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 Mississippi 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

156

warning

317

info

3,394

Total

3,867

Outliers by Type
Severity Distribution
critical
156 (4.0%)
warning
317 (8.2%)
info
3,394 (87.8%)
2,637 results
criticalCost OutlierScore: 20.4

Cost-per-claim above average for D0140 (Limited Oral Evaluation (Problem-Focused))

MISSISSIPPI BAND OF CHOCTAW INDIANS (1790865780) bills $434.38/claim for D0140 (Limited oral evaluation - problem focused) vs avg $33.59 (+20.4Οƒ). $34,751 across 80 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.

MISSISSIPPI BAND OF CHOCTAW INDIANSCHOCTAWProvider total: $57.0M
criticalCost OutlierScore: 19.9

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

MISSISSIPPI BAND OF CHOCTAW INDIANS (1073715579) bills $528.44/claim for D1120 (Prophylaxis - child) vs avg $23.20 (+19.9Οƒ). $191,823 across 363 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.

MISSISSIPPI BAND OF CHOCTAW INDIANSCHOCTAWProvider total: $437.7K
criticalCost OutlierScore: 19.4

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

MISSISSIPPI BAND OF CHOCTAW INDIANS (1790865780) bills $397.96/claim for D0274 (Bitewings - four radiographic images) vs avg $23.21 (+19.3Οƒ). $44,174 across 111 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.

MISSISSIPPI BAND OF CHOCTAW INDIANSCHOCTAWProvider total: $57.0M
criticalCost OutlierScore: 17.1

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

MISSISSIPPI BAND OF CHOCTAW INDIANS (1790865780) bills $482.70/claim for D1206 (Topical fluoride varnish) vs avg $19.49 (+17.1Οƒ). $736,115 across 1,525 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.

MISSISSIPPI BAND OF CHOCTAW INDIANSCHOCTAWProvider total: $57.0M
criticalCost OutlierScore: 16.9

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

MISSISSIPPI BAND OF CHOCTAW INDIANS (1073715579) bills $572.22/claim for D0220 (Intraoral - periapical first image) vs avg $11.97 (+16.9Οƒ). $74,388 across 130 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.

MISSISSIPPI BAND OF CHOCTAW INDIANSCHOCTAWProvider total: $437.7K
criticalCost OutlierScore: 15.6

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

MISSISSIPPI BAND OF CHOCTAW INDIANS (1073715579) bills $441.76/claim for D1206 (Topical fluoride varnish) vs avg $19.49 (+15.6Οƒ). $147,107 across 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.

MISSISSIPPI BAND OF CHOCTAW INDIANSCHOCTAWProvider total: $437.7K
criticalCost OutlierScore: 12.1

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

AILEEN DANKO MD LLC (1710266820) bills $452.60/claim for 99203 (Office o/p new low 30 min) vs avg $55.27 (+12.1Οƒ). $19,462 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.

AILEEN DANKO MD LLCCANTONProvider total: $174.0K
criticalCost OutlierScore: 11.0

Cost-per-claim above average for 97535

CTS,LLC (1366951410) bills $82.39/claim for 97535 (Self care mngment training) vs avg $2.40 (+11.0Οƒ). $12,935 across 157 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.

CTS,LLCOLIVE BRANCHProvider total: $541.4K
criticalCost OutlierScore: 10.4

Cost-per-claim above average for D0272 (Dental X-rays (Bitewings, 2 Films))

MISSISSIPPI BAPTIST MEDICAL CENTER, INC. (1710909585) bills $1,031.79/claim for D0272 (Bitewings - two radiographic images) vs avg $29.28 (+10.5Οƒ). $13,413 across 13 claims.

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

MISSISSIPPI BAPTIST MEDICAL CENTER, INC.JACKSONProvider total: $42.0M
criticalCost OutlierScore: 9.4

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

NORTH SUNFLOWER MEDICAL CENTER (1508913609) bills $58.05/claim for J2405 (Ondansetron hcl injection) vs avg $1.05 (+9.5Οƒ). $452,648 across 7,797 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.

NORTH SUNFLOWER MEDICAL CENTERRULEVILLEProvider total: $15.9M
criticalCost OutlierScore: 8.9

Cost-per-claim above average for 36415 (Blood Draw (Venipuncture))

MISSISSIPPI UROLOGY CLINIC, PLLC (1902837313) bills $23.37/claim for 36415 (Coll venous bld venipuncture) vs avg $1.77 (+8.9Οƒ). $15,402 across 659 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.

MISSISSIPPI UROLOGY CLINIC, PLLCJACKSONProvider total: $41.1K
criticalCost OutlierScore: 8.7

Cost-per-claim above average for J3490

BOND PHARMACY INC (1336243393) bills $68.19/claim for J3490 (Drugs unclassified injection) vs avg $1.19 (+8.7Οƒ). $1,462,060 across 21,441 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.

