Statistical Outliers

Single-test outliers in Georgia 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

108

warning

170

info

1,635

Total

1,913

Outliers by Type

Severity Distribution

critical

108 (5.6%)

warning

170 (8.9%)

info

1,635 (85.5%)

1,174 results

criticalCost OutlierScore: 11.7

Cost-per-claim above average for 81003 (Urinalysis by Dipstick (Automated))

AU MEDICAL CENTER, INC (1437135902) bills $88.65/claim for 81003 (Urinalysis auto w/o scope) vs avg $2.42 (+11.7σ). $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, INCAUGUSTAProvider total: $26.7M

criticalCost OutlierScore: 11.6

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

AU MEDICAL CENTER, INC (1437135902) bills $109.22/claim for 81002 (Urinalysis nonauto w/o scope) vs avg $3.32 (+11.6σ). $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.

AU MEDICAL CENTER, INCAUGUSTAProvider total: $26.7M

criticalCost OutlierScore: 10.8

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

DOCTORS HOSPITAL OF AUGUSTA LLC (1912951963) bills $126.98/claim for 36415 (Coll venous bld venipuncture) vs avg $2.75 (+10.8σ). $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.

DOCTORS HOSPITAL OF AUGUSTA LLCAUGUSTAProvider total: $2.2M

criticalCost OutlierScore: 10.4

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

AU MEDICAL CENTER, INC (1437135902) bills $70.13/claim for 90686 (Iiv4 vacc no prsv 0.5 ml im) vs avg $2.67 (+10.4σ). $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.

AU MEDICAL CENTER, INCAUGUSTAProvider total: $26.7M

criticalCost OutlierScore: 10.3

Cost-per-claim above average for 99284 (Emergency Dept Visit (Moderate/High Complexity))

ARUANA EMERGENCY PHYSICIANS LLC (1497151872) bills $1,089.00/claim for 99284 (Emergency dept visit mod mdm) vs avg $89.98 (+10.3σ). $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.

ARUANA EMERGENCY PHYSICIANS LLCDEMORESTProvider total: $196.0K

criticalCost OutlierScore: 10.0

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

LOUIS LEE (1053409797) bills $301.26/claim for 99212 (Office o/p est sf 10 min) vs avg $36.71 (+10.0σ). $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.

LOUIS LEELITHONIAProvider total: $1.6M

criticalCost OutlierScore: 9.9

Cost-per-claim above average for D0274 (Dental X-rays (Bitewings, 4 Films))

SCOTTISH RITE CHILDREN'S MEDICAL CENTER (1184779332) bills $433.64/claim for D0274 (Bitewings - four radiographic images) vs avg $27.01 (+9.9σ). $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.

SCOTTISH RITE CHILDREN'S MEDICAL CENTERATLANTAProvider total: $493.4M

criticalCost OutlierScore: 9.4

Cost-per-claim above average for D1208

FLOYD HEALTHCARE MANAGEMENT INC (1356444814) bills $412.95/claim for D1208 (Topical fluoride excluding varnish) vs avg $20.36 (+9.4σ). $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.

FLOYD HEALTHCARE MANAGEMENT INCROMEProvider total: $98.4M

criticalCost OutlierScore: 8.3

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

GEORGIA EM-I MEDICAL SERVICES PC (1912304932) bills $731.00/claim for 99283 (Emergency dept visit low mdm) vs avg $68.29 (+8.3σ). $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.

GEORGIA EM-I MEDICAL SERVICES PCDEMORESTProvider total: $13.9K

criticalCost OutlierScore: 8.1

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

ARUANA EMERGENCY PHYSICIANS LLC (1497151872) bills $715.02/claim for 99283 (Emergency dept visit low mdm) vs avg $68.29 (+8.1σ). $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.

ARUANA EMERGENCY PHYSICIANS LLCDEMORESTProvider total: $196.0K

criticalCost OutlierScore: 7.8

Cost-per-claim above average for D1120 (Child Dental Prophylaxis (Teeth Cleaning))

FLOYD HEALTHCARE MANAGEMENT INC (1356444814) bills $222.05/claim for D1120 (Prophylaxis - child) vs avg $34.50 (+7.8σ). $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.

FLOYD HEALTHCARE MANAGEMENT INCROMEProvider total: $98.4M

criticalCost OutlierScore: 7.8

Cost-per-claim above average for 99285 (Emergency Dept Visit (High Complexity))

ARTHUR M. BLANK HOSPITAL, INC. (1689744450) bills $1,211.36/claim for 99285 (Emergency dept visit hi mdm) vs avg $124.35 (+7.8σ). $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.

ARTHUR M. BLANK HOSPITAL, INC.ATLANTAProvider total: $116.5M

criticalCost OutlierScore: 7.7

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

ARTHUR M. BLANK HOSPITAL, INC. (1689744450) bills $1,375.70/claim for D7140 (Extraction erupted tooth or exposed root) vs avg $96.05 (+7.7σ). $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.

