Concourse Sentinel

Medicaid Integrity Analytics

πŸ“ŠOverviewπŸ₯ProvidersπŸ’ŠProcedures🚨WatchlistπŸ”Statistical Outliersβš–οΈCompareπŸ“ˆTrendsπŸ—ΊοΈGeography

Cross-Dataset

πŸ•ΈοΈEntity Networks🏠Home Healthβ›”Exclusions (LEIE)πŸ“‹Context & Disclaimers
πŸ‡ΊπŸ‡ΈAll States
by Concourse

Data: CMS T-MSIS 2018-2024

Source: opendata.hhs.gov

Statistical Outliers

Single-test outliers in Illinois 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

582

warning

709

info

8,484

Total

9,775

Outliers by Type
Severity Distribution
critical
582 (6.0%)
warning
709 (7.3%)
info
8,484 (86.8%)
6,951 results
criticalCost OutlierScore: 27.1

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

JODI ROQUE (1346478526) bills $180.53/claim for 99211 (Off/op est may x req phy/qhp) vs avg $11.61 (+27.1Οƒ). $102,899 across 570 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.

JODI ROQUECHICAGOProvider total: $151.7K
criticalCost OutlierScore: 24.9

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

1457361024 (1457361024) bills $265.66/claim for 99283 (Emergency dept visit low mdm) vs avg $35.95 (+24.9Οƒ). $18,862 across 71 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.

1457361024Provider total: $44.0K
criticalCost OutlierScore: 24.1

Cost-per-claim above average for 83036 (Hemoglobin A1c (Diabetes Monitoring))

PWN LABORATORY LLC (1477209740) bills $132.77/claim for 83036 (Hemoglobin glycosylated a1c) vs avg $3.92 (+24.1Οƒ). $191,455 across 1,442 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.

PWN LABORATORY LLCHOFFMAN ESTATESProvider total: $423.6K
criticalCost OutlierScore: 22.8

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

BRYSON WHALEN (1255727301) bills $31.04/claim for 81002 (Urinalysis nonauto w/o scope) vs avg $2.04 (+22.8Οƒ). $11,483 across 370 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.

BRYSON WHALENGLEN CARBONProvider total: $109.0K
criticalCost OutlierScore: 22.2

Cost-per-claim above average for 96372

1326447939 (1326447939) bills $153.24/claim for 96372 (Ther/proph/diag inj sc/im) vs avg $6.85 (+22.2Οƒ). $14,404 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.

GUAM HEALTHCARE DEVELOPMENT INCORPORATEDDEDEDOProvider total: $97.3K
criticalCost OutlierScore: 18.9

Cost-per-claim above average for 99173

JOHN GIROUX (1396774485) bills $75.72/claim for 99173 (Visual acuity screen) vs avg $4.80 (+18.9Οƒ). $66,706 across 881 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.

JOHN GIROUXALTONProvider total: $1.2M
criticalCost OutlierScore: 18.2

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

PHLLIP JENSEN (1699892042) bills $684.00/claim for D7140 (Extraction erupted tooth or exposed root) vs avg $53.41 (+18.2Οƒ). $10,260 across 15 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.

PHLLIP JENSENSPRINGFIELDProvider total: $16.5K
criticalCost OutlierScore: 17.3

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

PURVI PATEL (1881097244) bills $400.00/claim for 99213 (Office o/p est low 20 min) vs avg $38.53 (+17.3Οƒ). $12,000 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.

PURVI PATELROCKFORDProvider total: $1.5M
criticalCost OutlierScore: 17.3

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

SUSIE AVERY (1043709660) bills $400.00/claim for 99213 (Office o/p est low 20 min) vs avg $38.53 (+17.3Οƒ). $30,000 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.

SUSIE AVERYGALESBURGProvider total: $1.9M
criticalCost OutlierScore: 17.3

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

JAMIE SCHUPBACH (1932554714) bills $400.00/claim for 99213 (Office o/p est low 20 min) vs avg $38.53 (+17.3Οƒ). $32,000 across 80 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.

JAMIE SCHUPBACHPEORIAProvider total: $1.8M
criticalCost OutlierScore: 17.3

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

DANIELLE JORDAL (1639429855) bills $400.00/claim for 99213 (Office o/p est low 20 min) vs avg $38.53 (+17.3Οƒ). $12,800 across 32 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.

DANIELLE JORDALROCKFORDProvider total: $1.6M
criticalCost OutlierScore: 15.2

Cost-per-claim above average for 90461 (Immunization Administration (Each Additional Component))

1275586877 (1275586877) bills $55.39/claim for 90461 (Im admin each addl component) vs avg $0.50 (+15.2Οƒ). $11,908 across 215 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.

