Statistical Outliers

Single-test outliers in Hawaii 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

112

warning

149

info

1,468

Total

1,729

Outliers by Type

Severity Distribution

critical

112 (6.5%)

warning

149 (8.6%)

info

1,468 (84.9%)

1,196 results

criticalOverutilizationScore: 10.5

Unusually high claims-per-beneficiary ratio

MANA RECOVERY LLC (1588394472): 26.3 claims/beneficiary (avg 2.2). 2,660 claims, 101 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.

MANA RECOVERY LLCWAILUKUProvider total: $376.1K

criticalCost OutlierScore: 9.0

Cost-per-claim above average for 3008F

WAIKIKI HEALTH (1679646509) bills $2.96/claim for 3008F vs avg $0.05 (+9.0σ). $157,469 across 53,124 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.

WAIKIKI HEALTHHONOLULUProvider total: $22.3M

criticalCost OutlierScore: 7.6

Cost-per-claim above average for 87804 (Rapid Influenza Test (Optical/Immunoassay))

KAISER FOUNDATION HEALTH PLAN INC (1407862030) bills $119.78/claim for 87804 (Influenza assay w/optic) vs avg $7.88 (+7.6σ). $643,477 across 5,372 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.

KAISER FOUNDATION HEALTH PLAN INCHONOLULUProvider total: $7.4M

criticalCost OutlierScore: 6.9

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

1366519027 (1366519027) bills $154.43/claim for 99232 (Sbsq hosp ip/obs moderate 35) vs avg $33.39 (+6.9σ). $30,578 across 198 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 MEMORIAL HOSPITALOKA TAMUNINGProvider total: $58.6K

criticalCost OutlierScore: 6.8

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

COMMUNITY CLINIC OF MAUI, INC. (1528042561) bills $334.85/claim for 90837 (Psytx w pt 60 minutes) vs avg $86.36 (+6.8σ). $123,226 across 368 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.

COMMUNITY CLINIC OF MAUI, INC.WAILUKUProvider total: $21.7M

criticalOverutilizationScore: 6.6

Unusually high claims-per-beneficiary ratio

ELIM SENIOR DAYCARE INC (1780150680): 17.4 claims/beneficiary (avg 2.2). 18,145 claims, 1,042 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.

ELIM SENIOR DAYCARE INCHONOLULUProvider total: $1.3M

criticalCost OutlierScore: 6.6

Cost-per-claim above average for 87340

CASTLE MEDICAL CENTER (1316937691) bills $139.16/claim for 87340 (Hepatitis b surface ag ia) vs avg $4.03 (+6.6σ). $170,610 across 1,226 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.

CASTLE MEDICAL CENTERKAILUAProvider total: $37.6M

criticalOverutilizationScore: 6.3

Unusually high claims-per-beneficiary ratio

CARERESOURCE HAWAII (1558966135): 16.7 claims/beneficiary (avg 2.2). 31,860 claims, 1,907 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.

CARERESOURCE HAWAIIKAUNAKAKAIProvider total: $2.0M

criticalOverutilizationScore: 6.2

Unusually high claims-per-beneficiary ratio

ALOHAWELLNESS CENTER INC (1033436431): 16.4 claims/beneficiary (avg 2.2). 2,274 claims, 139 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.

ALOHAWELLNESS CENTER INCWAIPAHUProvider total: $152.6K

criticalCost OutlierScore: 6.1

Cost-per-claim above average for 97530 (Therapeutic Activities (per 15 min))

KAISER FOUNDATION HEALTH PLAN INC (1407862030) bills $348.88/claim for 97530 (Therapeutic activities) vs avg $39.48 (+6.1σ). $61,752 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.

KAISER FOUNDATION HEALTH PLAN INCHONOLULUProvider total: $7.4M

criticalCost OutlierScore: 6.0

Cost-per-claim above average for D0150 (Comprehensive Oral Evaluation (New or Established Patient))

ARTHUR KALFUS (1326367582) bills $82.46/claim for D0150 (Comprehensive oral evaluation) vs avg $36.59 (+6.0σ). $57,143 across 693 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 KALFUSPEARL HARBORProvider total: $632.2K

criticalOverutilizationScore: 6.0

Unusually high claims-per-beneficiary ratio

LEAHI HOSPITAL (1548344781): 15.9 claims/beneficiary (avg 2.2). 7,417 claims, 466 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.