ARTHUR M. BLANK HOSPITAL, INC.ATLANTAProvider total: $116.5M

criticalCost OutlierScore: 7.6

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

EGLESTON CHILDREN'S HOSPITAL AT EMORY UNIVERSITY, INC. (1558416701) bills $519.20/claim for D0230 (Intraoral - periapical each addl image) vs avg $19.23 (+7.6σ). $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.

EGLESTON CHILDREN'S HOSPITAL AT EMORY UNIVERSITY, INC.ATLANTAProvider total: $222.6M

criticalCost OutlierScore: 7.5

Cost-per-claim above average for 90847 (Family Psychotherapy with Patient (50 min))

BRENDA COPELAND (1598079212) bills $235.66/claim for 90847 (Family psytx w/pt 50 min) vs avg $71.99 (+7.5σ). $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.

BRENDA COPELANDTHOMASVILLEProvider total: $802.3K

criticalCost OutlierScore: 7.4

Cost-per-claim above average for D1351 (Dental Sealant (per Tooth))

EGLESTON CHILDREN'S HOSPITAL AT EMORY UNIVERSITY, INC. (1558416701) bills $468.03/claim for D1351 (Sealant per tooth) vs avg $42.54 (+7.4σ). $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.

EGLESTON CHILDREN'S HOSPITAL AT EMORY UNIVERSITY, INC.ATLANTAProvider total: $222.6M

criticalCost OutlierScore: 6.2

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

VIDALIA HEALTH SERVICES, LLC (1790376564) bills $563.86/claim for 99283 (Emergency dept visit low mdm) vs avg $68.29 (+6.2σ). $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.

VIDALIA HEALTH SERVICES, LLCVIDALIAProvider total: $75.4K

criticalCost OutlierScore: 6.0

Cost-per-claim above average for 99282 (Emergency Dept Visit (Low Complexity))

VIDALIA HEALTH SERVICES, LLC (1790376564) bills $556.82/claim for 99282 (Emergency dept visit sf mdm) vs avg $74.43 (+6.0σ). $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.

VIDALIA HEALTH SERVICES, LLCVIDALIAProvider total: $75.4K

criticalCost OutlierScore: 5.7

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

DOCTORS HOSPITAL OF AUGUSTA LLC (1912951963) bills $89.35/claim for 80053 (Comprehen metabolic panel) vs avg $8.33 (+5.7σ). $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.

DOCTORS HOSPITAL OF AUGUSTA LLCAUGUSTAProvider total: $2.2M

criticalCost OutlierScore: 5.6

Cost-per-claim above average for 96160

THE CHILDREN'S DOCTORS PC (1295724680) bills $20.49/claim for 96160 (Pt-focused hlth risk assmt) vs avg $3.43 (+5.6σ). $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.

THE CHILDREN'S DOCTORS PCFORT OGLETHORPEProvider total: $646.0K

criticalCost OutlierScore: 5.5

Cost-per-claim above average for G0447

KIDCARE PEDIATRICS (1871689265) bills $14.36/claim for G0447 (Behavior counsel obesity 15m) vs avg $1.00 (+5.5σ). $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.

KIDCARE PEDIATRICSCOLLEGE PARKProvider total: $860.7K

criticalCost OutlierScore: 5.5

Cost-per-claim above average for 1126F

VIDALIA CHILDREN'S CENTER LLC (1679705115) bills $4.64/claim for 1126F vs avg $0.15 (+5.5σ). $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.

VIDALIA CHILDREN'S CENTER LLCVIDALIAProvider total: $4.2M

criticalCost OutlierScore: 5.5

Cost-per-claim above average for 96372

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 (+5.5σ). $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.

OPTUM WOMEN'S AND CHILDREN'S HEALTH, LLCMARIETTAProvider total: $160.4M

criticalCost OutlierScore: 5.4

Cost-per-claim above average for 99284 (Emergency Dept Visit (Moderate/High Complexity))

VIDALIA HEALTH SERVICES, LLC (1790376564) bills $612.30/claim for 99284 (Emergency dept visit mod mdm) vs avg $89.98 (+5.4σ). $14,695 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.

VIDALIA HEALTH SERVICES, LLCVIDALIAProvider total: $75.4K

criticalCost OutlierScore: 5.4

Cost-per-claim above average for 90651 (HPV Vaccine (9-Valent))

COLQUITT COUNTY BOARD OF HEALTH (1740271899) bills $39.57/claim for 90651 (9vhpv vaccine 2/3 dose im) vs avg $2.59 (+5.4σ). $18,833 across 476 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.

