Statistical Outliers

Single-test outliers in Maine 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

warning

128

info

1,645

Total

1,848

Outliers by Type

Severity Distribution

critical

75 (4.1%)

warning

128 (6.9%)

info

1,645 (89.0%)

1,308 results

criticalCost OutlierScore: 14.6

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

MICMAC HEALTH DEPARTMENT (1881232346) bills $418.17/claim for 99213 (Office o/p est low 20 min) vs avg $28.14 (+14.6σ). $393,083 across 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.

MICMAC HEALTH DEPARTMENTPRESQUE ISLEProvider total: $818.0K

criticalCost OutlierScore: 11.8

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

MICMAC HEALTH DEPARTMENT (1881232346) bills $416.33/claim for 99214 (Office o/p est mod 30 min) vs avg $38.55 (+11.8σ). $175,690 across 422 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

MICMAC HEALTH DEPARTMENTPRESQUE ISLEProvider total: $818.0K

criticalCost OutlierScore: 9.5

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

EASTERN MAINE MEDICAL CENTER (1790789147) bills $767.88/claim for D0150 (Comprehensive oral evaluation) vs avg $47.88 (+9.5σ). $970,605 across 1,264 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.

EASTERN MAINE MEDICAL CENTERBANGORProvider total: $159.2M

criticalOverutilizationScore: 8.8

Unusually high claims-per-beneficiary ratio

OHI (1720153836): 31.0 claims/beneficiary (avg 2.9). 177,779 claims, 5,730 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.

OHIBANGORProvider total: $39.6M

criticalOverutilizationScore: 8.5

Unusually high claims-per-beneficiary ratio

WOODFORDS FAMILY SERVICES (1982847067): 30.3 claims/beneficiary (avg 2.9). 53,352 claims, 1,761 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.

WOODFORDS FAMILY SERVICESWESTBROOKProvider total: $5.2M

criticalOverutilizationScore: 8.4

Unusually high claims-per-beneficiary ratio

SPURWINK SERVICES (1295994804): 30.0 claims/beneficiary (avg 2.9). 306,197 claims, 10,214 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.

SPURWINK SERVICESPORTLANDProvider total: $112.8M

criticalCost OutlierScore: 8.3

Cost-per-claim above average for H2021

DISCOVERING KIDS CONSULTATION SERVICE (1952538324) bills $3,493.56/claim for H2021 (Com wrap-around sv, 15 min) vs avg $307.04 (+8.3σ). $5,953,024 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.

DISCOVERING KIDS CONSULTATION SERVICEBREMENProvider total: $6.0M

criticalOverutilizationScore: 8.2

Unusually high claims-per-beneficiary ratio

MOTIVATIONAL SERVICES INC (1609983907): 29.3 claims/beneficiary (avg 2.9). 355,895 claims, 12,164 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.

MOTIVATIONAL SERVICES INCAUGUSTAProvider total: $92.1M

criticalOverutilizationScore: 8.0

Unusually high claims-per-beneficiary ratio

PENQUIS C.A.P., INC. (1598830820): 28.5 claims/beneficiary (avg 2.9). 10,538 claims, 370 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.

PENQUIS C.A.P., INC.BANGORProvider total: $3.6M

criticalCost OutlierScore: 7.9

Cost-per-claim above average for 71046 (Chest X-ray (2 views, Frontal and Lateral))

1326447939 (1326447939) bills $246.10/claim for 71046 (X-ray exam chest 2 views) vs avg $18.23 (+7.9σ). $43,314 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.

GUAM HEALTHCARE DEVELOPMENT INCORPORATEDDEDEDOProvider total: $1.8M

criticalOverutilizationScore: 7.8

Unusually high claims-per-beneficiary ratio

OHI (1457426561): 27.9 claims/beneficiary (avg 2.9). 16,266 claims, 583 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.

OHIBANGORProvider total: $1.0M

criticalOverutilizationScore: 7.7

Unusually high claims-per-beneficiary ratio

COASTAL COMMUNITY CARE, LLC (1437702016): 27.7 claims/beneficiary (avg 2.9). 25,652 claims, 925 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.

COASTAL COMMUNITY CARE, LLCLEWISTONProvider total: $24.1M

criticalCost OutlierScore: 7.5

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

1326447939 (1326447939) bills $2,734.46/claim for 74177 (Ct abd & pelvis w/contrast) vs avg $131.88 (+7.5σ). $38,282 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.