LEAHI HOSPITALHONOLULUProvider total: $524.8K

criticalCost OutlierScore: 5.8

Cost-per-claim above average for 90999

USRC KALIHI LLC (1013661883) bills $3,773.15/claim for 90999 (Unlisted dialysis procedure) vs avg $323.99 (+5.8σ). $539,561 across 143 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.

USRC KALIHI LLCHONOLULUProvider total: $1.2M

criticalOverutilizationScore: 5.8

Unusually high claims-per-beneficiary ratio

CARERESOURCE HAWAII (1780288191): 15.4 claims/beneficiary (avg 2.2). 772 claims, 50 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.

CARERESOURCE HAWAIIHILOProvider total: $60.7K

criticalOverutilizationScore: 5.7

Unusually high claims-per-beneficiary ratio

EVERGREEN ADULT DAY CARE (1649724089): 15.3 claims/beneficiary (avg 2.2). 161,593 claims, 10,578 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.

EVERGREEN ADULT DAY CAREHONOLULUProvider total: $8.8M

criticalOverutilizationScore: 5.7

Unusually high claims-per-beneficiary ratio

MANA RECOVERY LLC (1598549529): 15.2 claims/beneficiary (avg 2.2). 945 claims, 62 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.

MANA RECOVERY LLCWAILUKUProvider total: $200.1K

criticalOverutilizationScore: 5.6

Unusually high claims-per-beneficiary ratio

PO AILANI (1922151026): 15.1 claims/beneficiary (avg 2.2). 25,485 claims, 1,688 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.

PO AILANIKANEOHEProvider total: $3.3M

criticalOverutilizationScore: 5.6

Unusually high claims-per-beneficiary ratio

BAYADA HOME CARE (1740665488): 15.0 claims/beneficiary (avg 2.2). 71,352 claims, 4,747 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.

BAYADA HOME CAREWAILUKUProvider total: $6.0M

criticalOverutilizationScore: 5.4

Unusually high claims-per-beneficiary ratio

ALL ISLANDS HOMECARE, INC. (1902424682): 14.7 claims/beneficiary (avg 2.2). 4,734 claims, 322 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.

ALL ISLANDS HOMECARE, INC.HONOLULUProvider total: $600.8K

criticalCost OutlierScore: 5.4

Cost-per-claim above average for 84100

CLINICAL LABORATORIES OF HAWAII LLP (1134195357) bills $3.41/claim for 84100 (Assay of phosphorus) vs avg $0.15 (+5.4σ). $31,480 across 9,243 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.

CLINICAL LABORATORIES OF HAWAII LLPEWA BEACHProvider total: $45.8M

criticalOverutilizationScore: 5.4

Unusually high claims-per-beneficiary ratio

METROPACIFIC GROUP, CORP (1679106256): 14.6 claims/beneficiary (avg 2.2). 14,651 claims, 1,005 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.

METROPACIFIC GROUP, CORPHILOProvider total: $3.4M

criticalOverutilizationScore: 5.3

Unusually high claims-per-beneficiary ratio

HAWAII MEALS ON WHEELS, INC. (1184952863): 14.4 claims/beneficiary (avg 2.2). 84,932 claims, 5,882 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.

HAWAII MEALS ON WHEELS, INC.HONOLULUProvider total: $1.0M

criticalOverutilizationScore: 5.3

Unusually high claims-per-beneficiary ratio

BAYADA HOME CARE (1639776578): 14.4 claims/beneficiary (avg 2.2). 35,044 claims, 2,431 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.

BAYADA HOME CAREWAILUKUProvider total: $3.7M

criticalCost OutlierScore: 5.3

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

ARTHUR KALFUS (1326367582) bills $66.10/claim for D1120 (Prophylaxis - child) vs avg $31.20 (+5.3σ). $60,618 across 917 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 KALFUSPEARL HARBORProvider total: $632.2K

criticalCost OutlierScore: 5.2

Cost-per-claim above average for 99397 (Preventive Visit, Established Patient (Ages 65+))

KALIHI PALAMA HEALTH CENTER (1457304966) bills $179.24/claim for 99397 (Per pm reeval est pat 65+ yr) vs avg $13.61 (+5.2σ). $131,202 across 732 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.

KALIHI PALAMA HEALTH CENTERHONOLULUProvider total: $39.0M

criticalCost OutlierScore: 5.2

Cost-per-claim above average for V2756

MRS HILO LLC (1467075721) bills $5.09/claim for V2756 (Eye glass case) vs avg $1.22 (+5.2σ). $13,607 across 2,674 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.

