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 Massachusetts 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

604

warning

909

info

7,598

Total

9,111

Outliers by Type
Severity Distribution
critical
604 (6.6%)
warning
909 (10.0%)
info
7,598 (83.4%)
6,037 results
criticalCost OutlierScore: 23.0

Cost-per-claim above average for 93010

PATRIOT AMBULANCE, INC. (1245231117) bills $129.75/claim for 93010 (Electrocardiogram report) vs avg $5.97 (+23.0Οƒ). $48,527 across 374 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.

PATRIOT AMBULANCE, INC.CHELMSFORDProvider total: $5.9M
criticalCost OutlierScore: 19.5

Cost-per-claim above average for 85018

ERIC KERNS (1013189174) bills $332.05/claim for 85018 (Hemoglobin) vs avg $2.65 (+19.5Οƒ). $65,083 across 196 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.

ERIC KERNSBURLINGTONProvider total: $1.7M
criticalCost OutlierScore: 16.1

Cost-per-claim above average for 92015

HUGH COOPER (1942296561) bills $86.37/claim for 92015 (Determine refractive state) vs avg $12.73 (+16.1Οƒ). $147,180 across 1,704 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.

HUGH COOPERSOUTHBRIDGEProvider total: $204.0K
criticalCost OutlierScore: 15.0

Cost-per-claim above average for S5102

EAGLE ADULT DAY CARE, LLC . (1457127185) bills $2,684.58/claim for S5102 (Adult day care per diem) vs avg $133.78 (+15.0Οƒ). $118,122 across 44 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.

EAGLE ADULT DAY CARE, LLC .WORCESTERProvider total: $164.5K
criticalCost OutlierScore: 14.1

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

ROBERT HELM (1235275991) bills $434.29/claim for 99213 (Office o/p est low 20 min) vs avg $49.41 (+14.1Οƒ). $16,069 across 37 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.

ROBERT HELMBOSTONProvider total: $40.4K
criticalCost OutlierScore: 13.6

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

SOUTHCOAST HOSPITALS GROUP (1245597418) bills $367.15/claim for 97110 (Therapeutic exercises) vs avg $18.97 (+13.6Οƒ). $306,938 across 836 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.

SOUTHCOAST HOSPITALS GROUPNEW BEDFORDProvider total: $3.0M
criticalCost OutlierScore: 13.4

Cost-per-claim above average for 83540

ERIC KERNS (1013189174) bills $155.17/claim for 83540 (Assay of iron) vs avg $3.23 (+13.4Οƒ). $80,686 across 520 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.

ERIC KERNSBURLINGTONProvider total: $1.7M
criticalCost OutlierScore: 13.4

Cost-per-claim above average for 87635

1326447939 (1326447939) bills $368.95/claim for 87635 (Sars-cov-2 covid-19 amp prb) vs avg $49.08 (+13.4Οƒ). $22,506 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.

GUAM HEALTHCARE DEVELOPMENT INCORPORATEDDEDEDOProvider total: $1.5M
criticalCost OutlierScore: 13.3

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

FAIRVIEW HOSPITAL (1124686530) bills $120.88/claim for 96127 (Brief emotional/behav assmt) vs avg $9.85 (+13.3Οƒ). $95,857 across 793 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.

FAIRVIEW HOSPITALWILLIAMSTOWNProvider total: $2.8M
criticalCost OutlierScore: 13.0

Cost-per-claim above average for 96110

CAMBRIDGE PUBLIC HEALTH COMMISSION (1306908405) bills $259.00/claim for 96110 (Developmental screen w/score) vs avg $12.54 (+13.0Οƒ). $331,002 across 1,278 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.

CAMBRIDGE PUBLIC HEALTH COMMISSIONCAMBRIDGEProvider total: $19.7M
criticalCost OutlierScore: 13.0

Cost-per-claim above average for 85027 (Complete Blood Count (CBC) without Differential)

ERIC KERNS (1013189174) bills $177.99/claim for 85027 (Complete cbc automated) vs avg $6.32 (+13.0Οƒ). $67,993 across 382 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.

