Statistical Outliers

Single-test outliers in Kentucky 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

412

warning

622

info

6,605

Total

7,639

Outliers by Type

Severity Distribution

critical

412 (5.4%)

warning

622 (8.1%)

info

6,605 (86.5%)

5,032 results

criticalCost OutlierScore: 26.0

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

SAINT JOSEPH HEALTH SYSTEM, INC (1679679146) bills $181.68/claim for D0220 (Intraoral - periapical first image) vs avg $8.50 (+26.0σ). $13,808 across 76 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.

SAINT JOSEPH HEALTH SYSTEM, INCMT STERLINGProvider total: $37.2M

criticalCost OutlierScore: 25.3

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

UNIVERSITY OF KENTUCKY (1518911338) bills $468.96/claim for D1110 (Prophylaxis - adult) vs avg $43.33 (+25.3σ). $130,370 across 278 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 OF KENTUCKYLEXINGTONProvider total: $716.4M

criticalCost OutlierScore: 24.0

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

PREMIER SURGERY CENTER OF LOUISVILLE LP (1740246792) bills $1,023.99/claim for D0150 (Comprehensive oral evaluation) vs avg $29.50 (+24.0σ). $220,158 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.

PREMIER SURGERY CENTER OF LOUISVILLE LPLOUISVILLEProvider total: $7.7M

criticalCost OutlierScore: 22.4

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

UNIVERSITY OF KENTUCKY (1518911338) bills $401.14/claim for D1120 (Prophylaxis - child) vs avg $46.59 (+22.4σ). $332,145 across 828 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 OF KENTUCKYLEXINGTONProvider total: $716.4M

criticalCost OutlierScore: 22.3

Cost-per-claim above average for D1206 (Topical Fluoride Varnish Application)

UNIVERSITY OF KENTUCKY (1518911338) bills $296.99/claim for D1206 (Topical fluoride varnish) vs avg $16.36 (+22.3σ). $236,402 across 796 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 OF KENTUCKYLEXINGTONProvider total: $716.4M

criticalCost OutlierScore: 22.0

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

SAINT JOSEPH HEALTH SYSTEM, INC (1679679146) bills $181.72/claim for D0230 (Intraoral - periapical each addl image) vs avg $6.54 (+22.0σ). $12,902 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.

SAINT JOSEPH HEALTH SYSTEM, INCMT STERLINGProvider total: $37.2M

criticalCost OutlierScore: 21.1

Cost-per-claim above average for D0272 (Dental X-rays (Bitewings, 2 Films))

SAINT JOSEPH HEALTH SYSTEM, INC (1679679146) bills $174.15/claim for D0272 (Bitewings - two radiographic images) vs avg $17.19 (+21.1σ). $12,365 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.

SAINT JOSEPH HEALTH SYSTEM, INCMT STERLINGProvider total: $37.2M

criticalCost OutlierScore: 16.1

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

OUR LADY OF BELLEFONTE HOSPITAL INC (1437156346) bills $695.86/claim for D0150 (Comprehensive oral evaluation) vs avg $29.50 (+16.1σ). $20,180 across 29 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.

OUR LADY OF BELLEFONTE HOSPITAL INCASHLANDProvider total: $12.1M

criticalCost OutlierScore: 16.0

Cost-per-claim above average for 87635

1326447939 (1326447939) bills $485.66/claim for 87635 (Sars-cov-2 covid-19 amp prb) vs avg $35.64 (+16.0σ). $34,482 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.

GUAM HEALTHCARE DEVELOPMENT INCORPORATEDDEDEDOProvider total: $2.2M

criticalCost OutlierScore: 15.3

Cost-per-claim above average for 80305 (Drug Screening, Presumptive (Instrument-Based))

CCMH CORPORATION (1225159601) bills $85.76/claim for 80305 (Drug test prsmv dir opt obs) vs avg $7.64 (+15.3σ). $146,645 across 1,710 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.

CCMH CORPORATIONCARROLLTONProvider total: $11.7M

criticalCost OutlierScore: 14.4

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

ASHLAND HOSPITAL CORPORATION (1851346720) bills $490.08/claim for D2391 (Resin composite - one surface posterior) vs avg $48.51 (+14.4σ). $78,902 across 161 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.

ASHLAND HOSPITAL CORPORATIONASHLANDProvider total: $222.8M

criticalCost OutlierScore: 13.1

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

APPALACHIAN REGIONAL HEALTHCARE, INC. (1609869916) bills $448.76/claim for D2391 (Resin composite - one surface posterior) vs avg $48.51 (+13.1σ). $81,675 across 182 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.

