Single-test outliers in Iowa 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
130
warning
260
info
3,482
Total
3,872
SPENCER MUNICIPAL HOSPITAL (1255328621) bills $949.52/claim for D0150 (Comprehensive oral evaluation) vs avg $25.66 (+18.0Ο). $11,394 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.
CATHOLIC HEALTH INITIATIVES-IOWA CORP (1508964883) bills $511.20/claim for D1206 (Topical fluoride varnish) vs avg $16.65 (+17.7Ο). $12,780 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.
HANCOCK COUNTY HEALTH SYSTEM (1912938606) bills $141.41/claim for 36415 (Coll venous bld venipuncture) vs avg $3.71 (+17.3Ο). $148,902 across 1,053 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.
CENTRAL IOWA HOSPITAL CORPORATION (1356433049) bills $492.60/claim for D1206 (Topical fluoride varnish) vs avg $16.65 (+17.0Ο). $726,093 across 1,474 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.
CATHOLIC HEALTH INITIATIVES-IOWA CORP (1508964883) bills $518.95/claim for D1120 (Prophylaxis - child) vs avg $29.32 (+13.0Ο). $15,568 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.
CENTRAL IOWA HOSPITAL CORPORATION (1356433049) bills $516.88/claim for D1120 (Prophylaxis - child) vs avg $29.32 (+12.9Ο). $292,556 across 566 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.
MESKWAKI PHARMACY (1902012305) bills $219.62/claim for 99212 (Office o/p est sf 10 min) vs avg $16.29 (+11.5Ο). $45,682 across 208 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.
MERCY HEALTH SERVICES-IOWA CORP (1467537886) bills $1,706.28/claim for D7140 (Extraction erupted tooth or exposed root) vs avg $60.08 (+10.7Ο). $899,211 across 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.
CLARKE COUNTY PUBLIC HOSPITAL (1114954997) bills $286.84/claim for 99211 (Off/op est may x req phy/qhp) vs avg $15.83 (+10.0Ο). $2,877,006 across 10,030 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.
MOSAIC (1669016457): 29.7 claims/beneficiary (avg 2.2). 1,784 claims, 60 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.
EXCEPTIONAL PERSONS INC (1134264807): 29.0 claims/beneficiary (avg 2.2). 99,399 claims, 3,424 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.
LAKES LIFESKILLS LLC (1710201520): 28.9 claims/beneficiary (avg 2.2). 106,942 claims, 3,695 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.
REM IOWA COMMUNITY SERVICES, INC. (1902968266): 28.4 claims/beneficiary (avg 2.2). 569,758 claims, 20,094 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.
HOSPICE OF THE MIDWEST, LLC (1023401254): 28.1 claims/beneficiary (avg 2.2). 22,216 claims, 790 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.
REM IOWA COMMUNITY SERVICES, INC (1811032949): 27.8 claims/beneficiary (avg 2.2). 87,415 claims, 3,142 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.
REM IOWA COMMUNITY SERVICES, INC (1447312780): 27.8 claims/beneficiary (avg 2.2). 171,911 claims, 6,181 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.
DEMI HENDRICKS (1336693290) bills $83.37/claim for D0120 (Periodic oral evaluation) vs avg $18.34 (+8.7Ο). $35,098 across 421 claims.
This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.
STATE UNIVERSITY OF IOWA (1376544320) bills $63.45/claim for 90670 (Pcv13 vaccine im) vs avg $2.17 (+8.6Ο). $122,513 across 1,931 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.
TYNIQUES ROSE GARDEN (1609436492): 26.3 claims/beneficiary (avg 2.2). 11,764 claims, 447 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.
MERCY HEALTH SERVICES-IOWA CORP (1467537886) bills $535.88/claim for D1351 (Sealant per tooth) vs avg $28.84 (+8.4Ο). $115,751 across 216 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.
CENTRAL IOWA HOSPITAL CORPORATION (1396837951) bills $53.05/claim for 90471 (Immunization admin) vs avg $4.66 (+8.4Ο). $33,796 across 637 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.
OSCAR HOME HEALTH CARE (1073060372): 25.6 claims/beneficiary (avg 2.2). 21,029 claims, 822 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.
BURGESS HEALTH CENTER (1730253360) bills $253.46/claim for 87426 (Sarscov coronavirus ag ia) vs avg $31.44 (+8.0Ο). $113,045 across 446 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.
MARK STUMPHY (1245607209) bills $78.63/claim for D0120 (Periodic oral evaluation) vs avg $18.34 (+8.0Ο). $103,396 across 1,315 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.