ERIC KERNSBURLINGTONProvider total: $1.7M
criticalCost OutlierScore: 13.0

Cost-per-claim above average for 80307 (Drug Testing, Presumptive (Chemistry Analyzers))

TANYA WHITE (1003278235) bills $243.37/claim for 80307 (Drug test prsmv chem anlyzr) vs avg $41.57 (+13.0Οƒ). $24,093 across 99 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.

TANYA WHITETAUNTONProvider total: $24.1K
criticalCost OutlierScore: 12.6

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

FAIRVIEW HOSPITAL (1639737042) bills $115.36/claim for 96127 (Brief emotional/behav assmt) vs avg $9.85 (+12.6Οƒ). $99,444 across 862 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.

FAIRVIEW HOSPITALNORTH ADAMSProvider total: $3.5M
criticalCost OutlierScore: 12.3

Cost-per-claim above average for 90834 (Psychotherapy (45 min))

MEGAN KIRBY (1548343742) bills $423.35/claim for 90834 (Psytx w pt 45 minutes) vs avg $77.96 (+12.3Οƒ). $218,873 across 517 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.

MEGAN KIRBYWORCESTERProvider total: $218.9K
criticalCost OutlierScore: 11.7

Cost-per-claim above average for 97530 (Therapeutic Activities (per 15 min))

SOUTHCOAST HOSPITALS GROUP (1245597418) bills $311.67/claim for 97530 (Therapeutic activities) vs avg $21.71 (+11.7Οƒ). $237,177 across 761 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.

SOUTHCOAST HOSPITALS GROUPNEW BEDFORDProvider total: $3.0M
criticalCost OutlierScore: 11.7

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

TIMOTHY BOARDMAN (1245687755) bills $261.78/claim for 85025 (Complete cbc w/auto diff wbc) vs avg $8.11 (+11.7Οƒ). $10,733 across 41 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.

TIMOTHY BOARDMANWORCESTERProvider total: $97.2K
criticalCost OutlierScore: 11.5

Cost-per-claim above average for 96110

MARTHA'S VINEYARD HOSPITAL, INC. (1134206386) bills $229.66/claim for 96110 (Developmental screen w/score) vs avg $12.54 (+11.5Οƒ). $746,640 across 3,251 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.

MARTHA'S VINEYARD HOSPITAL, INC.OAK BLUFFSProvider total: $50.4M
criticalCost OutlierScore: 11.2

Cost-per-claim above average for 99285 (Emergency Dept Visit (High Complexity))

CHRISTIAN ARBELAEZ (1124084017) bills $865.08/claim for 99285 (Emergency dept visit hi mdm) vs avg $133.25 (+11.2Οƒ). $45,849 across 53 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.

CHRISTIAN ARBELAEZBOSTONProvider total: $82.2K
criticalCost OutlierScore: 10.9

Cost-per-claim above average for 91307

SOUTHCOAST HOSPITALS GROUP, INC (1447275037) bills $403.78/claim for 91307 (Code 91307) vs avg $3.67 (+10.9Οƒ). $13,729 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.

SOUTHCOAST HOSPITALS GROUP, INCNEW BEDFORDProvider total: $172.8M
criticalCost OutlierScore: 10.9

Cost-per-claim above average for D8680

SIRENA HSIEH (1831353713) bills $693.14/claim for D8680 (Orthodontic retention) vs avg $93.51 (+10.9Οƒ). $11,090 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.

SIRENA HSIEHBROOKLINEProvider total: $215.2K
criticalCost OutlierScore: 10.8

Cost-per-claim above average for H2014

AMEGO INC. (1902060809) bills $1,666.24/claim for H2014 (Skills train and dev, 15 min) vs avg $135.49 (+10.8Οƒ). $8,069,613 across 4,843 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.

