Statistical Outliers

Single-test outliers in Louisiana 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

220

warning

580

info

7,253

Total

8,053

Outliers by Type

Severity Distribution

critical

220 (2.7%)

warning

580 (7.2%)

info

7,253 (90.1%)

5,963 results

criticalCost OutlierScore: 18.7

Cost-per-claim above average for 92551

OUR LADY OF THE ANGELS HOSPITAL, INC. (1093140600) bills $111.43/claim for 92551 (Pure tone hearing test air) vs avg $4.52 (+18.7σ). $56,605 across 508 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 THE ANGELS HOSPITAL, INC.BOGALUSAProvider total: $16.1M

criticalCost OutlierScore: 15.8

Cost-per-claim above average for G8427

LORI GAUTREAUX (1942576855) bills $17.67/claim for G8427 (Docrev cur meds by elig clin) vs avg $0.07 (+15.8σ). $11,451 across 648 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.

LORI GAUTREAUXLAFAYETTEProvider total: $26.0K

criticalCost OutlierScore: 15.6

Cost-per-claim above average for T1019

AA ANGEL CARE INC (1013269570) bills $435.30/claim for T1019 (Personal care ser per 15 min) vs avg $66.14 (+15.6σ). $206,767 across 475 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.

AA ANGEL CARE INCLAFAYETTEProvider total: $206.8K

criticalCost OutlierScore: 14.7

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

1326447939 (1326447939) bills $112.22/claim for 80053 (Comprehen metabolic panel) vs avg $5.07 (+14.7σ). $83,830 across 747 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: $1.3M

criticalCost OutlierScore: 13.2

Cost-per-claim above average for S5125

THE ARC OF SABINE INC (1457481376) bills $1,758.07/claim for S5125 (Attendant care service /15m) vs avg $143.86 (+13.1σ). $7,114,902 across 4,047 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 ARC OF SABINE INCMANYProvider total: $7.1M

criticalCost OutlierScore: 13.1

Cost-per-claim above average for 85025 (Complete Blood Count (CBC) with Differential)

1326447939 (1326447939) bills $48.50/claim for 85025 (Complete cbc w/auto diff wbc) vs avg $3.28 (+13.1σ). $50,436 across 1,040 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: $1.3M

criticalCost OutlierScore: 12.0

Cost-per-claim above average for 87635

1326447939 (1326447939) bills $265.79/claim for 87635 (Sars-cov-2 covid-19 amp prb) vs avg $23.50 (+12.0σ). $121,999 across 459 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: $1.3M

criticalCost OutlierScore: 10.8

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

CONVENIENT CARE LLC (1164422630) bills $89.11/claim for 99211 (Off/op est may x req phy/qhp) vs avg $10.27 (+10.8σ). $31,366 across 352 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.

CONVENIENT CARE LLCBATON ROUGEProvider total: $47.8M

criticalCost OutlierScore: 10.3

Cost-per-claim above average for 20610 (Joint Aspiration or Injection (Major Joint))

PARISH HOSPITAL SERVICE DISTRICT FOR THE PARISH OF ORLEANS - DIST A (1225450588) bills $1,318.26/claim for 20610 (Drain/inj joint/bursa w/o us) vs avg $45.31 (+10.3σ). $39,548 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.

PARISH HOSPITAL SERVICE DISTRICT FOR THE PARISH OF ORLEANS - DIST ANEW ORLEANSProvider total: $49.8M

criticalCost OutlierScore: 9.9

Cost-per-claim above average for J1885

CLHG-OAKDALE, LLC (1104873710) bills $50.82/claim for J1885 (Ketorolac tromethamine inj) vs avg $2.01 (+9.9σ). $61,137 across 1,203 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.

CLHG-OAKDALE, LLCOAKDALEProvider total: $2.5M

criticalCost OutlierScore: 9.7

Cost-per-claim above average for 96127 (Brief Emotional/Behavioral Assessment)

WK TOTS TO TEENS PEDIATRIC CENTER (1063769255) bills $18.61/claim for 96127 (Brief emotional/behav assmt) vs avg $0.75 (+9.7σ). $54,542 across 2,931 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.