COLQUITT COUNTY BOARD OF HEALTHMOULTRIEProvider total: $194.3K

criticalCost OutlierScore: 5.3

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

PHOEBE PUTNEY MEMORIAL HOSPITAL INC (1992789721) bills $297.33/claim for D2391 (Resin composite - one surface posterior) vs avg $69.56 (+5.4σ). $137,365 across 462 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.

PHOEBE PUTNEY MEMORIAL HOSPITAL INCALBANYProvider total: $84.3M

criticalCost OutlierScore: 5.2

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

GEORGIA EMERGENCY ASSOCIATES IMMEDIATE CARE CENTER (1306876081) bills $117.77/claim for 99308 (Sbsq nf care low mdm 20) vs avg $16.57 (+5.2σ). $21,552 across 183 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.

GEORGIA EMERGENCY ASSOCIATES IMMEDIATE CARE CENTERSAVANNAHProvider total: $674.3K

criticalCost OutlierScore: 5.2

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

ERNESTINA FRENCH (1265878268) bills $184.28/claim for 99213 (Office o/p est low 20 min) vs avg $46.35 (+5.2σ). $11,978 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.

ERNESTINA FRENCHBUFORDProvider total: $14.6K

criticalCost OutlierScore: 5.2

Cost-per-claim below average for 90837 (Psychotherapy (60 min))

BRYAN COLLINS (1164774543) bills $12.54/claim for 90837 (Psytx w pt 60 minutes) vs avg $85.43 (-5.2σ). $14,778 across 1,178 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.

BRYAN COLLINSDECATURProvider total: $17.8K

criticalCost OutlierScore: 5.1

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

DOCTORS HOSPITAL OF AUGUSTA LLC (1912951963) bills $20.02/claim for 81001 (Urinalysis auto w/scope) vs avg $2.52 (+5.1σ). $74,211 across 3,707 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 LLCAUGUSTAProvider total: $2.2M

criticalCost OutlierScore: 4.8

Cost-per-claim above average for 94640

TMC/HIGGINS GENERAL HOSPITAL (1194712083) bills $65.66/claim for 94640 (Airway inhalation treatment) vs avg $17.76 (+4.8σ). $138,738 across 2,113 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.

TMC/HIGGINS GENERAL HOSPITALBREMENProvider total: $12.2M

criticalCost OutlierScore: 4.7

Cost-per-claim above average for H2014

ALL AND ALL BEHAVIORAL HEALTH SERVICES LLC (1578105144) bills $399.07/claim for H2014 (Skills train and dev, 15 min) vs avg $68.56 (+4.7σ). $227,869 across 571 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 AND ALL BEHAVIORAL HEALTH SERVICES LLCLILBURNProvider total: $784.8K

criticalCost OutlierScore: 4.6

Cost-per-claim above average for 59025

KENNESTONE HOSPITAL, INC. (1649248626) bills $172.65/claim for 59025 (Fetal non-stress test) vs avg $38.48 (+4.6σ). $35,393 across 205 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.

KENNESTONE HOSPITAL, INC.MARIETTAProvider total: $1.9M

criticalCost OutlierScore: 4.6

Cost-per-claim above average for 90837 (Psychotherapy (60 min))

BEAUTIFUL DREAMERS (1396237731) bills $150.38/claim for 90837 (Psytx w pt 60 minutes) vs avg $85.43 (+4.6σ). $780,162 across 5,188 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.

BEAUTIFUL DREAMERSBUFORDProvider total: $804.5K

criticalCost OutlierScore: 4.5

Cost-per-claim above average for 92014

MELODY GARCIA (1902351588) bills $170.52/claim for 92014 (Compre oph exam est pt 1/>) vs avg $46.84 (+4.5σ). $40,243 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.

MELODY GARCIAPEACHTREE CORNERSProvider total: $59.6K

criticalCost OutlierScore: 4.5

Cost-per-claim above average for 96110

THE CHILDREN'S DOCTORS PC (1295724680) bills $23.70/claim for 96110 (Developmental screen w/score) vs avg $9.73 (+4.5σ). $19,365 across 817 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 CHILDREN'S DOCTORS PCFORT OGLETHORPEProvider total: $646.0K

criticalCost OutlierScore: 4.4

Cost-per-claim above average for D1110 (Adult Dental Prophylaxis (Teeth Cleaning))

NEW BENEVIS INC. (1760494249) bills $98.53/claim for D1110 (Prophylaxis - adult) vs avg $35.99 (+4.4σ). $527,933 across 5,358 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 BENEVIS INC.SAVANNAHProvider total: $1.1M

criticalCost OutlierScore: 4.4

Cost-per-claim above average for J2405 (Ondansetron (Zofran) Injection (1 mg))

OPTUM WOMEN'S AND CHILDREN'S HEALTH, LLC (1073561825) bills $118.65/claim for J2405 (Ondansetron hcl injection) vs avg $7.58 (+4.4σ). $1,645,674 across 13,870 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, LLCMARIETTAProvider total: $160.4M

criticalCost OutlierScore: 4.3

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

UNIVERSITY HEALTH SERVICES,INC (1588665566) bills $17.36/claim for 81001 (Urinalysis auto w/scope) vs avg $2.52 (+4.3σ). $114,478 across 6,594 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.