MRS HILO LLCHILOProvider total: $1.4M

criticalCost OutlierScore: 5.1

Cost-per-claim above average for 99214 (Office Visit, Established Patient (30 min, Moderate Complexi)

LANAI COMMUNITY HEALTH CENTER (1679754097) bills $272.48/claim for 99214 (Office o/p est mod 30 min) vs avg $55.25 (+5.1σ). $249,865 across 917 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.

LANAI COMMUNITY HEALTH CENTERLANAI CITYProvider total: $1.4M

criticalCost OutlierScore: 5.1

Cost-per-claim above average for 92012

WAIMANALO HEALTH CENTER (1780738005) bills $226.13/claim for 92012 (Intrm oph exam est patient) vs avg $37.47 (+5.1σ). $17,865 across 79 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.

WAIMANALO HEALTH CENTERWAIMANALOProvider total: $11.3M

criticalOverutilizationScore: 5.1

Unusually high claims-per-beneficiary ratio

METROPACIFIC GROUP, CORP (1013517036): 13.9 claims/beneficiary (avg 2.2). 33,645 claims, 2,415 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.

METROPACIFIC GROUP, CORPWAIPAHUProvider total: $2.8M

criticalCost OutlierScore: 5.1

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

WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INCORPORATED (1730253626) bills $252.08/claim for 99213 (Office o/p est low 20 min) vs avg $39.94 (+5.1σ). $374,591 across 1,486 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.

WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INCORPORATEDWAIPAHUProvider total: $1.1M

criticalOverutilizationScore: 5.0

Unusually high claims-per-beneficiary ratio

BAYADA HOME CARE (1225417801): 13.7 claims/beneficiary (avg 2.2). 37,138 claims, 2,706 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.

BAYADA HOME CARELIHUEProvider total: $3.5M

criticalCost OutlierScore: 4.9

Cost-per-claim above average for Q4081

USRC KALIHI LLC (1013661883) bills $7,066.98/claim for Q4081 (Epoetin alfa, 100 units esrd) vs avg $441.02 (+4.9σ). $657,229 across 93 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.

USRC KALIHI LLCHONOLULUProvider total: $1.2M

criticalCost OutlierScore: 4.8

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

WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INCORPORATED (1164597795) bills $242.86/claim for 99213 (Office o/p est low 20 min) vs avg $39.94 (+4.8σ). $641,635 across 2,642 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.

WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INCORPORATEDWAIANAEProvider total: $2.2M

criticalCost OutlierScore: 4.8

Cost-per-claim above average for 70450 (CT Head without Contrast)

MOLOKAI GENERAL HOSPITAL (1366486979) bills $395.04/claim for 70450 (Ct head/brain w/o dye) vs avg $50.00 (+4.8σ). $115,748 across 293 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.

MOLOKAI GENERAL HOSPITALKAUNAKAKAIProvider total: $14.5M

criticalCost OutlierScore: 4.8

Cost-per-claim above average for S9122

TRIPLE ACE VENTURE CAPITAL, CORP. (1275167173) bills $820.23/claim for S9122 (Home health aide or certifie) vs avg $161.79 (+4.8σ). $190,293 across 232 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.

TRIPLE ACE VENTURE CAPITAL, CORP.HILOProvider total: $878.5K

criticalCost OutlierScore: 4.7

Cost-per-claim above average for 99211 (Office Visit, Established Patient (May not require physician)

WAIKIKI HEALTH (1679646509) bills $135.38/claim for 99211 (Off/op est may x req phy/qhp) vs avg $16.45 (+4.7σ). $63,086 across 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.

WAIKIKI HEALTHHONOLULUProvider total: $22.3M

criticalCost OutlierScore: 4.7

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

LANAI COMMUNITY HEALTH CENTER (1679754097) bills $235.65/claim for 99213 (Office o/p est low 20 min) vs avg $39.94 (+4.7σ). $312,242 across 1,325 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.

LANAI COMMUNITY HEALTH CENTERLANAI CITYProvider total: $1.4M

criticalCost OutlierScore: 4.7

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

HAMAKUA HEALTH CENTER, INC. (1164001954) bills $235.63/claim for 99213 (Office o/p est low 20 min) vs avg $39.94 (+4.7σ). $142,087 across 603 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.

