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 Minnesota 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

482

warning

569

info

5,775

Total

6,826

Outliers by Type
Severity Distribution
critical
482 (7.1%)
warning
569 (8.3%)
info
5,775 (84.6%)
5,031 results
criticalCost OutlierScore: 20.2

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

LEECH LAKE TRIBAL COUNCIL (1942310875) bills $298.14/claim for 90686 (Iiv4 vacc no prsv 0.5 ml im) vs avg $5.65 (+20.2Οƒ). $113,590 across 381 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.

LEECH LAKE TRIBAL COUNCILCASS LAKEProvider total: $5.3M
criticalCost OutlierScore: 18.4

Cost-per-claim above average for 99173

WHITE EARTH INDIAN HEALTH CENTER (1093761710) bills $414.05/claim for 99173 (Visual acuity screen) vs avg $2.21 (+18.4Οƒ). $93,162 across 225 claims.

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

WHITE EARTH INDIAN HEALTH CENTEROGEMAProvider total: $24.3M
criticalCost OutlierScore: 18.3

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

WHITE EARTH INDIAN HEALTH CENTER (1093761710) bills $279.01/claim for 96127 (Brief emotional/behav assmt) vs avg $4.37 (+18.3Οƒ). $33,481 across 120 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.

WHITE EARTH INDIAN HEALTH CENTEROGEMAProvider total: $24.3M
criticalCost OutlierScore: 17.8

Cost-per-claim above average for 92015

FOND DU LAC RESERVATION BUSINESS COMMITTEE (1326053166) bills $305.74/claim for 92015 (Determine refractive state) vs avg $12.14 (+17.8Οƒ). $456,773 across 1,494 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.

FOND DU LAC RESERVATION BUSINESS COMMITTEECLOQUETProvider total: $25.8M
criticalCost OutlierScore: 17.4

Cost-per-claim above average for 98941

FOND DU LAC RESERVATION BUSINESS COMMITTEE (1326053166) bills $542.11/claim for 98941 (Chiropract manj 3-4 regions) vs avg $19.66 (+17.4Οƒ). $771,970 across 1,424 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.

FOND DU LAC RESERVATION BUSINESS COMMITTEECLOQUETProvider total: $25.8M
criticalCost OutlierScore: 16.7

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

PHS INDIAN HOSPITAL (1508809765) bills $656.48/claim for D1206 (Topical fluoride varnish) vs avg $22.56 (+16.7Οƒ). $30,198 across 46 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.

PHS INDIAN HOSPITALRED LAKEProvider total: $59.4M
criticalCost OutlierScore: 16.7

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

PHS INDIAN HOSPITAL (1508809765) bills $450.52/claim for D0220 (Intraoral - periapical first image) vs avg $13.81 (+16.7Οƒ). $705,512 across 1,566 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.

PHS INDIAN HOSPITALRED LAKEProvider total: $59.4M
criticalCost OutlierScore: 14.8

Cost-per-claim above average for 90471 (Immunization Administration (Injection))

WHITE EARTH BAND OF CHIPPEWA (1649295502) bills $498.24/claim for 90471 (Immunization admin) vs avg $12.91 (+14.8Οƒ). $251,111 across 504 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.

WHITE EARTH BAND OF CHIPPEWAWHITE EARTHProvider total: $32.8M
criticalCost OutlierScore: 14.1

Cost-per-claim above average for 92551

WHITE EARTH INDIAN HEALTH CENTER (1093761710) bills $446.32/claim for 92551 (Pure tone hearing test air) vs avg $7.32 (+14.1Οƒ). $29,011 across 65 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.

WHITE EARTH INDIAN HEALTH CENTEROGEMAProvider total: $24.3M
criticalCost OutlierScore: 13.8

Cost-per-claim above average for 98941

LEECH LAKE TRIBAL COUNCIL (1942310875) bills $434.92/claim for 98941 (Chiropract manj 3-4 regions) vs avg $19.66 (+13.8Οƒ). $1,021,185 across 2,348 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.