WK TOTS TO TEENS PEDIATRIC CENTERSHREVEPORTProvider total: $4.7M

criticalCost OutlierScore: 9.7

Cost-per-claim above average for 99490

HOMEDICA OF LOUISIANA, LLC (1174866479) bills $123.23/claim for 99490 (Chrnc care mgmt staff 1st 20) vs avg $3.68 (+9.7σ). $2,185,897 across 17,739 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.

HOMEDICA OF LOUISIANA, LLCBATON ROUGEProvider total: $4.7M

criticalCost OutlierScore: 9.4

Cost-per-claim above average for 90734

UNIVERSITY HOSPITAL & CLINICS, INC. (1306281126) bills $107.98/claim for 90734 (Menacwyd/menacwycrm vacc im) vs avg $1.38 (+9.4σ). $14,793 across 137 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 HOSPITAL & CLINICS, INC.LAFAYETTEProvider total: $60.9M

criticalCost OutlierScore: 9.1

Cost-per-claim above average for 96372

BIENVILLE MEDICAL CENTER INC (1285835561) bills $100.54/claim for 96372 (Ther/proph/diag inj sc/im) vs avg $5.11 (+9.1σ). $160,762 across 1,599 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.

BIENVILLE MEDICAL CENTER INCARCADIAProvider total: $1.7M

criticalCost OutlierScore: 8.8

Cost-per-claim above average for K1034

MEDCOMP GX, LLC (1508268731) bills $2.86/claim for K1034 (Provision of covid-19 test, nonprescription self-administered and) vs avg $0.05 (+8.8σ). $13,221 across 4,622 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.

MEDCOMP GX, LLCGRETNAProvider total: $13.7K

criticalCost OutlierScore: 8.7

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

RAFAEL JUSTINIANO MAGRANER (1871925297) bills $127.50/claim for 99232 (Sbsq hosp ip/obs moderate 35) vs avg $22.13 (+8.7σ). $58,266 across 457 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.

RAFAEL JUSTINIANO MAGRANERSHREVEPORTProvider total: $90.0K

criticalCost OutlierScore: 8.7

Cost-per-claim above average for T2003

ESSENTIAL TRANSPORTATION LLC (1235813940) bills $283.09/claim for T2003 (N-et; encounter/trip) vs avg $36.19 (+8.7σ). $73,321 across 259 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.

ESSENTIAL TRANSPORTATION LLCBATON ROUGEProvider total: $73.3K

criticalCost OutlierScore: 8.6

Cost-per-claim above average for S5125

EVERGREEN PRESBYTERIAN MINISTRIES, INC. (1336288802) bills $1,193.27/claim for S5125 (Attendant care service /15m) vs avg $143.86 (+8.5σ). $8,265,761 across 6,927 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.

EVERGREEN PRESBYTERIAN MINISTRIES, INC.BOSSIER CITYProvider total: $8.3M

criticalCost OutlierScore: 8.3

Cost-per-claim above average for 96361

CHRISTUS HEALTH CENTRAL LOUISIANA (1205824208) bills $898.73/claim for 96361 (Hydrate iv infusion add-on) vs avg $41.88 (+8.3σ). $26,962 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.

CHRISTUS HEALTH CENTRAL LOUISIANACOUSHATTAProvider total: $4.9M

criticalCost OutlierScore: 8.0

Cost-per-claim above average for T2023

BRUCE PROFESSIONAL COUNSELING SERVICES, LLC (1477956126) bills $900.00/claim for T2023 (Targeted case mgmt per month) vs avg $168.95 (+8.0σ). $14,400 across 16 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.

BRUCE PROFESSIONAL COUNSELING SERVICES, LLCHARAHANProvider total: $13.4M

criticalCost OutlierScore: 7.9

Cost-per-claim above average for D1351 (Dental Sealant (per Tooth))

JOSHUA KALUZNY (1225652449) bills $108.62/claim for D1351 (Sealant per tooth) vs avg $28.14 (+7.9σ). $25,092 across 231 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.