GENERAL CONFERENCE CORP OF SDATAMUNINGProvider total: $32.1K
criticalCost OutlierScore: 13.7

Cost-per-claim above average for D0220 (Dental X-ray (Periapical, First Film))

GHASSAN SOURI (1831110006) bills $81.50/claim for D0220 (Intraoral - periapical first image) vs avg $6.02 (+13.7Οƒ). $19,070 across 234 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.

GHASSAN SOURICHICAGOProvider total: $31.0K
criticalCost OutlierScore: 12.9

Cost-per-claim above average for H0004 (Behavioral Health Counseling and Therapy (per 15 min))

JAMI MARTIN (1073688941) bills $548.03/claim for H0004 (Behavioral health counseling and therapy, per 15 minutes) vs avg $81.30 (+12.9Οƒ). $588,041 across 1,073 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.

JAMI MARTINMARTINSVILLEProvider total: $588.0K
criticalCost OutlierScore: 12.4

Cost-per-claim above average for H2010

DREXEL COUNSELING SERVICES, INC. (1679846919) bills $848.87/claim for H2010 (Comprehensive med svc 15 min) vs avg $42.63 (+12.4Οƒ). $1,576,359 across 1,857 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.

DREXEL COUNSELING SERVICES, INC.CHICAGOProvider total: $3.2M
criticalCost OutlierScore: 12.0

Cost-per-claim above average for 90670

WALGREEN CO. (1447335765) bills $157.47/claim for 90670 (Pcv13 vaccine im) vs avg $12.25 (+12.0Οƒ). $339,029 across 2,153 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 CO.MOUNT VERNONProvider total: $1.2M
criticalCost OutlierScore: 11.8

Cost-per-claim above average for 99490

THE ROBERT YOUNG CENTER FOR COMMUNITY MENTAL HEALTH (1871542829) bills $129.53/claim for 99490 (Chrnc care mgmt staff 1st 20) vs avg $9.04 (+11.8Οƒ). $6,271,779 across 48,420 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 ROBERT YOUNG CENTER FOR COMMUNITY MENTAL HEALTHROCK ISLANDProvider total: $9.5M
criticalCost OutlierScore: 11.3

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

KURTIS WIRTH (1407850761) bills $587.42/claim for D7210 (Extraction - surgical, erupted tooth) vs avg $85.03 (+11.3Οƒ). $1,089,080 across 1,854 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.

KURTIS WIRTHROCKFORDProvider total: $2.1M
criticalCost OutlierScore: 11.0

Cost-per-claim above average for 96413

TRINITY MEDICAL CENTER (1316047632) bills $605.76/claim for 96413 (Chemo iv infusion 1 hr) vs avg $47.72 (+11.0Οƒ). $10,298 across 17 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.

TRINITY MEDICAL CENTERROCK ISLANDProvider total: $2.7M
criticalCost OutlierScore: 10.6

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

KAREN ROBERTS (1740235084) bills $260.00/claim for 99213 (Office o/p est low 20 min) vs avg $38.53 (+10.6Οƒ). $24,440 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.

KAREN ROBERTSPALATINEProvider total: $236.4K
criticalCost OutlierScore: 10.6

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

SYLVIA COLEMAN (1205471083) bills $260.00/claim for 99213 (Office o/p est low 20 min) vs avg $38.53 (+10.6Οƒ). $18,200 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.

SYLVIA COLEMANCHICAGOProvider total: $215.9K
criticalCost OutlierScore: 10.6

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

LISA TREVINO (1467090308) bills $260.00/claim for 99213 (Office o/p est low 20 min) vs avg $38.53 (+10.6Οƒ). $57,720 across 222 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.

LISA TREVINOJOLIETProvider total: $379.0K
criticalCost OutlierScore: 10.6

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

PRECIOUS LEVON (1639675432) bills $260.00/claim for 99213 (Office o/p est low 20 min) vs avg $38.53 (+10.6Οƒ). $88,920 across 342 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.

PRECIOUS LEVONCHICAGO RIDGEProvider total: $526.6K
criticalCost OutlierScore: 10.6

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

LARETTA WILEY (1952885949) bills $260.00/claim for 99213 (Office o/p est low 20 min) vs avg $38.53 (+10.6Οƒ). $17,940 across 69 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.

LARETTA WILEYMATTESONProvider total: $1.4M
criticalCost OutlierScore: 10.6

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

EDITH JENKINS (1982142527) bills $260.00/claim for 99213 (Office o/p est low 20 min) vs avg $38.53 (+10.6Οƒ). $12,480 across 48 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.