BOND PHARMACY INCRIDGELANDProvider total: $10.4M
criticalCost OutlierScore: 8.3

Cost-per-claim above average for S5150

LENDING LOVE (1104280353) bills $1,121.97/claim for S5150 (Unskilled respite care /15m) vs avg $83.18 (+8.3Οƒ). $315,273 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.

LENDING LOVENATCHEZProvider total: $315.3K
criticalCost OutlierScore: 8.3

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

GPCH-GP, INC. (1598719577) bills $586.04/claim for 99283 (Emergency dept visit low mdm) vs avg $73.43 (+8.3Οƒ). $1,051,946 across 1,795 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.

GPCH-GP, INC.GULFPORTProvider total: $1.1M
criticalOverutilizationScore: 8.3

Unusually high claims-per-beneficiary ratio

SPRINGWOOD HEALTH & SUPPORTIVE LIVING SERVICES (1538792932): 31.0 claims/beneficiary (avg 2.6). 2,232 claims, 72 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.

SPRINGWOOD HEALTH & SUPPORTIVE LIVING SERVICESOLIVE BRANCHProvider total: $665.2K
criticalCost OutlierScore: 8.2

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

SINGING RIVER GULFPORT (1639797913) bills $1,093.85/claim for D7140 (Extraction erupted tooth or exposed root) vs avg $95.32 (+8.2Οƒ). $15,314 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.

SINGING RIVER GULFPORTGULFPORTProvider total: $25.0M
criticalCost OutlierScore: 7.5

Cost-per-claim above average for J2704

MEMORIAL HOSPITAL AT GULFPORT (1215546635) bills $60.49/claim for J2704 (Inj, propofol, 10 mg) vs avg $1.17 (+7.5Οƒ). $19,297 across 319 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.

MEMORIAL HOSPITAL AT GULFPORTBILOXIProvider total: $20.7K
criticalCost OutlierScore: 7.5

Cost-per-claim above average for 81002 (Urinalysis without Microscopy)

BAPTIST MEDICAL CENTER-LEAKE, INC. (1194861260) bills $10.90/claim for 81002 (Urinalysis nonauto w/o scope) vs avg $1.34 (+7.5Οƒ). $19,643 across 1,802 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.

BAPTIST MEDICAL CENTER-LEAKE, INC.CARTHAGEProvider total: $2.2M
criticalCost OutlierScore: 7.4

Cost-per-claim above average for 99204 (Office Visit, New Patient (45 min, Moderate Complexity))

AILEEN DANKO MD LLC (1710266820) bills $332.87/claim for 99204 (Office o/p new mod 45 min) vs avg $68.60 (+7.4Οƒ). $97,865 across 294 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.

AILEEN DANKO MD LLCCANTONProvider total: $174.0K
criticalCost OutlierScore: 7.4

Cost-per-claim above average for 90670

OCHSNER MEDICAL CENTER - HANCOCK LLC (1588629968) bills $106.89/claim for 90670 (Pcv13 vaccine im) vs avg $4.28 (+7.4Οƒ). $17,743 across 166 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.

OCHSNER MEDICAL CENTER - HANCOCK LLCBAY SAINT LOUISProvider total: $16.9M
criticalCost OutlierScore: 7.3

Cost-per-claim above average for J3010

BOND PHARMACY INC (1336243393) bills $34.53/claim for J3010 (Fentanyl citrate injection) vs avg $0.86 (+7.3Οƒ). $285,215 across 8,261 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.

BOND PHARMACY INCRIDGELANDProvider total: $10.4M
criticalOverutilizationScore: 7.3

Unusually high claims-per-beneficiary ratio

TF ACQUISITION LLC (1740900042): 27.6 claims/beneficiary (avg 2.6). 8,183 claims, 297 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.

TF ACQUISITION LLCTERRYProvider total: $532.7K
criticalCost OutlierScore: 7.3

Cost-per-claim above average for T1019

SOUTHERN HEALTHCARE AGENCY, INC. (1336338763) bills $2,366.49/claim for T1019 (Personal care ser per 15 min) vs avg $197.46 (+7.3Οƒ). $20,037,064 across 8,467 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.

SOUTHERN HEALTHCARE AGENCY, INC.RIDGELANDProvider total: $83.7M
criticalCost OutlierScore: 7.1

Cost-per-claim above average for D0272 (Dental X-rays (Bitewings, 2 Films))

BAPTIST MEMORIAL HOSPITAL NORTH MISSISSIPPI, INC (1053375576) bills $714.60/claim for D0272 (Bitewings - two radiographic images) vs avg $29.28 (+7.1Οƒ). $686,730 across 961 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.