APPALACHIAN REGIONAL HEALTHCARE, INC.HAZARDProvider total: $107.9M

criticalCost OutlierScore: 12.8

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

FLAGET HEALTHCARE, INC (1871588772) bills $703.44/claim for D7140 (Extraction erupted tooth or exposed root) vs avg $54.07 (+12.8σ). $79,489 across 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.

FLAGET HEALTHCARE, INCBARDSTOWNProvider total: $26.5M

criticalCost OutlierScore: 12.1

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

APPALACHIAN REGIONAL HEALTHCARE, INC. (1144405101) bills $30.11/claim for 81002 (Urinalysis nonauto w/o scope) vs avg $1.46 (+12.0σ). $11,230 across 373 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.

APPALACHIAN REGIONAL HEALTHCARE, INC.BELFRYProvider total: $145.4K

criticalCost OutlierScore: 11.8

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

APPALACHIAN REGIONAL HEALTHCARE, INC. (1891792495) bills $972.25/claim for D7210 (Extraction - surgical, erupted tooth) vs avg $91.05 (+11.8σ). $210,978 across 217 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.

APPALACHIAN REGIONAL HEALTHCARE, INC.MIDDLESBOROProvider total: $38.8M

criticalCost OutlierScore: 11.7

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

1326447939 (1326447939) bills $192.54/claim for 80053 (Comprehen metabolic panel) vs avg $10.52 (+11.7σ). $62,190 across 323 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: $2.2M

criticalCost OutlierScore: 11.5

Cost-per-claim above average for J1100 (Dexamethasone Injection (1 mg))

ARH MARY BRECKINRIDGE HEALTH SERVICES, INC. (1992176655) bills $47.14/claim for J1100 (Dexamethasone sodium phos) vs avg $2.07 (+11.5σ). $13,813 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.

ARH MARY BRECKINRIDGE HEALTH SERVICES, INC.BARBOURVILLEProvider total: $33.2M

criticalOverutilizationScore: 11.2

Unusually high claims-per-beneficiary ratio

D&S RESIDENTIAL SERVICES, LP (1699430314): 43.6 claims/beneficiary (avg 2.5). 15,583 claims, 357 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.

D&S RESIDENTIAL SERVICES, LPOWENSBOROProvider total: $1.1M

criticalCost OutlierScore: 11.1

Cost-per-claim above average for 96372

MONROE MEDICAL FOUNDATION, INC. (1053499350) bills $114.23/claim for 96372 (Ther/proph/diag inj sc/im) vs avg $14.42 (+11.1σ). $1,009,195 across 8,835 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.

MONROE MEDICAL FOUNDATION, INC.TOMPKINSVILLEProvider total: $7.3M

criticalCost OutlierScore: 11.0

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

APPALACHIAN REGIONAL HEALTHCARE, INC. (1609869916) bills $610.17/claim for D7140 (Extraction erupted tooth or exposed root) vs avg $54.07 (+11.0σ). $226,984 across 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.

APPALACHIAN REGIONAL HEALTHCARE, INC.HAZARDProvider total: $107.9M

criticalCost OutlierScore: 11.0

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

CCMH CORPORATION (1225159601) bills $258.52/claim for 90853 (Group psychotherapy) vs avg $16.02 (+11.0σ). $142,187 across 550 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.

CCMH CORPORATIONCARROLLTONProvider total: $11.7M

criticalCost OutlierScore: 10.8

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

JANE TODD CRAWFORD MEMORIAL HOSPITAL INC. (1225161524) bills $59.73/claim for 83036 (Hemoglobin glycosylated a1c) vs avg $7.13 (+10.8σ). $158,643 across 2,656 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.

JANE TODD CRAWFORD MEMORIAL HOSPITAL INC.GREENSBURGProvider total: $7.7M

criticalOverutilizationScore: 10.7

Unusually high claims-per-beneficiary ratio

HOME DIALYSIS OF MUHLENBERG COUNTY, INC. (1053413252): 41.6 claims/beneficiary (avg 2.5). 8,148 claims, 196 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.

HOME DIALYSIS OF MUHLENBERG COUNTY, INC.CENTRAL CITYProvider total: $79.0K

criticalOverutilizationScore: 10.3

Unusually high claims-per-beneficiary ratio

SOUTHERN HOME CARE SERVICES, INC. (1316241961): 40.1 claims/beneficiary (avg 2.5). 317,213 claims, 7,905 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.

SOUTHERN HOME CARE SERVICES, INC.LOUISVILLEProvider total: $11.0M

criticalCost OutlierScore: 10.1

Cost-per-claim above average for 81025

BRECKINRIDGE HEALTH, INC (1104828383) bills $63.18/claim for 81025 (Urine pregnancy test) vs avg $6.44 (+10.1σ). $140,313 across 2,221 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.