REM IOWA COMMUNITY SERVICES, INC (1386706638): 23.8 claims/beneficiary (avg 2.2). 275,858 claims, 11,567 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.
WESTMINSTER HOUSE, INC. (1457574543): 23.6 claims/beneficiary (avg 2.2). 8,519 claims, 361 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.
SIOUX VALLEY MEMORIAL HOSPITAL ASSOCIATION (1689640500) bills $47.19/claim for 90471 (Immunization admin) vs avg $4.66 (+7.3Ο). $47,994 across 1,017 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.
V AND D LEASING, LC (1225574825): 22.8 claims/beneficiary (avg 2.2). 53,626 claims, 2,350 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.
WESTMINSTER HOUSE, INC. (1386867489): 22.8 claims/beneficiary (avg 2.2). 570 claims, 25 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.
AMENITY HEALTHCARE, LLC (1003813908): 22.4 claims/beneficiary (avg 2.2). 33,269 claims, 1,488 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.
COVENANT MEDICAL CENTER INC (1700827896) bills $451.16/claim for D1351 (Sealant per tooth) vs avg $28.84 (+7.0Ο). $33,837 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.
BRADLEY'S RELIABLE TRANSPORTATION (1366038804): 21.8 claims/beneficiary (avg 2.2). 4,771 claims, 219 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.
HELPING HANDS TRANSPORTING SERVICES,LLC (1265873574): 21.7 claims/beneficiary (avg 2.2). 101,469 claims, 4,672 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.
RESOURCES FOR HUMAN DEVELOPMENT (1952757320): 21.5 claims/beneficiary (avg 2.2). 242,848 claims, 11,320 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.
MARK STUMPHY (1245607209) bills $104.33/claim for D0603 (Caries risk assessment - high risk) vs avg $4.72 (+6.7Ο). $21,179 across 203 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.
FRIENDSHIP ARK, INC. (1194177220) bills $355.46/claim for T2021 (Day habil waiver per 15 min) vs avg $54.77 (+6.7Ο). $821,470 across 2,311 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.
ARCH, INC (1700928629): 21.1 claims/beneficiary (avg 2.2). 29,897 claims, 1,415 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.
MARK STUMPHY (1245607209) bills $120.36/claim for D0140 (Limited oral evaluation - problem focused) vs avg $22.93 (+6.7Ο). $16,128 across 134 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.
MOSAIC (1558402271): 21.0 claims/beneficiary (avg 2.2). 67,470 claims, 3,209 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.
MENTOR ABI, LLC (1609224203): 20.8 claims/beneficiary (avg 2.2). 521 claims, 25 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.
VERA FRENCH SHERIDAN SPRINGS (1245309749): 20.1 claims/beneficiary (avg 2.2). 119,221 claims, 5,920 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.
WINNESHIEK MEDICAL CENTER (1619922051) bills $126.54/claim for 99213 (Office o/p est low 20 min) vs avg $24.12 (+6.4Ο). $290,402 across 2,295 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.
SBH-DAVENPORT, LLC (1831720556) bills $146.80/claim for 90853 (Group psychotherapy) vs avg $44.85 (+6.3Ο). $34,792 across 237 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.
CENTERVILLE COMMUNITY BETTERMENT INC ZYLPHA PRICE HOUSE (1083791396) bills $2,034.94/claim for H2025 (Supp maint employ, 15 min) vs avg $431.71 (+6.2Ο). $307,276 across 151 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.
EXCEPTIONAL PERSONS INC (1861567794): 19.4 claims/beneficiary (avg 2.2). 428,122 claims, 22,046 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.
MAHASKA COUNTY HOSPITAL (1356320659) bills $179.29/claim for 99211 (Off/op est may x req phy/qhp) vs avg $15.83 (+6.1Ο). $135,362 across 755 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.
IOWA NORTHLAND REGIONAL TRANSIT COMMISSION (1841417151): 19.2 claims/beneficiary (avg 2.2). 86,961 claims, 4,523 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.
SCENIC ACRES (1174737209): 18.7 claims/beneficiary (avg 2.2). 72,675 claims, 3,890 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.
STORM LAKE C.S.D. (1528115094): 18.4 claims/beneficiary (avg 2.2). 994 claims, 54 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.
AMERISERVE INTERNATIONAL OF NEBRASKA, INC. (1568997179): 18.3 claims/beneficiary (avg 2.2). 7,339 claims, 402 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.