AMEGO INC.ATTLEBOROProvider total: $33.9M
criticalCost OutlierScore: 10.7

Cost-per-claim above average for 90837 (Psychotherapy (60 min))

CHILDREN'S HOSPITAL CORPORATION (1710087127) bills $502.29/claim for 90837 (Psytx w pt 60 minutes) vs avg $100.83 (+10.7Οƒ). $566,080 across 1,127 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.

CHILDREN'S HOSPITAL CORPORATIONBOSTONProvider total: $330.8M
criticalCost OutlierScore: 10.5

Cost-per-claim above average for G2023

MARY JOE (1063402659) bills $118.60/claim for G2023 (Specimen collection for severe acute respiratory syndrome coronavirus 2) vs avg $23.70 (+10.5Οƒ). $15,300 across 129 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.

MARY JOELAWRENCEProvider total: $501.8K
criticalCost OutlierScore: 10.4

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

RICHMOND PSYCHIATRY GROUP PRACTICE (1629148036) bills $278.64/claim for 99232 (Sbsq hosp ip/obs moderate 35) vs avg $31.63 (+10.4Οƒ). $124,554 across 447 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.

RICHMOND PSYCHIATRY GROUP PRACTICEBOSTONProvider total: $692.1K
criticalCost OutlierScore: 10.4

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

FAIRVIEW HOSPITAL (1881252286) bills $384.14/claim for 99203 (Office o/p new low 30 min) vs avg $73.38 (+10.4Οƒ). $44,561 across 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.

FAIRVIEW HOSPITALGREAT BARRINGTONProvider total: $2.0M
criticalCost OutlierScore: 10.3

Cost-per-claim above average for 97153

AUTISM THERAPY & TRAINING SERVICES (1194389304) bills $1,729.08/claim for 97153 (Adaptive behavior tx by tech) vs avg $216.46 (+10.4Οƒ). $69,163 across 40 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.

AUTISM THERAPY & TRAINING SERVICESWORCESTERProvider total: $82.6K
criticalCost OutlierScore: 10.2

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

FAIRVIEW HOSPITAL (1881252286) bills $95.50/claim for 96127 (Brief emotional/behav assmt) vs avg $9.85 (+10.2Οƒ). $107,436 across 1,125 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.

FAIRVIEW HOSPITALGREAT BARRINGTONProvider total: $2.0M
criticalCost OutlierScore: 10.1

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

JOANNE WILKINSON (1174597330) bills $73.37/claim for 83036 (Hemoglobin glycosylated a1c) vs avg $6.85 (+10.1Οƒ). $19,662 across 268 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.

JOANNE WILKINSONBOSTONProvider total: $1.1M
criticalCost OutlierScore: 10.1

Cost-per-claim above average for 99233 (Subsequent Hospital Care (High Complexity))

RICHMOND PSYCHIATRY GROUP PRACTICE (1629148036) bills $479.78/claim for 99233 (Sbsq hosp ip/obs high 50) vs avg $42.60 (+10.1Οƒ). $380,949 across 794 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.

RICHMOND PSYCHIATRY GROUP PRACTICEBOSTONProvider total: $692.1K
criticalCost OutlierScore: 9.9

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

DANA FARBER CANCER INSTITUTE (1215097910) bills $289.37/claim for 80053 (Comprehen metabolic panel) vs avg $8.87 (+9.9Οƒ). $252,037 across 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.

DANA FARBER CANCER INSTITUTEBOSTONProvider total: $1.8M
criticalCost OutlierScore: 9.8

Cost-per-claim above average for 90847 (Family Psychotherapy with Patient (50 min))

CHILDREN'S HOSPITAL PEDIATRIC ASSOCIATES, INC (1457306664) bills $466.32/claim for 90847 (Family psytx w/pt 50 min) vs avg $90.37 (+9.8Οƒ). $71,346 across 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.

