ο). $120,353 across 5,875 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.
KIDCARE PEDIATRICS (1871689265) bills $14.36/claim for G0447 (Behavior counsel obesity 15m) vs avg $1.00 (+5.5Ο). $19,100 across 1,330 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.
VIDALIA CHILDREN'S CENTER LLC (1679705115) bills $4.64/claim for 1126F vs avg $0.15 (+5.5Ο). $15,379 across 3,311 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.
OPTUM WOMEN'S AND CHILDREN'S HEALTH, LLC (1073561825) bills $139.55/claim for 96372 (Ther/proph/diag inj sc/im) vs avg $15.64 (+5.5Ο). $953,978 across 6,836 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.