UNIVERSITY HEALTH SERVICES,INCAUGUSTAProvider total: $2.3M

criticalCost OutlierScore: 4.3

Cost-per-claim above average for T1003

GEORGIA PINES COMMUNITY SERVICE BOARD (1811041676) bills $2,251.12/claim for T1003 (Lpn/lvn services up to 15min) vs avg $175.88 (+4.3σ). $592,044 across 263 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.

GEORGIA PINES COMMUNITY SERVICE BOARDTHOMASVILLEProvider total: $45.3M

criticalCost OutlierScore: 4.3

Cost-per-claim above average for 92004

MELODY GARCIA (1902351588) bills $203.41/claim for 92004 (Compre oph exam new pt 1/>) vs avg $54.77 (+4.3σ). $18,510 across 91 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.

MELODY GARCIAPEACHTREE CORNERSProvider total: $59.6K

criticalCost OutlierScore: 4.2

Cost-per-claim above average for T1019

AMAZING CARE AGENCY INC (1548714843) bills $754.94/claim for T1019 (Personal care ser per 15 min) vs avg $168.93 (+4.2σ). $3,151,139 across 4,174 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.

AMAZING CARE AGENCY INCLAWRENCEVILLEProvider total: $3.7M

criticalCost OutlierScore: 4.2

Cost-per-claim above average for 96372

CANDLER HOSPITAL INCORPORATED (1275527889) bills $109.99/claim for 96372 (Ther/proph/diag inj sc/im) vs avg $15.64 (+4.2σ). $15,838 across 144 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.

CANDLER HOSPITAL INCORPORATEDSAVANNAHProvider total: $135.5K

criticalCost OutlierScore: 4.1

Cost-per-claim above average for 90999

TOTAL RENAL CARE INC (1558466714) bills $312.04/claim for 90999 (Unlisted dialysis procedure) vs avg $30.24 (+4.1σ). $7,338,635 across 23,518 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.

TOTAL RENAL CARE INCATLANTAProvider total: $7.4M

criticalCost OutlierScore: 4.1

Cost-per-claim above average for A4657

DVA HEALTHCARE RENAL CARE INC (1073581203) bills $4.20/claim for A4657 (Syringe w/wo needle) vs avg $0.23 (+4.1σ). $11,037 across 2,629 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.

DVA HEALTHCARE RENAL CARE INCATLANTAProvider total: $913.5K

criticalCost OutlierScore: 4.1

Cost-per-claim above average for 90832 (Psychotherapy (30 min))

CHRIST COMMUNITY HEALTH SERVICES AUGUSTA, INC. (1174716989) bills $124.66/claim for 90832 (Psytx w pt 30 minutes) vs avg $42.59 (+4.1σ). $11,094 across 89 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.

CHRIST COMMUNITY HEALTH SERVICES AUGUSTA, INC.AUGUSTAProvider total: $265.1K

criticalCost OutlierScore: 4.1

Cost-per-claim above average for 99202 (Office Visit, New Patient (15 min, Straightforward))

BENDU PAYTON (1861732265) bills $318.75/claim for 99202 (Office o/p new sf 15 min) vs avg $65.73 (+4.1σ). $14,662 across 46 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.

BENDU PAYTONATLANTAProvider total: $74.6K

criticalCost OutlierScore: 4.1

Cost-per-claim above average for A0425 (Ground Ambulance Mileage (per mile))

AMERIMED EMERGENCY MEDICAL SERVICES, LLC (1639462476) bills $158.97/claim for A0425 (Ground mileage) vs avg $25.57 (+4.1σ). $15,526,012 across 97,669 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.

AMERIMED EMERGENCY MEDICAL SERVICES, LLCBUFORDProvider total: $28.5M

criticalCost OutlierScore: 4.1

Cost-per-claim above average for 99202 (Office Visit, New Patient (15 min, Straightforward))

MORGAN JACKSON (1033621776) bills $318.75/claim for 99202 (Office o/p new sf 15 min) vs avg $65.73 (+4.1σ). $14,662 across 46 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.

MORGAN JACKSONCAIROProvider total: $14.7K

criticalCost OutlierScore: 4.1

Cost-per-claim above average for 99202 (Office Visit, New Patient (15 min, Straightforward))

KENESIA GENAS (1134685118) bills $318.18/claim for 99202 (Office o/p new sf 15 min) vs avg $65.73 (+4.1σ). $77,635 across 244 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.

KENESIA GENASGRAYSONProvider total: $77.6K

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