JOSHUA KALUZNYALEXANDRIAProvider total: $128.0K

criticalCost OutlierScore: 7.9

Cost-per-claim above average for S5125

EVERGREEN PRESBYTERIAN MINISTRIES, INC. (1326192634) bills $1,111.65/claim for S5125 (Attendant care service /15m) vs avg $143.86 (+7.9σ). $10,418,374 across 9,372 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.

EVERGREEN PRESBYTERIAN MINISTRIES, INC.PINEVILLEProvider total: $10.4M

criticalCost OutlierScore: 7.8

Cost-per-claim above average for J0696

RIVERSIDE MEDICAL CENTER (1700874062) bills $104.12/claim for J0696 (Ceftriaxone sodium injection) vs avg $4.92 (+7.8σ). $42,794 across 411 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.

RIVERSIDE MEDICAL CENTERFRANKLINTONProvider total: $9.3M

criticalCost OutlierScore: 7.8

Cost-per-claim above average for T2002

THE ARC OF SABINE INC (1518097435) bills $312.21/claim for T2002 (N-et; per diem) vs avg $27.45 (+7.8σ). $24,040 across 77 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 ARC OF SABINE INCMANYProvider total: $24.0K

criticalCost OutlierScore: 7.8

Cost-per-claim above average for T2003

SECURE PATIENT DELIVERY LLC (1538515036) bills $256.10/claim for T2003 (N-et; encounter/trip) vs avg $36.19 (+7.8σ). $2,342,321 across 9,146 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.

SECURE PATIENT DELIVERY LLCMETAIRIEProvider total: $2.4M

criticalCost OutlierScore: 7.8

Cost-per-claim above average for A4253 (Blood Glucose Test Strips (per 50))

LOUISIANA EXPRESS PHARMACY (1326122987) bills $97.54/claim for A4253 (Blood glucose/reagent strips) vs avg $5.85 (+7.8σ). $67,594 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.

LOUISIANA EXPRESS PHARMACYBATON ROUGEProvider total: $67.6K

criticalCost OutlierScore: 7.3

Cost-per-claim above average for 99499

UPWARD HEALTH OF LOUISIANA LLC (1871144725) bills $289.06/claim for 99499 (Unlisted e&m service) vs avg $14.40 (+7.3σ). $4,860,624 across 16,815 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.

UPWARD HEALTH OF LOUISIANA LLCNEW ORLEANSProvider total: $6.8M

criticalCost OutlierScore: 7.3

Cost-per-claim above average for J0702

ST MARTIN HOSPITAL, INC. (1437482817) bills $47.25/claim for J0702 (Betamethasone acet&sod phosp) vs avg $2.42 (+7.3σ). $10,111 across 214 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.

ST MARTIN HOSPITAL, INC.BREAUX BRIDGEProvider total: $12.8M

criticalCost OutlierScore: 7.2

Cost-per-claim above average for 90785

DARRYL BRUNO (1710072178) bills $10.21/claim for 90785 (Psytx complex interactive) vs avg $1.59 (+7.2σ). $19,798 across 1,940 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.

DARRYL BRUNOMANDEVILLEProvider total: $262.0K

criticalCost OutlierScore: 7.2

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

SOUTHLAKE PEDIATRICS, INC. (1144315250) bills $61.69/claim for 90461 (Im admin each addl component) vs avg $1.44 (+7.2σ). $39,546 across 641 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.