GUAM HEALTHCARE DEVELOPMENT INCORPORATEDDEDEDOProvider total: $1.8M

criticalCost OutlierScore: 7.4

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

ST CROIX REGIONAL FAMILY HEALTH CENTER (1831174614) bills $65.96/claim for 80305 (Drug test prsmv dir opt obs) vs avg $4.04 (+7.4σ). $13,653 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.

ST CROIX REGIONAL FAMILY HEALTH CENTERPRINCETONProvider total: $6.4M

criticalCost OutlierScore: 7.3

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

ST. JOSEPH HOSPITAL (1154321545) bills $3,677.82/claim for D7140 (Extraction erupted tooth or exposed root) vs avg $144.59 (+7.3σ). $95,623 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.

ST. JOSEPH HOSPITALBANGORProvider total: $38.8M

criticalCost OutlierScore: 7.0

Cost-per-claim above average for 99000

PASSAMAQUODDY TRIBAL COUNCIL (1760474613) bills $48.12/claim for 99000 (Specimen handling office-lab) vs avg $3.29 (+7.0σ). $12,993 across 270 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.

PASSAMAQUODDY TRIBAL COUNCILPLEASANT POINTProvider total: $6.9M

criticalOverutilizationScore: 6.9

Unusually high claims-per-beneficiary ratio

EASY CARE RESIDENTIAL (1437616737): 24.9 claims/beneficiary (avg 2.9). 12,906 claims, 518 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.

EASY CARE RESIDENTIALBIDDEFORDProvider total: $10.3M

criticalCost OutlierScore: 6.6

Cost-per-claim above average for 92340

MADISON RHOTON (1528685948) bills $63.88/claim for 92340 (Fit spectacles monofocal) vs avg $16.52 (+6.6σ). $39,862 across 624 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.

MADISON RHOTONLEWISTONProvider total: $88.8K

criticalCost OutlierScore: 6.5

Cost-per-claim above average for 84100

AMBREEN IJAZ (1194831925) bills $41.60/claim for 84100 (Assay of phosphorus) vs avg $2.00 (+6.5σ). $47,468 across 1,141 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.

AMBREEN IJAZAUGUSTAProvider total: $1.0M

criticalCost OutlierScore: 6.4

Cost-per-claim above average for 83735

AMBREEN IJAZ (1194831925) bills $44.89/claim for 83735 (Assay of magnesium) vs avg $2.12 (+6.4σ). $52,657 across 1,173 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.

AMBREEN IJAZAUGUSTAProvider total: $1.0M

criticalOverutilizationScore: 6.3

Unusually high claims-per-beneficiary ratio

ATLANTIC ACADEMY (1225550460): 23.1 claims/beneficiary (avg 2.9). 7,662 claims, 332 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.

ATLANTIC ACADEMYCAMDENProvider total: $1.8M

criticalCost OutlierScore: 6.0

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

BRIGHT START THERAPY, INC. (1114363686) bills $70.05/claim for 97110 (Therapeutic exercises) vs avg $14.28 (+6.0σ). $11,278 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.

BRIGHT START THERAPY, INC.LEWISTONProvider total: $1.1M

criticalCost OutlierScore: 6.0

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

PASSAMAQUODDY TRIBAL COUNCIL (1760474613) bills $277.51/claim for 99211 (Off/op est may x req phy/qhp) vs avg $18.29 (+6.0σ). $55,502 across 200 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.

PASSAMAQUODDY TRIBAL COUNCILPLEASANT POINTProvider total: $6.9M

criticalOverutilizationScore: 5.9

Unusually high claims-per-beneficiary ratio

SACO RIVER SENIOR SERVICES INC (1528393220): 21.9 claims/beneficiary (avg 2.9). 2,149 claims, 98 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.

SACO RIVER SENIOR SERVICES INCWATERBOROProvider total: $240.6K

criticalCost OutlierScore: 5.9

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

MARY DONAHUE (1760769673) bills $240.74/claim for H0004 (Behavioral health counseling and therapy, per 15 minutes) vs avg $79.91 (+5.9σ). $154,316 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.

MARY DONAHUEKITTERYProvider total: $154.3K

criticalCost OutlierScore: 5.8

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

FAMILY PLANNING ASSOCIATION OF MAINE INC (1477768216) bills $197.42/claim for 99203 (Office o/p new low 30 min) vs avg $34.74 (+5.8σ). $283,293 across 1,435 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.