CHILDREN'S HOSPITAL PEDIATRIC ASSOCIATES, INCBOSTONProvider total: $19.1M
criticalCost OutlierScore: 9.8

Cost-per-claim above average for T1015 (Clinic Service)

MASHPEE SERVICE UNIT/INDIAN HEALTH SERVICE (1992001457) bills $539.39/claim for T1015 (Clinic service) vs avg $157.11 (+9.7Οƒ). $3,986,626 across 7,391 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.

MASHPEE SERVICE UNIT/INDIAN HEALTH SERVICEMASHPEEProvider total: $4.0M
criticalCost OutlierScore: 9.4

Cost-per-claim above average for 90686 (Influenza Vaccine (Quadrivalent))

ATHOL MEMORIAL HOSPITAL INCORPORATED (1336120047) bills $99.41/claim for 90686 (Iiv4 vacc no prsv 0.5 ml im) vs avg $6.85 (+9.4Οƒ). $32,407 across 326 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.

ATHOL MEMORIAL HOSPITAL INCORPORATEDATHOLProvider total: $30.8M
criticalCost OutlierScore: 9.4

Cost-per-claim above average for T2003

EAGLE ADULT DAY CARE, LLC . (1457127185) bills $799.68/claim for T2003 (N-et; encounter/trip) vs avg $45.65 (+9.4Οƒ). $46,381 across 58 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.

EAGLE ADULT DAY CARE, LLC .WORCESTERProvider total: $164.5K
criticalCost OutlierScore: 9.4

Cost-per-claim above average for 99212 (Office Visit, Established Patient (10 min, Straightforward))

FAIRVIEW HOSPITAL (1881252286) bills $435.66/claim for 99212 (Office o/p est sf 10 min) vs avg $37.42 (+9.4Οƒ). $71,449 across 164 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.

FAIRVIEW HOSPITALGREAT BARRINGTONProvider total: $2.0M
criticalCost OutlierScore: 9.4

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

1326447939 (1326447939) bills $724.80/claim for 99283 (Emergency dept visit low mdm) vs avg $76.53 (+9.4Οƒ). $360,949 across 498 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: $1.5M
criticalCost OutlierScore: 9.3

Cost-per-claim above average for 99443 (Telephone E&M (21-30 min))

DANA FARBER CANCER INSTITUTE (1215097910) bills $277.53/claim for 99443 (Code 99443) vs avg $20.28 (+9.3Οƒ). $17,484 across 63 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.

DANA FARBER CANCER INSTITUTEBOSTONProvider total: $1.8M
criticalCost OutlierScore: 9.3

Cost-per-claim above average for 90834 (Psychotherapy (45 min))

CHILDREN'S HOSPITAL PEDIATRIC ASSOCIATES, INC (1457306664) bills $339.98/claim for 90834 (Psytx w pt 45 minutes) vs avg $77.96 (+9.3Οƒ). $47,597 across 140 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.

CHILDREN'S HOSPITAL PEDIATRIC ASSOCIATES, INCBOSTONProvider total: $19.1M
criticalOverutilizationScore: 9.2

Unusually high claims-per-beneficiary ratio

OLD COLONY ADULT DAY HEALTH CARE, INC. (1649307984): 38.7 claims/beneficiary (avg 2.5). 15,102 claims, 390 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.

OLD COLONY ADULT DAY HEALTH CARE, INC.STOUGHTONProvider total: $452.4K
criticalOverutilizationScore: 9.2

Unusually high claims-per-beneficiary ratio

SAFETYNET SOLUTIONS (1457685620): 38.7 claims/beneficiary (avg 2.5). 195,853 claims, 5,065 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.

