Single-test outliers in Idaho 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
77
warning
105
info
2,046
Total
2,228
JAMES SKOUSEN (1073894523) bills $87.95/claim for D0220 (Intraoral - periapical first image) vs avg $1.47 (+13.3Ο). $10,466 across 119 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.
FAMILY SUPPORT SERVICES OF NORTH IDAHO (1124124797): 32.8 claims/beneficiary (avg 2.5). 90,240 claims, 2,752 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.
ADAM BUNKER (1215193792) bills $97.96/claim for D0120 (Periodic oral evaluation) vs avg $3.18 (+9.8Ο). $29,291 across 299 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.
BRANCH MANAGEMENT LLC (1619645868): 29.2 claims/beneficiary (avg 2.5). 3,065 claims, 105 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.
TRENT PRYOR (1780813691) bills $92.53/claim for D0120 (Periodic oral evaluation) vs avg $3.18 (+9.2Ο). $358,165 across 3,871 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.
BLAINE COUNTY SCHOOL DISTRICT (1205980950) bills $836.32/claim for H2017 (Psysoc rehab svc, per 15 min) vs avg $112.04 (+9.2Ο). $47,670 across 57 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.
COURTNEY JACKSON (1972864825) bills $127.66/claim for D0274 (Bitewings - four radiographic images) vs avg $4.76 (+8.9Ο). $20,297 across 159 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 CONNECTIONS SOUTH CENTRAL (1962889055): 26.9 claims/beneficiary (avg 2.5). 8,621 claims, 321 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.
CLUBHOUSE PEDIATRIC DENTISTRY OF MADISON (1306321351) bills $122.36/claim for D0274 (Bitewings - four radiographic images) vs avg $4.76 (+8.5Ο). $308,481 across 2,521 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.
JOANN'S SHUTTLE (1417493560): 25.4 claims/beneficiary (avg 2.5). 4,445 claims, 175 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.
NIGHT BOAT PLLC (1013188804) bills $59.41/claim for D1206 (Topical fluoride varnish) vs avg $1.97 (+8.1Ο). $21,684 across 365 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.
TRENT PRYOR (1780813691) bills $130.03/claim for D9230 (Inhalation of nitrous oxide/analgesia) vs avg $4.04 (+8.0Ο). $42,261 across 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.
ACCESS BEHAVIORAL HEALTH SERVICES, INC (1962018564): 24.7 claims/beneficiary (avg 2.5). 4,393 claims, 178 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.
PROSPER DDA (1083362065): 24.5 claims/beneficiary (avg 2.5). 588 claims, 24 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.
LIFEPATH SERVICES LLC (1477920270) bills $81.59/claim for T1014 (Telehealth transmit, per min) vs avg $18.08 (+7.3Ο). $23,580 across 289 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.
DAVID WILSON (1124231261) bills $114.14/claim for D0140 (Limited oral evaluation - problem focused) vs avg $19.35 (+6.8Ο). $21,459 across 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.
ADDUS HEALTHCARE (IDAHO), INC (1245451251): 20.9 claims/beneficiary (avg 2.5). 20,873 claims, 1,001 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.
SHANNON DRYER (1629482070) bills $47.38/claim for D1206 (Topical fluoride varnish) vs avg $1.97 (+6.4Ο). $18,384 across 388 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.
SUNSHINE THERAPY LLC (1164988267) bills $484.88/claim for H0031 (Mh health assess by non-md) vs avg $84.97 (+6.3Ο). $28,608 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.
FRONT LINE EMS LLC (1255802047) bills $955.41/claim for A0425 (Ground mileage) vs avg $88.44 (+6.2Ο). $371,654 across 389 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.
ROLLING HILLS CHARTER SCHOOL (1558558379) bills $777.88/claim for H0004 (Behavioral health counseling and therapy, per 15 minutes) vs avg $135.37 (+6.0Ο). $206,916 across 266 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.
RES-CARE WASHINGTON, INC. (1437546199) bills $1,003.95/claim for T1019 (Personal care ser per 15 min) vs avg $115.40 (+6.0Ο). $12,047 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.
LOVING HANDS (1053188441): 19.0 claims/beneficiary (avg 2.5). 5,260 claims, 277 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.
STONEBRIDGE ASSISTED LIVING LLC (1326702549) bills $150.97/claim for S5130 (Homaker service nos per 15m) vs avg $27.76 (+5.8Ο). $16,003 across 106 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.
KIDSCARE HOME HEALTH OF IDAHO, LLC (1265902332) bills $165.39/claim for 92507 (Tx sp lang voice comm indiv) vs avg $43.93 (+5.7Ο). $184,579 across 1,116 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 CANYON MEDICAL CENTER INC. (1609046671) bills $28.91/claim for 93010 (Electrocardiogram report) vs avg $5.72 (+5.6Ο). $11,303 across 391 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.