FAMILY PLANNING ASSOCIATION OF MAINE INCAUGUSTAProvider total: $2.8M

criticalCost OutlierScore: 5.8

Cost-per-claim above average for G0439 (Annual Wellness Visit (Subsequent))

HOULTON REGIONAL HOSPITAL (1386601524) bills $126.33/claim for G0439 (Ppps, subseq visit) vs avg $8.63 (+5.8σ). $61,651 across 488 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.

HOULTON REGIONAL HOSPITALHOULTONProvider total: $3.1M

criticalOverutilizationScore: 5.8

Unusually high claims-per-beneficiary ratio

WOODFORDS FAMILY SERVICES (1346483435): 21.4 claims/beneficiary (avg 2.9). 384,142 claims, 17,957 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.

WOODFORDS FAMILY SERVICESWESTBROOKProvider total: $101.6M

criticalOverutilizationScore: 5.8

Unusually high claims-per-beneficiary ratio

BRIGHTER HEIGHTS MAINE, LLC (1477869725): 21.4 claims/beneficiary (avg 2.9). 41,188 claims, 1,928 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.

BRIGHTER HEIGHTS MAINE, LLCYARMOUTHProvider total: $4.0M

criticalCost OutlierScore: 5.8

Cost-per-claim above average for G0467

INDIAN TOWNSHIP TRIBAL GOVERNMENT (1205952140) bills $295.79/claim for G0467 (Fqhc visit, estab pt) vs avg $55.18 (+5.8σ). $612,868 across 2,072 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.

INDIAN TOWNSHIP TRIBAL GOVERNMENTPRINCETONProvider total: $12.2M

criticalCost OutlierScore: 5.7

Cost-per-claim above average for 90734

MAINEGENERAL MEDICAL CENTER (1063716710) bills $190.00/claim for 90734 (Menacwyd/menacwycrm vacc im) vs avg $8.25 (+5.7σ). $15,010 across 79 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.

MAINEGENERAL MEDICAL CENTERAUGUSTAProvider total: $375.1K

criticalOverutilizationScore: 5.6

Unusually high claims-per-beneficiary ratio

MORRISON CENTER (1063746519): 20.9 claims/beneficiary (avg 2.9). 86,219 claims, 4,132 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.

MORRISON CENTERSCARBOROUGHProvider total: $24.8M

criticalCost OutlierScore: 5.3

Cost-per-claim above average for J2405 (Ondansetron (Zofran) Injection (1 mg))

DOWN EAST COMMUNITY HOSPITAL (1528087004) bills $6.58/claim for J2405 (Ondansetron hcl injection) vs avg $0.49 (+5.3σ). $10,384 across 1,578 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.

DOWN EAST COMMUNITY HOSPITALMACHIASProvider total: $4.5M

criticalOverutilizationScore: 5.3

Unusually high claims-per-beneficiary ratio

R & C HOME CARE, INC. (1497999304): 19.9 claims/beneficiary (avg 2.9). 153,382 claims, 7,726 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.

R & C HOME CARE, INC.LINCOLNProvider total: $13.4M

criticalCost OutlierScore: 5.1

Cost-per-claim above average for C9803

MAINEHEALTH (1619510047) bills $96.76/claim for C9803 (Hospital outpatient clinic visit specimen collection for severe acute) vs avg $9.65 (+5.1σ). $319,974 across 3,307 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.

MAINEHEALTHFARMINGTONProvider total: $2.4M

criticalCost OutlierScore: 5.1

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

PHILIP RUSSELL (1073625794) bills $118.42/claim for 80307 (Drug test prsmv chem anlyzr) vs avg $12.90 (+5.1σ). $59,564 across 503 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.

PHILIP RUSSELLSANFORDProvider total: $722.2K

criticalOverutilizationScore: 5.0

Unusually high claims-per-beneficiary ratio

IN HOME SENIOR SERVICES, INC. (1922374321): 19.0 claims/beneficiary (avg 2.9). 102,900 claims, 5,430 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.

IN HOME SENIOR SERVICES, INC.GORHAMProvider total: $10.5M

criticalCost OutlierScore: 4.9

Cost-per-claim above average for 88305

PORTLAND GASTROENTEROLOGY ASSOCIATES P.A. (1508087289) bills $132.11/claim for 88305 (Tissue exam by pathologist) vs avg $19.65 (+4.9σ). $11,097 across 84 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.