EDITH JENKINSCALUMET CITYProvider total: $194.7K
criticalCost OutlierScore: 10.6

Cost-per-claim above average for 82043

PWN LABORATORY LLC (1477209740) bills $18.72/claim for 82043 (Ur albumin quantitative) vs avg $1.95 (+10.6Οƒ). $15,219 across 813 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.

PWN LABORATORY LLCHOFFMAN ESTATESProvider total: $423.6K
criticalCost OutlierScore: 10.5

Cost-per-claim above average for 90853 (Group Psychotherapy)

ADVOCATE NORTH SIDE HEALTH NETWORK (1912014564) bills $278.74/claim for 90853 (Group psychotherapy) vs avg $13.22 (+10.5Οƒ). $18,397 across 66 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.

ADVOCATE NORTH SIDE HEALTH NETWORKCHICAGOProvider total: $1.2M
criticalCost OutlierScore: 10.2

Cost-per-claim above average for 82570

PWN LABORATORY LLC (1477209740) bills $18.72/claim for 82570 (Assay of urine creatinine) vs avg $2.37 (+10.2Οƒ). $15,219 across 813 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.

PWN LABORATORY LLCHOFFMAN ESTATESProvider total: $423.6K
criticalCost OutlierScore: 10.2

Cost-per-claim above average for 99203 (Office Visit, New Patient (30 min, Low Complexity))

KATHLEEN WODRICH (1821494568) bills $400.00/claim for 99203 (Office o/p new low 30 min) vs avg $42.55 (+10.2Οƒ). $13,600 across 34 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.

KATHLEEN WODRICHROCKFORDProvider total: $245.0K
criticalCost OutlierScore: 10.2

Cost-per-claim above average for T1040

BREE DALLINGA (1982990271) bills $234.13/claim for T1040 (Comm bh clinic svc per diem) vs avg $67.19 (+10.2Οƒ). $24,349 across 104 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.

BREE DALLINGACHICAGOProvider total: $24.7K
criticalCost OutlierScore: 10.0

Cost-per-claim above average for T2003

PEORIA HOSPITAL'S MOBILE MEDICAL SERVICES (1699836379) bills $138.88/claim for T2003 (N-et; encounter/trip) vs avg $19.15 (+10.0Οƒ). $117,912 across 849 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.

PEORIA HOSPITAL'S MOBILE MEDICAL SERVICESPEORIAProvider total: $41.8M
criticalCost OutlierScore: 9.5

Cost-per-claim above average for 99204 (Office Visit, New Patient (45 min, Moderate Complexity))

MARLA VANVICKLE (1730777145) bills $394.21/claim for 99204 (Office o/p new mod 45 min) vs avg $69.45 (+9.5Οƒ). $21,682 across 55 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.

MARLA VANVICKLEROCKFORDProvider total: $51.4K
criticalCost OutlierScore: 9.5

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

CHELSEA SCHMITZ (1609369057) bills $33.88/claim for D0230 (Intraoral - periapical each addl image) vs avg $5.08 (+9.5Οƒ). $17,888 across 528 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.

CHELSEA SCHMITZWEST DUNDEEProvider total: $335.4K
criticalCost OutlierScore: 9.4

Cost-per-claim above average for 90716

NORMA KIMMIG (1477994523) bills $142.68/claim for 90716 (Var vaccine live subq) vs avg $11.79 (+9.4Οƒ). $24,541 across 172 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.

NORMA KIMMIGCHICAGOProvider total: $253.4K
criticalCost OutlierScore: 9.4

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

BRADLEY LUTCHKA (1780654202) bills $501.61/claim for D7210 (Extraction - surgical, erupted tooth) vs avg $85.03 (+9.4Οƒ). $13,543 across 27 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 LUTCHKAMOLINEProvider total: $736.6K
criticalCost OutlierScore: 9.3

Cost-per-claim above average for D0220 (Dental X-ray (Periapical, First Film))

HUY LE (1194210534) bills $57.46/claim for D0220 (Intraoral - periapical first image) vs avg $6.02 (+9.3Οƒ). $25,744 across 448 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.

HUY LEROCK FALLSProvider total: $106.2K
criticalCost OutlierScore: 9.3

Cost-per-claim above average for 99203 (Office Visit, New Patient (30 min, Low Complexity))

SARAH NKWOCHA (1164909412) bills $366.28/claim for 99203 (Office o/p new low 30 min) vs avg $42.55 (+9.3Οƒ). $34,430 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.