SAFETYNET SOLUTIONSANDOVERProvider total: $7.9M
criticalCost OutlierScore: 9.2

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

DANA-FARBER CANCER INSTITUTE, INC. (1346433257) bills $269.50/claim for 80053 (Comprehen metabolic panel) vs avg $8.87 (+9.2Οƒ). $709,598 across 2,633 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.

DANA-FARBER CANCER INSTITUTE, INC.BOSTONProvider total: $4.8M
criticalCost OutlierScore: 9.2

Cost-per-claim above average for 74177 (CT Abdomen and Pelvis with Contrast)

DANA-FARBER CANCER INSTITUTE, INC. (1346433257) bills $1,780.52/claim for 74177 (Ct abd & pelvis w/contrast) vs avg $113.97 (+9.2Οƒ). $217,223 across 122 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.

DANA-FARBER CANCER INSTITUTE, INC.BOSTONProvider total: $4.8M
criticalCost OutlierScore: 9.0

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

KENNETH FRAUSTO (1831403054) bills $524.49/claim for 99284 (Emergency dept visit mod mdm) vs avg $99.27 (+9.0Οƒ). $29,896 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.

KENNETH FRAUSTOBROCKTONProvider total: $46.3K
criticalCost OutlierScore: 9.0

Cost-per-claim above average for 93971

NASHOBA VALLEY MEDICAL CENTER, A STEWARD FAMILY HOSPITAL, INC (1477859254) bills $1,171.92/claim for 93971 (Extremity study) vs avg $84.58 (+9.0Οƒ). $16,407 across 14 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.

NASHOBA VALLEY MEDICAL CENTER, A STEWARD FAMILY HOSPITAL, INCAYERProvider total: $10.9M
criticalCost OutlierScore: 9.0

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

PREETINDER SANDHU (1457500753) bills $102.60/claim for D1351 (Sealant per tooth) vs avg $37.47 (+9.0Οƒ). $10,260 across 100 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.

PREETINDER SANDHUBOSTONProvider total: $184.8K
criticalCost OutlierScore: 9.0

Cost-per-claim above average for 93306

FAIRVIEW HOSPITAL (1730112251) bills $691.09/claim for 93306 (Tte w/doppler complete) vs avg $76.96 (+9.0Οƒ). $17,968 across 26 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.

FAIRVIEW HOSPITALGREAT BARRINGTONProvider total: $17.7M
criticalCost OutlierScore: 9.0

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

LIUDVIKAS JAGMINAS (1659354488) bills $521.93/claim for 99284 (Emergency dept visit mod mdm) vs avg $99.27 (+9.0Οƒ). $17,224 across 33 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.

LIUDVIKAS JAGMINASATTLEBOROProvider total: $17.2K
criticalCost OutlierScore: 8.9

Cost-per-claim above average for 99231 (Subsequent Hospital Care (Low Complexity))

RICHMOND PSYCHIATRY GROUP PRACTICE (1629148036) bills $155.24/claim for 99231 (Sbsq hosp ip/obs sf/low 25) vs avg $18.02 (+8.9Οƒ). $68,927 across 444 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.

RICHMOND PSYCHIATRY GROUP PRACTICEBOSTONProvider total: $692.1K
criticalCost OutlierScore: 8.7

Cost-per-claim above average for S5101

A JOYFUL ADULT HEALTH CARE CENTER LLC (1285094656) bills $388.00/claim for S5101 (Adult day care per half day) vs avg $63.54 (+8.7Οƒ). $812,074 across 2,093 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 JOYFUL ADULT HEALTH CARE CENTER LLCWOBURNProvider total: $19.2M
criticalCost OutlierScore: 8.5

Cost-per-claim above average for 96110

HENRY HEYWOOD MEMORIAL HOSPITAL (1205823879) bills $173.01/claim for 96110 (Developmental screen w/score) vs avg $12.54 (+8.5Οƒ). $1,722,862 across 9,958 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.

HENRY HEYWOOD MEMORIAL HOSPITALGARDNERProvider total: $54.5M
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