Single-test outliers in Maryland 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
348
warning
462
info
5,654
Total
6,464
KLEIN AND ASSOCIATES MD PA (1962434449) bills $518.46/claim for 36415 (Coll venous bld venipuncture) vs avg $5.08 (+19.4Ο). $20,220 across 39 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 ENDRES (1861968430) bills $78.33/claim for D0220 (Intraoral - periapical first image) vs avg $8.88 (+16.9Ο). $13,316 across 170 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.
ARTHRITIS AND RHEUMATISM ASSOCIATES PC (1447259866) bills $136.01/claim for 85025 (Complete cbc w/auto diff wbc) vs avg $4.03 (+12.4Ο). $725,343 across 5,333 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.
1326447939 (1326447939) bills $471.65/claim for 87635 (Sars-cov-2 covid-19 amp prb) vs avg $36.10 (+12.3Ο). $83,011 across 176 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.
CHASE BREXTON HEALTH SERVICES, INC. (1588606305) bills $274.19/claim for H0005 (Alcohol and/or drug services; group counseling by a clinician) vs avg $48.68 (+12.2Ο). $105,291 across 384 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.
SILVER OAK ACADEMY, INC. (1467917195) bills $335.89/claim for 90832 (Psytx w pt 30 minutes) vs avg $54.13 (+12.2Ο). $11,756 across 35 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.
SILVER OAK ACADEMY, INC. (1467917195) bills $274.47/claim for 90853 (Group psychotherapy) vs avg $40.86 (+12.1Ο). $15,096 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.
COMMUNITY SUPPORT SYSTEM LLC (1336540061): 44.3 claims/beneficiary (avg 2.6). 29,929 claims, 675 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.
MARYLAND MEDICAL DAY SERVICES II (1255093209): 44.3 claims/beneficiary (avg 2.6). 35,774 claims, 807 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.
1326447939 (1326447939) bills $181.67/claim for 71045 (X-ray exam chest 1 view) vs avg $6.31 (+10.8Ο). $16,169 across 89 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.
MARYLAND MEDICAL DAY SERVICES, LLC (1750829362): 38.5 claims/beneficiary (avg 2.6). 427,999 claims, 11,105 beneficiaries.
The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.
DIMENSIONS HEALTH CORPORATION (1891706271) bills $108.91/claim for 87804 (Influenza assay w/optic) vs avg $11.08 (+10.0Ο). $22,545 across 207 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.
SD CARTER ENTERPRISE, LLC (1750761011) bills $2,578.36/claim for 97150 (Group therapeutic procedures) vs avg $35.52 (+9.8Ο). $812,185 across 315 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 JOHNS HOPKINS HOSPITAL (1578597993) bills $336.50/claim for 99213 (Office o/p est low 20 min) vs avg $62.52 (+9.8Ο). $21,200 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.
EXTENDED FAMILY ADULT DAYCARE, INC. (1306968086): 37.4 claims/beneficiary (avg 2.6). 39,675 claims, 1,062 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.
GREATER BALTIMORE MEDICAL CENTER, INC. (1396774238) bills $407.34/claim for 96372 (Ther/proph/diag inj sc/im) vs avg $18.31 (+9.7Ο). $127,497 across 313 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 LAZEROW (1306996269) bills $53.23/claim for V2784 (Lens polycarb or equal) vs avg $5.40 (+9.4Ο). $34,066 across 640 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.
SYMBRAL FOUNDATION FOR COMMUNITY SERVICES INC (1871778233): 36.0 claims/beneficiary (avg 2.6). 42,646 claims, 1,186 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.
RHEUMATOLOGY ASSOCIATES OF BALTIMORE LLC (1801829932) bills $247.22/claim for 36415 (Coll venous bld venipuncture) vs avg $5.08 (+9.1Ο). $10,631 across 43 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.
JASMINE MEDICAL DAYCARE CENTER, INC. (1134550437): 33.9 claims/beneficiary (avg 2.6). 171,733 claims, 5,061 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.
UNIVERSITY OF MARYLAND PEDIATRIC ASSOCIATES, PA (1528163912) bills $98.66/claim for 90651 (9vhpv vaccine 2/3 dose im) vs avg $21.52 (+8.7Ο). $10,063 across 102 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.
LEVINDALE HEBREW GERIATRIC CENTER & HOSPITAL INC (1598740821) bills $336.24/claim for 90834 (Psytx w pt 45 minutes) vs avg $89.41 (+8.7Ο). $94,484 across 281 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.
JIM LEE (1003259631) bills $468.66/claim for D8670 (Periodic orthodontic treatment visit) vs avg $78.47 (+8.7Ο). $15,934 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.
MEDI-RENTS & SALES, INC. (1861480048) bills $30.07/claim for A4657 (Syringe w/wo needle) vs avg $0.86 (+8.5Ο). $802,428 across 26,683 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.