SARAH NKWOCHACHICAGOProvider total: $407.8K
criticalCost OutlierScore: 9.2

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

HELEN MULCAHY (1235799644) bills $120.39/claim for 99283 (Emergency dept visit low mdm) vs avg $35.95 (+9.2Οƒ). $20,587 across 171 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.

HELEN MULCAHYWILMETTEProvider total: $200.6K
criticalCost OutlierScore: 9.2

Cost-per-claim above average for 90670

KELSEY HOPKINS (1508012527) bills $122.89/claim for 90670 (Pcv13 vaccine im) vs avg $12.25 (+9.2Οƒ). $11,551 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.

KELSEY HOPKINSGREENVILLEProvider total: $2.3M
criticalCost OutlierScore: 9.0

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

HELEN MULCAHY (1235799644) bills $209.14/claim for 99284 (Emergency dept visit mod mdm) vs avg $60.14 (+9.0Οƒ). $170,870 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.

HELEN MULCAHYWILMETTEProvider total: $200.6K
criticalCost OutlierScore: 8.8

Cost-per-claim above average for H2010

SUNDANCE METHADONE TREATMENT CENTER,LLC (1316296007) bills $611.24/claim for H2010 (Comprehensive med svc 15 min) vs avg $42.63 (+8.8Οƒ). $56,234 across 92 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.

SUNDANCE METHADONE TREATMENT CENTER,LLCCHICAGOProvider total: $3.1M
criticalCost OutlierScore: 8.7

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

GREGORY BIDDULPH (1932237856) bills $117.12/claim for D0150 (Comprehensive oral evaluation) vs avg $21.83 (+8.7Οƒ). $36,306 across 310 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.

GREGORY BIDDULPHO FALLONProvider total: $761.4K
criticalCost OutlierScore: 8.7

Cost-per-claim above average for 87186

FAROOQ AHMED (1275553240) bills $32.41/claim for 87186 (Microbe susceptible mic) vs avg $5.94 (+8.7Οƒ). $36,302 across 1,120 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.

FAROOQ AHMEDSKOKIEProvider total: $2.7M
criticalCost OutlierScore: 8.6

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

NORMA KIMMIG (1477994523) bills $214.78/claim for 90651 (9vhpv vaccine 2/3 dose im) vs avg $18.66 (+8.6Οƒ). $13,102 across 61 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.

NORMA KIMMIGCHICAGOProvider total: $253.4K
criticalCost OutlierScore: 8.6

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

BRADLEY LUTCHKA (1780654202) bills $351.01/claim for D7140 (Extraction erupted tooth or exposed root) vs avg $53.41 (+8.6Οƒ). $499,132 across 1,422 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 LUTCHKAMOLINEProvider total: $736.6K
criticalCost OutlierScore: 8.5

Cost-per-claim above average for 93971

CHICAGO UPTOWN MEDICAL CENTER (1255427704) bills $81.21/claim for 93971 (Extremity study) vs avg $11.72 (+8.5Οƒ). $11,613 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.

CHICAGO UPTOWN MEDICAL CENTERCHICAGOProvider total: $11.6K
criticalCost OutlierScore: 8.2

Cost-per-claim above average for 97110 (Therapeutic Exercise (per 15 min))

GIBSON COMMUNITY HOSPITAL ASSOCIATION (1114935681) bills $381.53/claim for 97110 (Therapeutic exercises) vs avg $47.63 (+8.2Οƒ). $1,133,520 across 2,971 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.

GIBSON COMMUNITY HOSPITAL ASSOCIATIONGIBSON CITYProvider total: $1.3M
criticalCost OutlierScore: 8.1

Cost-per-claim above average for 99203 (Office Visit, New Patient (30 min, Low Complexity))

SUSIE AVERY (1043709660) bills $327.28/claim for 99203 (Office o/p new low 30 min) vs avg $42.55 (+8.1Οƒ). $23,891 across 73 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.

SUSIE AVERYGALESBURGProvider total: $1.9M
criticalCost OutlierScore: 8.1

Cost-per-claim above average for 97535

HELP AT HOME, LLC (1093823098) bills $98.18/claim for 97535 (Self care mngment training) vs avg $14.46 (+8.1Οƒ). $605,960 across 6,172 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.

HELP AT HOME, LLCCHICAGOProvider total: $23.9M
criticalCost OutlierScore: 8.1

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

CRAIG THATCHER (1013984541) bills $443.40/claim for D7210 (Extraction - surgical, erupted tooth) vs avg $85.03 (+8.1Οƒ). $60,302 across 136 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.

CRAIG THATCHERMOLINEProvider total: $546.2K
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