LEECH LAKE TRIBAL COUNCILCASS LAKEProvider total: $5.3M
criticalCost OutlierScore: 13.1

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

FAIRVIEW HEALTH SERVICES (1013994359) bills $520.19/claim for D1206 (Topical fluoride varnish) vs avg $22.56 (+13.1Οƒ). $571,692 across 1,099 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 HEALTH SERVICESMINNEAPOLISProvider total: $90.4M
criticalCost OutlierScore: 13.1

Cost-per-claim above average for T1013

MUBARAK IBRAHIM (1952043861) bills $806.19/claim for T1013 (Sign lang/oral interpreter) vs avg $39.60 (+13.1Οƒ). $606,252 across 752 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.

MUBARAK IBRAHIMSAINT CLOUDProvider total: $606.3K
criticalCost OutlierScore: 12.6

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

FAIRVIEW HEALTH SERVICES (1013994359) bills $351.57/claim for D1351 (Sealant per tooth) vs avg $25.94 (+12.6Οƒ). $34,806 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.

FAIRVIEW HEALTH SERVICESMINNEAPOLISProvider total: $90.4M
criticalCost OutlierScore: 12.4

Cost-per-claim above average for 91300

MILLE LACS BAND OF OJIBWE INDIANS (1740357169) bills $510.95/claim for 91300 (Code 91300) vs avg $3.92 (+12.4Οƒ). $65,913 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.

MILLE LACS BAND OF OJIBWE INDIANSONAMIAProvider total: $9.9M
criticalCost OutlierScore: 12.4

Cost-per-claim above average for U0003

ALLINA HEALTH SYSTEM (1316904287) bills $442.59/claim for U0003 (Infectious agent detection by nucleic acid (dna or rna); severe acute) vs avg $73.70 (+12.4Οƒ). $580,236 across 1,311 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.

ALLINA HEALTH SYSTEMCOON RAPIDSProvider total: $48.8M
criticalCost OutlierScore: 12.3

Cost-per-claim above average for 96110

SANFORD HEALTH NETWORK (1396712618) bills $129.75/claim for 96110 (Developmental screen w/score) vs avg $5.95 (+12.3Οƒ). $16,349 across 126 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.

SANFORD HEALTH NETWORKWORTHINGTONProvider total: $7.6M
criticalCost OutlierScore: 12.1

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

PHS INDIAN HOSPITAL (1508809765) bills $354.70/claim for D1120 (Prophylaxis - child) vs avg $29.53 (+12.1Οƒ). $311,428 across 878 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.

PHS INDIAN HOSPITALRED LAKEProvider total: $59.4M
criticalCost OutlierScore: 12.1

Cost-per-claim above average for 92014

MILLE LACS BAND OF OJIBWE INDIANS (1740357169) bills $581.87/claim for 92014 (Compre oph exam est pt 1/>) vs avg $73.69 (+12.1Οƒ). $225,185 across 387 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.

MILLE LACS BAND OF OJIBWE INDIANSONAMIAProvider total: $9.9M
criticalCost OutlierScore: 11.8

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

WHITE EARTH BAND OF CHIPPEWA (1649295502) bills $353.86/claim for 90460 (Im admin 1st/only component) vs avg $25.05 (+11.8Οƒ). $182,589 across 516 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.

WHITE EARTH BAND OF CHIPPEWAWHITE EARTHProvider total: $32.8M
criticalCost OutlierScore: 11.7

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

MAYO CLINIC HOSPITAL-ROCHESTER (1841266194) bills $890.29/claim for D0150 (Comprehensive oral evaluation) vs avg $48.78 (+11.7Οƒ). $49,856 across 56 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.

MAYO CLINIC HOSPITAL-ROCHESTERROCHESTERProvider total: $11.5M
criticalCost OutlierScore: 11.6

Cost-per-claim above average for T2003

CURRENT ACCESSIBILITY SOLUTIONS LLC (1497236418) bills $1,436.11/claim for T2003 (N-et; encounter/trip) vs avg $41.26 (+11.6Οƒ). $804,223 across 560 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.