BRECKINRIDGE HEALTH, INCHARDINSBURGProvider total: $11.2M

criticalCost OutlierScore: 9.8

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

MODERN CARE LLC (1659673655) bills $218.02/claim for 97110 (Therapeutic exercises) vs avg $24.31 (+9.8σ). $1,395,567 across 6,401 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.

MODERN CARE LLCCAMPBELLSVILLEProvider total: $29.7M

criticalCost OutlierScore: 9.3

Cost-per-claim above average for D2930

APPALACHIAN REGIONAL HEALTHCARE, INC. (1609869916) bills $702.39/claim for D2930 (Prefabricated stainless steel crown primary) vs avg $120.79 (+9.3σ). $35,119 across 50 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.

APPALACHIAN REGIONAL HEALTHCARE, INC.HAZARDProvider total: $107.9M

criticalCost OutlierScore: 9.3

Cost-per-claim above average for 97012 (Mechanical Traction Therapy)

SAINT JOSEPH HEALTH SYSTEM, INC (1437150984) bills $44.49/claim for 97012 (Mechanical traction therapy) vs avg $8.96 (+9.3σ). $129,638 across 2,914 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.

SAINT JOSEPH HEALTH SYSTEM, INCLEXINGTONProvider total: $85.5M

criticalCost OutlierScore: 9.1

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

BABATUNDE SOKAN (1346225703) bills $126.34/claim for 99213 (Office o/p est low 20 min) vs avg $29.74 (+9.1σ). $53,443 across 423 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.

BABATUNDE SOKANPARISProvider total: $113.4K

criticalCost OutlierScore: 9.1

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

UHS OF RIDGE LLC (1316917198) bills $216.30/claim for 90853 (Group psychotherapy) vs avg $16.02 (+9.1σ). $62,728 across 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.

UHS OF RIDGE LLCLEXINGTONProvider total: $9.1M

criticalCost OutlierScore: 9.0

Cost-per-claim above average for 82306 (Vitamin D Level (25-Hydroxy))

CASEY COUNTY HOSPITAL DISTRICT (1407829567) bills $165.65/claim for 82306 (Vitamin d 25 hydroxy) vs avg $21.92 (+9.0σ). $142,460 across 860 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.

CASEY COUNTY HOSPITAL DISTRICTLIBERTYProvider total: $11.1M

criticalCost OutlierScore: 8.8

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

APPALACHIAN REGIONAL HEALTHCARE, INC. (1891792495) bills $501.58/claim for D7140 (Extraction erupted tooth or exposed root) vs avg $54.07 (+8.8σ). $40,628 across 81 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.

APPALACHIAN REGIONAL HEALTHCARE, INC.MIDDLESBOROProvider total: $38.8M

criticalOverutilizationScore: 8.8

Unusually high claims-per-beneficiary ratio

HELP AT HOME, LLC (1871836486): 34.7 claims/beneficiary (avg 2.5). 63,529 claims, 1,833 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.

HELP AT HOME, LLCLOUISVILLEProvider total: $10.3M

criticalOverutilizationScore: 8.8

Unusually high claims-per-beneficiary ratio

TOTAL RENAL CARE INC (1740240183): 34.6 claims/beneficiary (avg 2.5). 16,845 claims, 487 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.

TOTAL RENAL CARE INCHAGERHILLProvider total: $217.5K

criticalCost OutlierScore: 8.7

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

LAKE CUMBERLAND SURGERY CENTER LP (1720143779) bills $389.88/claim for D0150 (Comprehensive oral evaluation) vs avg $29.50 (+8.7σ). $31,581 across 81 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.

LAKE CUMBERLAND SURGERY CENTER LPSOMERSETProvider total: $8.7M

criticalCost OutlierScore: 8.6

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

BABATUNDE SOKAN (1346225703) bills $170.24/claim for 99214 (Office o/p est mod 30 min) vs avg $42.34 (+8.6σ). $53,114 across 312 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.

BABATUNDE SOKANPARISProvider total: $113.4K

criticalOverutilizationScore: 8.6

Unusually high claims-per-beneficiary ratio

BLUEGRASS DIALYSIS LLC (1194998013): 34.0 claims/beneficiary (avg 2.5). 11,623 claims, 342 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.

BLUEGRASS DIALYSIS LLCWILLIAMSTOWNProvider total: $210.9K

criticalCost OutlierScore: 8.6

Cost-per-claim above average for 87880 (Rapid Strep A Test (Optical/Immunoassay))

JANE TODD CRAWFORD MEMORIAL HOSPITAL INC. (1225161524) bills $43.68/claim for 87880 (Strep a assay w/optic) vs avg $11.48 (+8.6σ). $82,996 across 1,900 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.