IDAHO FALLS ASC (1174005235) bills $467.53/claim for D2930 (Prefabricated stainless steel crown primary) vs avg $87.82 (+5.6Ο). $138,388 across 296 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.
A CARING HAND TWIN FALLS LLC (1619340726): 18.0 claims/beneficiary (avg 2.5). 101,105 claims, 5,620 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.
RES-CARE WASHINGTON, INC (1053558643): 17.8 claims/beneficiary (avg 2.5). 771,978 claims, 43,422 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.
LIVING INDEPENDENCE NETWORK CORPORATION (1730312935): 17.7 claims/beneficiary (avg 2.5). 280,239 claims, 15,866 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.
ADDUS HEALTHCARE, INC. (1699198242): 17.6 claims/beneficiary (avg 2.5). 163,302 claims, 9,265 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.
COMMUNITY CONNECTIONS, INC (1245440692): 17.6 claims/beneficiary (avg 2.5). 228,933 claims, 13,001 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.
ADVANCED SERVICES LLC (1316061054): 17.5 claims/beneficiary (avg 2.5). 75,358 claims, 4,302 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.
CURTIS MASON (1699833061) bills $273.06/claim for 97162 (Pt eval mod complex 30 min) vs avg $62.58 (+5.4Ο). $10,376 across 38 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.
SEAN MCGUIRE (1245736610) bills $63.30/claim for D1351 (Sealant per tooth) vs avg $6.23 (+5.3Ο). $62,098 across 981 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.
CARIBOU MEMORIAL HOSPITAL (1912998261) bills $452.56/claim for 99284 (Emergency dept visit mod mdm) vs avg $100.48 (+5.3Ο). $248,001 across 548 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.
AUTOBUS VENTURES, LLC (1437208899): 17.0 claims/beneficiary (avg 2.5). 179,861 claims, 10,558 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.
ISAAC BELL (1396995239) bills $14.94/claim for 92340 (Fit spectacles monofocal) vs avg $22.94 (-5.1Ο). $32,067 across 2,146 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.
ADOLESCENT & CHILD DEVELOPMENT CENTER, LLC (1063671469): 16.8 claims/beneficiary (avg 2.5). 22,114 claims, 1,313 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.
MICHAEL PYSNAK (1922467992) bills $18.59/claim for D1208 (Topical fluoride excluding varnish) vs avg $0.81 (+5.1Ο). $42,572 across 2,290 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.
SYRINGA FAMILY PARTNERSHIP, LLC (1962658500) bills $470.81/claim for H0032 (Mh svc plan dev by non-md) vs avg $78.76 (+5.1Ο). $40,489 across 86 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.
BETTER CHOICE CARE L.L.C (1750742250): 16.7 claims/beneficiary (avg 2.5). 27,230 claims, 1,634 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.
TERRI JONES (1104033687) bills $147.57/claim for G9002 (Mccd,maintenance rate) vs avg $40.90 (+4.9Ο). $433,276 across 2,936 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.
COMMUNITY HEALTH ASSOCIATION OF SPOKANE (1497205652) bills $20.92/claim for D1999 (Unspecified preventive proc) vs avg $1.03 (+4.9Ο). $16,168 across 773 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.
VALLEY FAMILY HEALTH CARE INC (1407886484) bills $20.19/claim for 90633 (Hepa vacc ped/adol 2 dose im) vs avg $0.98 (+4.8Ο). $20,531 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.
RAISE THE BOTTOM TRAINING & COUNSELING SERVICES, LLC (1962707166) bills $40.50/claim for H0003 (Alcohol and/or drug screenin) vs avg $14.71 (+4.8Ο). $47,750 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.
KIDSCARE HOME HEALTH OF IDAHO, LLC (1265902332) bills $123.22/claim for 97110 (Therapeutic exercises) vs avg $35.50 (+4.7Ο). $50,151 across 407 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.
SHANNON DRYER (1629482070) bills $161.49/claim for D2391 (Resin composite - one surface posterior) vs avg $33.66 (+4.7Ο). $15,180 across 94 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.
COUNTY OF MADISON SCHOOL DISTRICT 321 (1003960659) bills $400.72/claim for H2014 (Skills train and dev, 15 min) vs avg $70.20 (+4.7Ο). $7,245,791 across 18,082 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.
CHILDRENS DENTISTRY OF FRUITLAND (1619634250) bills $16.74/claim for D1208 (Topical fluoride excluding varnish) vs avg $0.81 (+4.6Ο). $34,879 across 2,083 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.