CURRENT ACCESSIBILITY SOLUTIONS LLCBECKERProvider total: $3.0M
criticalCost OutlierScore: 11.0

Cost-per-claim above average for H0046

HENNEPIN COUNTY (1780790345) bills $119.44/claim for H0046 (Mental health service, nos) vs avg $12.20 (+11.0Οƒ). $65,217 across 546 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.

HENNEPIN COUNTYMINNEAPOLISProvider total: $9.3M
criticalCost OutlierScore: 10.9

Cost-per-claim above average for 90688

LEECH LAKE TRIBAL COUNCIL (1942310875) bills $292.16/claim for 90688 (Iiv4 vaccine splt 0.5 ml im) vs avg $7.92 (+10.9Οƒ). $11,102 across 38 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.

LEECH LAKE TRIBAL COUNCILCASS LAKEProvider total: $5.3M
criticalCost OutlierScore: 10.7

Cost-per-claim above average for 90833

MILLE LACS BAND OF OJIBWE INDIANS (1740357169) bills $576.61/claim for 90833 (Psytx w pt w e/m 30 min) vs avg $60.68 (+10.7Οƒ). $600,825 across 1,042 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.

MILLE LACS BAND OF OJIBWE INDIANSONAMIAProvider total: $9.9M
criticalCost OutlierScore: 10.6

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

DEPARTMENT OF HEALTH & HUMAN SERVICES PHS IHS (1194754382) bills $402.79/claim for 97530 (Therapeutic activities) vs avg $49.11 (+10.6Οƒ). $285,578 across 709 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.

DEPARTMENT OF HEALTH & HUMAN SERVICES PHS IHSCASS LAKEProvider total: $25.6M
criticalCost OutlierScore: 10.4

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

RED LAKE BAND OF CHIPPEWA INDIANS (1689225351) bills $694.21/claim for 99213 (Office o/p est low 20 min) vs avg $61.85 (+10.4Οƒ). $40,264 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.

RED LAKE BAND OF CHIPPEWA INDIANSMINNEAPOLISProvider total: $16.8M
criticalCost OutlierScore: 10.4

Cost-per-claim above average for 92015

DEPARTMENT OF HEALTH & HUMAN SERVICES PHS IHS (1194754382) bills $184.14/claim for 92015 (Determine refractive state) vs avg $12.14 (+10.4Οƒ). $267,365 across 1,452 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.

DEPARTMENT OF HEALTH & HUMAN SERVICES PHS IHSCASS LAKEProvider total: $25.6M
criticalCost OutlierScore: 10.2

Cost-per-claim above average for D0120 (Periodic Oral Evaluation (Established Patient))

SANFORD HEALTH OF NORTHERN MINNESOTA (1801870191) bills $573.70/claim for D0120 (Periodic oral evaluation) vs avg $33.61 (+10.2Οƒ). $99,823 across 174 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.

SANFORD HEALTH OF NORTHERN MINNESOTABEMIDJIProvider total: $47.5M
criticalCost OutlierScore: 10.1

Cost-per-claim above average for A0100

PRS TRANSPORTATION SERVICES, INC. (1932650546) bills $1,015.40/claim for A0100 (Nonemergency transport taxi) vs avg $26.99 (+10.1Οƒ). $2,683,715 across 2,643 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.

PRS TRANSPORTATION SERVICES, INC.BRAINERDProvider total: $7.0M
criticalCost OutlierScore: 10.1

Cost-per-claim above average for 90480

WHITE EARTH BAND OF CHIPPEWA (1649295502) bills $631.45/claim for 90480 (Admn sarscov2 vacc 1 dose) vs avg $26.98 (+10.0Οƒ). $18,312 across 29 claims.