LUMINIS HEALTH MEDICAL GROUP, LLC (1942834551) bills $14.71/claim for 3078F vs avg $0.48 (+8.5Ο). $10,722 across 729 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.
KINGDOM ELEMENTS (1942871967): 32.1 claims/beneficiary (avg 2.6). 30,841 claims, 961 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.
BLOSSOM SERVICES, INC. (1962667113): 31.7 claims/beneficiary (avg 2.6). 43,814 claims, 1,381 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.
TIDALHEALTH SPECIALTY CARE, LLC (1619504735) bills $341.57/claim for 96372 (Ther/proph/diag inj sc/im) vs avg $18.31 (+8.1Ο). $253,790 across 743 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.
ROB N NESS INC (1730390394): 31.3 claims/beneficiary (avg 2.6). 54,937 claims, 1,756 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.
PARK WEST HEALTH SYSTEMS INCORPORATED (1205896719) bills $256.15/claim for 99212 (Office o/p est sf 10 min) vs avg $42.16 (+8.0Ο). $1,540,771 across 6,015 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.
HEALTH CARE FOR THE HOMELESS, INC (1003819665) bills $196.66/claim for H0005 (Alcohol and/or drug services; group counseling by a clinician) vs avg $48.68 (+8.0Ο). $1,101,102 across 5,599 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.
ARTHRITIS AND RHEUMATISM ASSOCIATES PC (1447259866) bills $79.46/claim for 81001 (Urinalysis auto w/scope) vs avg $3.49 (+8.0Ο). $13,667 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.
ASSOCIATED COMMUNITY SERVICES (1871785733): 30.8 claims/beneficiary (avg 2.6). 52,988 claims, 1,722 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.
PARK WEST HEALTH SYSTEMS INCORPORATED (1205896719) bills $210.22/claim for 99211 (Off/op est may x req phy/qhp) vs avg $22.68 (+7.9Ο). $28,380 across 135 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.
KINGDOM ELEMENTS MIDWAY LLC (1508630906): 30.7 claims/beneficiary (avg 2.6). 9,675 claims, 315 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.
IMPACT DIAGNOSTIC LAB & HEALTH SERVICES (1821728031) bills $32.79/claim for 36416 (Collj capillary blood spec) vs avg $1.10 (+7.9Ο). $29,580 across 902 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.
RHEUMATOLOGY ASSOCIATES OF BALTIMORE LLC (1801829932) bills $91.08/claim for G8427 (Docrev cur meds by elig clin) vs avg $5.13 (+7.9Ο). $19,400 across 213 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.
AGAPE INC (1972786374): 30.5 claims/beneficiary (avg 2.6). 9,818 claims, 322 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.
ST. AGNES HEALTHCARE, INC. (1245274901) bills $280.15/claim for 99213 (Office o/p est low 20 min) vs avg $62.52 (+7.8Ο). $10,926 across 39 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.
YEHEYIS T. NEGUSSIE MD PC (1932310851) bills $8.99/claim for 99000 (Specimen handling office-lab) vs avg $0.40 (+7.7Ο). $13,100 across 1,457 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.
TOTAL HEALTH CARE INC (1972597425) bills $189.52/claim for H0005 (Alcohol and/or drug services; group counseling by a clinician) vs avg $48.68 (+7.6Ο). $1,798,771 across 9,491 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.
CHASE BREXTON HEALTH SERVICES, INC. (1588606305) bills $245.39/claim for 99212 (Office o/p est sf 10 min) vs avg $42.16 (+7.6Ο). $1,296,171 across 5,282 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 NURSES SERVICES, INC (1124355227): 29.5 claims/beneficiary (avg 2.6). 62,635 claims, 2,120 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.
FAMILY COMES 1ST, LLC (1104591007): 29.5 claims/beneficiary (avg 2.6). 18,897 claims, 641 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.
SINAI HOSPITAL OF BALTIMORE INC (1255359782) bills $62.16/claim for 90471 (Immunization admin) vs avg $7.69 (+7.5Ο). $10,443 across 168 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.
JOYFUL ADULT MEDICAL DAY CARE CENTER (1316336571): 29.4 claims/beneficiary (avg 2.6). 106,574 claims, 3,626 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.
DIMENSIONS HEALTH CORPORATION (1720099286) bills $223.26/claim for 87651 (Strep a dna amp probe) vs avg $24.83 (+7.5Ο). $36,168 across 162 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.
CHANGE AGENT NETWORK AFRICA,INC. (1720619356): 29.2 claims/beneficiary (avg 2.6). 23,740 claims, 813 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.
DANIEL SEUBERT (1417323833) bills $81.32/claim for 97140 (Manual therapy 1/> regions) vs avg $14.10 (+7.4Ο). $473,770 across 5,826 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.
EVISION MEDICAL ADULT DAY CENTER CORPORATION (1700556222): 28.7 claims/beneficiary (avg 2.6). 4,764 claims, 166 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.