JANE TODD CRAWFORD MEMORIAL HOSPITAL INC.GREENSBURGProvider total: $7.7M

criticalOverutilizationScore: 8.6

Unusually high claims-per-beneficiary ratio

D&S RESIDENTIAL SERVICES, LP (1760147482): 33.9 claims/beneficiary (avg 2.5). 74,251 claims, 2,192 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.

D&S RESIDENTIAL SERVICES, LPLOUISVILLEProvider total: $17.5M

criticalCost OutlierScore: 8.5

Cost-per-claim above average for J0696

OPTION CARE ENTERPRISES INC (1902182637) bills $158.23/claim for J0696 (Ceftriaxone sodium injection) vs avg $16.74 (+8.5σ). $907,939 across 5,738 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.

OPTION CARE ENTERPRISES INCLOUISVILLEProvider total: $39.1M

criticalCost OutlierScore: 8.4

Cost-per-claim above average for J0696

SCOTT-WILSON, INC. (1255336517) bills $156.45/claim for J0696 (Ceftriaxone sodium injection) vs avg $16.74 (+8.4σ). $121,719 across 778 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.

SCOTT-WILSON, INC.LEXINGTONProvider total: $24.5M

criticalCost OutlierScore: 8.4

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

CARING MOORE HOMES (1578011326) bills $190.45/claim for 97110 (Therapeutic exercises) vs avg $24.31 (+8.4σ). $381,082 across 2,001 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.

CARING MOORE HOMESASHLANDProvider total: $21.0M

criticalCost OutlierScore: 8.4

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

SUPERIOR SOLUTIONS, PLLC. (1174060453) bills $190.27/claim for 97110 (Therapeutic exercises) vs avg $24.31 (+8.4σ). $410,022 across 2,155 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.

SUPERIOR SOLUTIONS, PLLC.COXS CREEKProvider total: $4.9M

criticalCost OutlierScore: 8.3

Cost-per-claim above average for J1170

KRISHNA NADAR (1801821962) bills $239.86/claim for J1170 (Injection, hydromorphone, up to 4 mg) vs avg $8.45 (+8.3σ). $22,067 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.

KRISHNA NADARLOUISVILLEProvider total: $986.5K

criticalOverutilizationScore: 8.3

Unusually high claims-per-beneficiary ratio

BLUEGRASS DIALYSIS LLC (1255566444): 33.0 claims/beneficiary (avg 2.5). 20,636 claims, 626 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.

BLUEGRASS DIALYSIS LLCCOVINGTONProvider total: $446.0K

criticalCost OutlierScore: 8.3

Cost-per-claim above average for S5108

ALLIED ADULT DAY CARE, LLC (1467004069) bills $1,625.86/claim for S5108 (Homecare train pt 15 min) vs avg $160.17 (+8.3σ). $13,471,882 across 8,286 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.

ALLIED ADULT DAY CARE, LLCOWENSBOROProvider total: $14.0M

criticalCost OutlierScore: 8.2

Cost-per-claim above average for 83735

APPALACHIAN REGIONAL HEALTHCARE, INC. (1306842521) bills $67.02/claim for 83735 (Assay of magnesium) vs avg $6.36 (+8.2σ). $598,364 across 8,928 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.

APPALACHIAN REGIONAL HEALTHCARE, INC.HARLANProvider total: $55.2M

criticalCost OutlierScore: 8.1

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

BOBBI LAKIN (1770961492) bills $115.11/claim for 99213 (Office o/p est low 20 min) vs avg $29.74 (+8.1σ). $25,899 across 225 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.

BOBBI LAKINEDGEWOODProvider total: $25.9K

criticalCost OutlierScore: 7.9

Cost-per-claim above average for 96372

WAYNE COUNTY HOSPITAL, INC (1871548016) bills $85.88/claim for 96372 (Ther/proph/diag inj sc/im) vs avg $14.42 (+7.9σ). $548,579 across 6,388 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.

WAYNE COUNTY HOSPITAL, INCMONTICELLOProvider total: $17.7M

criticalCost OutlierScore: 7.9

Cost-per-claim above average for 84703

BRECKINRIDGE HEALTH, INC (1104828383) bills $84.74/claim for 84703 (Chorionic gonadotropin assay) vs avg $9.18 (+7.9σ). $18,644 across 220 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.

BRECKINRIDGE HEALTH, INCHARDINSBURGProvider total: $11.2M

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Statistical Outliers

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