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

WHITE EARTH BAND OF CHIPPEWAWHITE EARTHProvider total: $32.8M
criticalCost OutlierScore: 9.9

Cost-per-claim above average for D1208

COMPREHENSIVE HEALTH SERVICES (1740547728) bills $438.53/claim for D1208 (Topical fluoride excluding varnish) vs avg $18.32 (+9.9Οƒ). $3,624,489 across 8,265 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.

COMPREHENSIVE HEALTH SERVICESRED LAKEProvider total: $4.8M
criticalCost OutlierScore: 9.9

Cost-per-claim above average for D0274 (Dental X-rays (Bitewings, 4 Films))

FOND DU LAC RESERVATION BUSINESS COMMITTEE (1326053166) bills $207.43/claim for D0274 (Bitewings - four radiographic images) vs avg $29.97 (+9.9Οƒ). $316,531 across 1,526 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.

FOND DU LAC RESERVATION BUSINESS COMMITTEECLOQUETProvider total: $25.8M
criticalCost OutlierScore: 9.8

Cost-per-claim above average for 92551

DEPARTMENT OF HEALTH & HUMAN SERVICES PHS IHS (1194754382) bills $311.50/claim for 92551 (Pure tone hearing test air) vs avg $7.32 (+9.8Οƒ). $16,821 across 54 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.

DEPARTMENT OF HEALTH & HUMAN SERVICES PHS IHSCASS LAKEProvider total: $25.6M
criticalCost OutlierScore: 9.7

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

COMPREHENSIVE HEALTH SERVICES (1740547728) bills $288.77/claim for D1120 (Prophylaxis - child) vs avg $29.53 (+9.7Οƒ). $644,254 across 2,231 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.

COMPREHENSIVE HEALTH SERVICESRED LAKEProvider total: $4.8M
criticalCost OutlierScore: 9.4

Cost-per-claim above average for S0215

BLUE BUTTON TRANSPORT (1619459005) bills $640.72/claim for S0215 (Nonemerg transp mileage) vs avg $39.28 (+9.4Οƒ). $1,198,782 across 1,871 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.

BLUE BUTTON TRANSPORTBECKERProvider total: $3.9M
criticalCost OutlierScore: 9.3

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

RED LAKE BAND OF CHIPPEWA INDIANS (1689225351) bills $642.78/claim for 99214 (Office o/p est mod 30 min) vs avg $84.02 (+9.3Οƒ). $2,506,847 across 3,900 claims.

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

RED LAKE BAND OF CHIPPEWA INDIANSMINNEAPOLISProvider total: $16.8M
criticalCost OutlierScore: 9.2

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

RED LAKE BAND OF CHIPPEWA INDIANS (1689225351) bills $631.27/claim for 90837 (Psytx w pt 60 minutes) vs avg $98.48 (+9.2Οƒ). $620,539 across 983 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.

RED LAKE BAND OF CHIPPEWA INDIANSMINNEAPOLISProvider total: $16.8M
criticalOverutilizationScore: 9.1

Unusually high claims-per-beneficiary ratio

ABILITY CARE PARTNERS INCORPORATED (1629249826): 68.4 claims/beneficiary (avg 4.8). 62,576 claims, 915 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.

ABILITY CARE PARTNERS INCORPORATEDCRYSTALProvider total: $7.8M
criticalCost OutlierScore: 8.9

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

CHILDRENS HEALTH CARE (1881793750) bills $477.93/claim for J1100 (Dexamethasone sodium phos) vs avg $9.17 (+8.9Οƒ). $3,684,357 across 7,709 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.

CHILDRENS HEALTH CAREMINNEAPOLISProvider total: $100.0M
criticalCost OutlierScore: 8.4

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

COMMUNITY HEALTH SERVICE INC. (1316921406) bills $585.81/claim for 90837 (Psytx w pt 60 minutes) vs avg $98.48 (+8.4Οƒ). $294,075 across 502 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 HEALTH SERVICE INC.MOORHEADProvider total: $351.8K
criticalCost OutlierScore: 8.3

Cost-per-claim above average for 99072

NEXUS OF HOPE PSYCHIATRY & MENTAL HEALTH WELLNESS PLLC (1407315096) bills $237.93/claim for 99072 (Addl supl matrl&staf tm phe) vs avg $9.80 (+8.4Οƒ). $101,122 across 425 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.