PORTLAND GASTROENTEROLOGY ASSOCIATES P.A.PORTLANDProvider total: $110.3K

criticalCost OutlierScore: 4.9

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

GRANITE BAY CARE, INC (1518022763) bills $211.86/claim for H0004 (Behavioral health counseling and therapy, per 15 minutes) vs avg $79.91 (+4.9σ). $151,271 across 714 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.

GRANITE BAY CARE, INCPORTLANDProvider total: $281.7M

criticalCost OutlierScore: 4.8

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

PINES HEALTH SERVICES (1942277819) bills $54.03/claim for D0220 (Intraoral - periapical first image) vs avg $10.88 (+4.8σ). $103,842 across 1,922 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.

PINES HEALTH SERVICESCARIBOUProvider total: $7.6M

criticalCost OutlierScore: 4.8

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

HOULTON BAND OF MALISEET INDIANS (1225124050) bills $539.39/claim for T1015 (Clinic service) vs avg $173.06 (+4.8σ). $3,857,747 across 7,152 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.

HOULTON BAND OF MALISEET INDIANSHOULTONProvider total: $4.3M

criticalCost OutlierScore: 4.7

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

PINES HEALTH SERVICES (1942277819) bills $43.50/claim for D0230 (Intraoral - periapical each addl image) vs avg $9.74 (+4.7σ). $24,010 across 552 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.

PINES HEALTH SERVICESCARIBOUProvider total: $7.6M

criticalCost OutlierScore: 4.7

Cost-per-claim above average for E0601 (CPAP Device (Continuous Positive Airway Pressure))

REGIONAL HOME CARE INC (1336563196) bills $116.85/claim for E0601 (Continuous positive airway pressure (cpap) device) vs avg $33.50 (+4.7σ). $598,050 across 5,118 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.

REGIONAL HOME CARE INCWATERVILLEProvider total: $2.0M

criticalCost OutlierScore: 4.6

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

WENDELIN WITT (1851365738) bills $496.01/claim for 99284 (Emergency dept visit mod mdm) vs avg $86.60 (+4.6σ). $18,352 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.

WENDELIN WITTPITTSFIELDProvider total: $26.6K

criticalCost OutlierScore: 4.5

Cost-per-claim above average for A0425 (Ground Ambulance Mileage (per mile))

TOWN OF MEDWAY (1689297137) bills $407.65/claim for A0425 (Ground mileage) vs avg $75.19 (+4.5σ). $15,083 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.

TOWN OF MEDWAYMEDWAYProvider total: $15.1K

criticalCost OutlierScore: 4.5

Cost-per-claim above average for T1017

RUMFORD GROUP HOMES INC (1629022645) bills $534.19/claim for T1017 (Targeted case management) vs avg $115.46 (+4.5σ). $1,789,539 across 3,350 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.

RUMFORD GROUP HOMES INCRUMFORDProvider total: $2.3M

criticalCost OutlierScore: 4.5

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

INDIAN TOWNSHIP TRIBAL GOVERNMENT (1205952140) bills $519.23/claim for T1015 (Clinic service) vs avg $173.06 (+4.5σ). $10,934,947 across 21,060 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.

INDIAN TOWNSHIP TRIBAL GOVERNMENTPRINCETONProvider total: $12.2M

criticalCost OutlierScore: 4.5

Cost-per-claim above average for G0480 (Drug Test, Definitive (1-7 classes))

PHILIP RUSSELL (1073625794) bills $146.48/claim for G0480 (Drug test def 1-7 classes) vs avg $16.69 (+4.5σ). $76,758 across 524 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.

PHILIP RUSSELLSANFORDProvider total: $722.2K

criticalCost OutlierScore: 4.2

Cost-per-claim above average for 99392 (Preventive Visit, Established Patient (Ages 1-4))

JOCELIN REATIRAZA (1598777930) bills $201.73/claim for 99392 (Prev visit est age 1-4) vs avg $39.17 (+4.2σ). $13,919 across 69 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

JOCELIN REATIRAZAOAKLANDProvider total: $60.0K

criticalCost OutlierScore: 4.2

Cost-per-claim above average for D1330

PINES HEALTH SERVICES (1942277819) bills $65.36/claim for D1330 (Oral hygiene instructions) vs avg $14.40 (+4.2σ). $67,195 across 1,028 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.

PINES HEALTH SERVICESCARIBOUProvider total: $7.6M

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Statistical Outliers

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