HAMAKUA HEALTH CENTER, INC.KAMUELAProvider total: $161.0K

criticalCost OutlierScore: 4.7

Cost-per-claim above average for J3490

STRAUB CLINIC & HOSPITAL (1295443216) bills $3,649.32/claim for J3490 (Drugs unclassified injection) vs avg $199.20 (+4.6σ). $284,647 across 78 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.

STRAUB CLINIC & HOSPITALHONOLULUProvider total: $985.0K

criticalCost OutlierScore: 4.5

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

HANA HEALTH (1992811954) bills $229.69/claim for 99213 (Office o/p est low 20 min) vs avg $39.94 (+4.5σ). $541,380 across 2,357 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.

HANA HEALTHHANAProvider total: $1.6M

criticalCost OutlierScore: 4.5

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

WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INCORPORATED (1356416986) bills $227.57/claim for 99213 (Office o/p est low 20 min) vs avg $39.94 (+4.5σ). $1,240,055 across 5,449 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.

WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INCORPORATEDKAPOLEIProvider total: $3.3M

criticalCost OutlierScore: 4.4

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

WAIMANALO HEALTH CENTER (1780738005) bills $225.82/claim for 99213 (Office o/p est low 20 min) vs avg $39.94 (+4.4σ). $1,983,597 across 8,784 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.

WAIMANALO HEALTH CENTERWAIMANALOProvider total: $11.3M

criticalCost OutlierScore: 4.4

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

LANAI COMMUNITY HEALTH CENTER (1679754097) bills $505.96/claim for D0140 (Limited oral evaluation - problem focused) vs avg $72.68 (+4.4σ). $34,405 across 68 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.

LANAI COMMUNITY HEALTH CENTERLANAI CITYProvider total: $1.4M

criticalCost OutlierScore: 4.3

Cost-per-claim above average for 99214 (Office Visit, Established Patient (30 min, Moderate Complexi)

HANA HEALTH (1992811954) bills $238.71/claim for 99214 (Office o/p est mod 30 min) vs avg $55.25 (+4.3σ). $476,939 across 1,998 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.

HANA HEALTHHANAProvider total: $1.6M

criticalCost OutlierScore: 4.3

Cost-per-claim above average for 87635

KAU HOSPITAL (1558441311) bills $124.10/claim for 87635 (Sars-cov-2 covid-19 amp prb) vs avg $21.36 (+4.3σ). $662,183 across 5,336 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.

KAU HOSPITALPAHALAProvider total: $4.9M

criticalCost OutlierScore: 4.3

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

MAUI HEALTH SYSTEM A KAISER FOUNDATION HOSPITALS LLC (1861854226) bills $1,834.24/claim for 99284 (Emergency dept visit mod mdm) vs avg $330.14 (+4.3σ). $137,568 across 75 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.

MAUI HEALTH SYSTEM A KAISER FOUNDATION HOSPITALS LLCKULAProvider total: $3.8M

criticalCost OutlierScore: 4.2

Cost-per-claim below average for D7210 (Tooth Extraction (Surgical, Erupted))

JUSTIN HOLLAR (1861698193) bills $82.63/claim for D7210 (Extraction - surgical, erupted tooth) vs avg $143.76 (-4.2σ). $28,592 across 346 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.

JUSTIN HOLLARHONOLULUProvider total: $937.8K

criticalCost OutlierScore: 4.2

Cost-per-claim above average for J3490

WALGREEN CO (1366823114) bills $3,312.14/claim for J3490 (Drugs unclassified injection) vs avg $199.20 (+4.2σ). $24,228,305 across 7,315 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.

WALGREEN COHONOLULUProvider total: $25.3M

criticalCost OutlierScore: 4.2

Cost-per-claim above average for H2021

BOCHA, LLC (1386005924) bills $5,811.39/claim for H2021 (Com wrap-around sv, 15 min) vs avg $779.17 (+4.2σ). $406,797 across 70 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.

BOCHA, LLCKIHEIProvider total: $406.8K

criticalCost OutlierScore: 4.2

Cost-per-claim above average for 90662 (Influenza Vaccine (High-Dose))

STRAUB CLINIC & HOSPITAL (1720031701) bills $26.95/claim for 90662 (Iiv no prsv increased ag im) vs avg $3.43 (+4.2σ). $13,069 across 485 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.

STRAUB CLINIC & HOSPITALHONOLULUProvider total: $45.6M

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Statistical Outliers

Single-test outliers in Hawaii Medicaid data. These are individual statistical flags — most are informational.