NEXUS OF HOPE PSYCHIATRY & MENTAL HEALTH WELLNESS PLLCBURNSVILLEProvider total: $970.5K
criticalCost OutlierScore: 8.2

Cost-per-claim above average for D8670

KENT GULDEN (1124123328) bills $2,120.24/claim for D8670 (Periodic orthodontic treatment visit) vs avg $224.24 (+8.2Οƒ). $31,804 across 15 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.

KENT GULDENWHITE BEAR LAKEProvider total: $91.0K
criticalCost OutlierScore: 8.2

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

WHITE EARTH BAND OF CHIPPEWA (1093898660) bills $577.32/claim for 99214 (Office o/p est mod 30 min) vs avg $84.02 (+8.2Οƒ). $548,456 across 950 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.

WHITE EARTH BAND OF CHIPPEWAWHITE EARTHProvider total: $37.7M
criticalCost OutlierScore: 8.2

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

SANFORD HEALTH OF NORTHERN MINNESOTA (1801870191) bills $1,172.35/claim for D7140 (Extraction erupted tooth or exposed root) vs avg $100.07 (+8.2Οƒ). $143,026 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.

SANFORD HEALTH OF NORTHERN MINNESOTABEMIDJIProvider total: $47.5M
criticalCost OutlierScore: 8.2

Cost-per-claim above average for H0032

WHITE EARTH BAND OF CHIPPEWA (1093898660) bills $368.10/claim for H0032 (Mh svc plan dev by non-md) vs avg $81.21 (+8.2Οƒ). $507,974 across 1,380 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.

WHITE EARTH BAND OF CHIPPEWAWHITE EARTHProvider total: $37.7M
criticalCost OutlierScore: 7.9

Cost-per-claim above average for Q3014

PARK NICOLLET METHODIST HOSPITAL (1942585286) bills $118.48/claim for Q3014 (Telehealth facility fee) vs avg $15.90 (+7.9Οƒ). $14,217 across 120 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.

PARK NICOLLET METHODIST HOSPITALST LOUIS PARKProvider total: $989.7K
criticalCost OutlierScore: 7.7

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

AMERICAN INDIAN FAMILY CENTER (1467592865) bills $674.40/claim for 90834 (Psytx w pt 45 minutes) vs avg $81.01 (+7.7Οƒ). $134,206 across 199 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.

AMERICAN INDIAN FAMILY CENTERSAINT PAULProvider total: $2.5M
criticalCost OutlierScore: 7.7

Cost-per-claim above average for 90651 (HPV Vaccine (9-Valent))

HENNEPIN COUNTY (1295812386) bills $220.71/claim for 90651 (9vhpv vaccine 2/3 dose im) vs avg $12.60 (+7.7Οƒ). $21,851 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.

HENNEPIN COUNTYMINNEAPOLISProvider total: $1.6M
criticalCost OutlierScore: 7.4

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

OBAASHING TREATMENT CENTER (1104412402) bills $529.43/claim for 99214 (Office o/p est mod 30 min) vs avg $84.02 (+7.4Οƒ). $11,118 across 21 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.

OBAASHING TREATMENT CENTERPONEMAHProvider total: $1.4M
criticalCost OutlierScore: 7.4

Cost-per-claim above average for U0005

MAHNOMEN HEALTH CENTER (1942233234) bills $76.17/claim for U0005 (Infectious agent detection by nucleic acid (dna or rna); severe acute) vs avg $20.56 (+7.4Οƒ). $18,053 across 237 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.

MAHNOMEN HEALTH CENTERMAHNOMENProvider total: $1.7M
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