SOUTHLAKE PEDIATRICS, INC.BIRMINGHAMProvider total: $1.0M

criticalCost OutlierScore: 7.2

Cost-per-claim above average for 96372

THE HOSPITAL SERVICE DISTRICT OF WEST FELICIANA PARISH LOUISIANA (1164497533) bills $80.94/claim for 96372 (Ther/proph/diag inj sc/im) vs avg $5.11 (+7.2σ). $236,664 across 2,924 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 HOSPITAL SERVICE DISTRICT OF WEST FELICIANA PARISH LOUISIANASAINT FRANCISVILLEProvider total: $10.0M

criticalCost OutlierScore: 7.1

Cost-per-claim above average for H2017 (Psychosocial Rehabilitation (per 15 min))

VOLUNTEERS OF AMERICA OF NORTH LOUISIANA (1417252230) bills $221.35/claim for H2017 (Psysoc rehab svc, per 15 min) vs avg $57.78 (+7.1σ). $7,250,982 across 32,758 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.

VOLUNTEERS OF AMERICA OF NORTH LOUISIANASHREVEPORTProvider total: $12.5M

criticalCost OutlierScore: 7.1

Cost-per-claim above average for 17110 (Destruction of Warts (up to 14))

BATON ROUGE GENERAL MEDICAL CENTER (1962537407) bills $807.16/claim for 17110 (Destruct b9 lesion 1-14) vs avg $68.61 (+7.1σ). $10,493 across 13 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.

BATON ROUGE GENERAL MEDICAL CENTERBATON ROUGEProvider total: $24.3M

criticalCost OutlierScore: 7.0

Cost-per-claim above average for 99307 (Subsequent Nursing Facility Care (Straightforward))

STERLINGTON CRITICAL ACCESS HOSPITAL, L.L.C. (1811171085) bills $39.75/claim for 99307 (Sbsq nf care sf mdm 10) vs avg $3.80 (+7.0σ). $145,706 across 3,666 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.

STERLINGTON CRITICAL ACCESS HOSPITAL, L.L.C.MER ROUGEProvider total: $1.2M

criticalCost OutlierScore: 6.7

Cost-per-claim above average for S5125

ASSOCIATION FOR RETARDED CITIZENS (1588687412) bills $965.63/claim for S5125 (Attendant care service /15m) vs avg $143.86 (+6.7σ). $24,254,717 across 25,118 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.

ASSOCIATION FOR RETARDED CITIZENSNEW ORLEANSProvider total: $24.3M

criticalCost OutlierScore: 6.7

Cost-per-claim above average for 87186

MEDCOMP SCIENCES LLC (1982940862) bills $43.44/claim for 87186 (Microbe susceptible mic) vs avg $5.87 (+6.7σ). $14,118 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.

MEDCOMP SCIENCES LLCZACHARYProvider total: $12.9M

criticalCost OutlierScore: 6.6

Cost-per-claim above average for J0887

RENEX DIALYSIS FACILITIES, INC. (1124130828) bills $62.87/claim for J0887 (Epoetin beta esrd use) vs avg $1.42 (+6.6σ). $104,615 across 1,664 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.

RENEX DIALYSIS FACILITIES, INC.DELTAProvider total: $867.4K

criticalCost OutlierScore: 6.6

Cost-per-claim above average for 90620

JEFFERSON PEDIATRIC CLINIC (1972642197) bills $29.95/claim for 90620 (Menb-4c vacc 2 dose im) vs avg $1.56 (+6.6σ). $11,769 across 393 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.

JEFFERSON PEDIATRIC CLINICMARREROProvider total: $4.4M

criticalCost OutlierScore: 6.5

Cost-per-claim above average for 96127 (Brief Emotional/Behavioral Assessment)

LESLIE BOSTICK (1477575009) bills $12.72/claim for 96127 (Brief emotional/behav assmt) vs avg $0.75 (+6.5σ). $12,772 across 1,004 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.

LESLIE BOSTICKBATON ROUGEProvider total: $387.2K

criticalCost OutlierScore: 6.5

Cost-per-claim above average for 90460 (Immunization Administration (First Component))

SOUTHLAKE PEDIATRICS, INC. (1144315250) bills $58.37/claim for 90460 (Im admin 1st/only component) vs avg $2.19 (+6.5σ). $93,333 across 1,599 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.

SOUTHLAKE PEDIATRICS, INC.BIRMINGHAMProvider total: $1.0M

criticalCost OutlierScore: 6.5

Cost-per-claim above average for V2020

KYLE ANDRUS (1316982028) bills $47.55/claim for V2020 (Vision svcs frames purchases) vs avg $16.25 (+6.5σ). $20,685 across 435 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.

KYLE ANDRUSSHREVEPORTProvider total: $51.9K

criticalCost OutlierScore: 6.4

Cost-per-claim above average for 87798

DELUXE MEDICAL CORPORATION (1255899936) bills $277.27/claim for 87798 (Detect agent nos dna amp) vs avg $34.43 (+6.4σ). $245,384 across 885 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.

DELUXE MEDICAL CORPORATIONGRETNAProvider total: $375.4K

criticalCost OutlierScore: 6.1

Cost-per-claim above average for 94010

THE REGIONAL HEALTH SYSTEM OF ACADIANA, LLC (1336173590) bills $206.19/claim for 94010 (Breathing capacity test) vs avg $20.36 (+6.1σ). $71,343 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.

THE REGIONAL HEALTH SYSTEM OF ACADIANA, LLCLAFAYETTEProvider total: $2.9M

criticalCost OutlierScore: 6.0

Cost-per-claim above average for T2003

FLEUR D' FEAUX TRANSPORT LLC (1649801234) bills $207.27/claim for T2003 (N-et; encounter/trip) vs avg $36.19 (+6.0σ). $25,079 across 121 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.

FLEUR D' FEAUX TRANSPORT LLCNEW ORLEANSProvider total: $25.1K

criticalCost OutlierScore: 6.0

Cost-per-claim above average for T2003

LAVELL'S MEDICAL TRANSPORTATION, LLC (1376387621) bills $206.19/claim for T2003 (N-et; encounter/trip) vs avg $36.19 (+6.0σ). $30,310 across 147 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.

LAVELL'S MEDICAL TRANSPORTATION, LLCWINNSBOROProvider total: $30.3K

criticalCost OutlierScore: 6.0

Cost-per-claim above average for 96372

HOMER MEMORIAL HOSPITAL (1831183748) bills $67.90/claim for 96372 (Ther/proph/diag inj sc/im) vs avg $5.11 (+6.0σ). $507,158 across 7,469 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.

HOMER MEMORIAL HOSPITALHOMERProvider total: $5.8M

criticalCost OutlierScore: 6.0

Cost-per-claim above average for D1351 (Dental Sealant (per Tooth))

JASON ABRAHAM (1730792359) bills $88.55/claim for D1351 (Sealant per tooth) vs avg $28.14 (+5.9σ). $113,079 across 1,277 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.

JASON ABRAHAMLAFAYETTEProvider total: $696.3K

criticalCost OutlierScore: 5.9

Cost-per-claim above average for Q5001

HEART OF HOSPICE LLC (1629451604) bills $1,637.02/claim for Q5001 (Hospice or home hlth in home) vs avg $52.49 (+5.9σ). $27,829 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.

HEART OF HOSPICE LLCTERRYTOWNProvider total: $181.9K

criticalCost OutlierScore: 5.9

Cost-per-claim above average for T2021

CALCASIEU ASSOC FOR RETARDED CITIZENS, INC. (1407908478) bills $390.85/claim for T2021 (Day habil waiver per 15 min) vs avg $62.52 (+5.9σ). $738,322 across 1,889 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.

CALCASIEU ASSOC FOR RETARDED CITIZENS, INC.LAKE CHARLESProvider total: $891.0K

criticalCost OutlierScore: 5.9

Cost-per-claim above average for 97161 (Physical Therapy Evaluation (Low Complexity))

ANNESKA WHITENACK (1710653118) bills $198.54/claim for 97161 (Pt eval low complex 20 min) vs avg $49.70 (+5.9σ). $18,464 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.

ANNESKA WHITENACKBOSSIER CITYProvider total: $35.7K

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