BAPTIST MEMORIAL HOSPITAL NORTH MISSISSIPPI, INCOXFORDProvider total: $38.9M
criticalCost OutlierScore: 7.1

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

AMANDA TAPPER (1477281905) bills $103.56/claim for 97110 (Therapeutic exercises) vs avg $20.52 (+7.1Οƒ). $20,506 across 198 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.

AMANDA TAPPERGULFPORTProvider total: $20.5K
criticalOverutilizationScore: 7.1

Unusually high claims-per-beneficiary ratio

CAROL NEWTON (1083128698): 27.0 claims/beneficiary (avg 2.6). 44,298 claims, 1,641 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.

CAROL NEWTONHAZLEHURSTProvider total: $2.5M
criticalCost OutlierScore: 7.1

Cost-per-claim above average for 99173

NORTH MISSISSIPPI MEDICAL CENTER INC. (1649727447) bills $25.92/claim for 99173 (Visual acuity screen) vs avg $1.27 (+7.1Οƒ). $28,223 across 1,089 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.

NORTH MISSISSIPPI MEDICAL CENTER INC.TUPELOProvider total: $7.7M
criticalCost OutlierScore: 7.0

Cost-per-claim above average for J1170

BOND PHARMACY INC (1336243393) bills $60.63/claim for J1170 (Injection, hydromorphone, up to 4 mg) vs avg $1.38 (+7.0Οƒ). $422,041 across 6,961 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.

BOND PHARMACY INCRIDGELANDProvider total: $10.4M
criticalCost OutlierScore: 6.9

Cost-per-claim above average for D2930

RUSH MEDICAL FOUNDATION (1770543399) bills $424.18/claim for D2930 (Prefabricated stainless steel crown primary) vs avg $109.11 (+6.9Οƒ). $37,752 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.

RUSH MEDICAL FOUNDATIONMERIDIANProvider total: $29.4M
criticalCost OutlierScore: 6.9

Cost-per-claim above average for D0272 (Dental X-rays (Bitewings, 2 Films))

KING'S DAUGHTERS MEDICAL CENTER (1972503464) bills $688.10/claim for D0272 (Bitewings - two radiographic images) vs avg $29.28 (+6.9Οƒ). $500,248 across 727 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.

KING'S DAUGHTERS MEDICAL CENTERBROOKHAVENProvider total: $32.2M
criticalOverutilizationScore: 6.8

Unusually high claims-per-beneficiary ratio

ISLUV ROBERTSON (1649758301): 26.0 claims/beneficiary (avg 2.6). 6,465 claims, 249 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.

ISLUV ROBERTSONJACKSONProvider total: $3.7M
criticalCost OutlierScore: 6.7

Cost-per-claim above average for 92507 (Speech-Language Therapy (Individual))

DEBORAH SEBRELL (1821188285) bills $281.27/claim for 92507 (Tx sp lang voice comm indiv) vs avg $43.31 (+6.6Οƒ). $53,161 across 189 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.

DEBORAH SEBRELLJACKSONProvider total: $53.2K
criticalCost OutlierScore: 6.6

Cost-per-claim above average for J2001

INDEPENDENT HEALTHCARE MANAGEMENT, INC. (1306909734) bills $258.01/claim for J2001 (Injection, lidocaine hcl for intravenous infusion, 10 mg) vs avg $5.80 (+6.6Οƒ). $16,513 across 64 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.

INDEPENDENT HEALTHCARE MANAGEMENT, INC.FORESTProvider total: $12.4M
criticalCost OutlierScore: 6.6

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

NORTH MISSISSIPPI MEDICAL CENTER INC. (1649727447) bills $45.19/claim for 96127 (Brief emotional/behav assmt) vs avg $3.22 (+6.6Οƒ). $12,066 across 267 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.

NORTH MISSISSIPPI MEDICAL CENTER INC.TUPELOProvider total: $7.7M
criticalCost OutlierScore: 6.6

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

FORREST COUNTY GENERAL HOSPITAL (1225041809) bills $897.53/claim for D7140 (Extraction erupted tooth or exposed root) vs avg $95.32 (+6.6Οƒ). $22,438 across 25 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.

FORREST COUNTY GENERAL HOSPITALHATTIESBURGProvider total: $81.6M
criticalCost OutlierScore: 6.6

Cost-per-claim above average for A7038

KCC, INC. (1780619528) bills $23.25/claim for A7038 (Pos airway pressure filter) vs avg $3.47 (+6.6Οƒ). $68,805 across 2,960 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.

KCC, INC.MERIDIANProvider total: $211.8K
criticalCost OutlierScore: 6.5

Cost-per-claim above average for J0690

KING'S DAUGHTERS MEDICAL CENTER (1972503464) bills $19.71/claim for J0690 (Cefazolin sodium injection) vs avg $0.57 (+6.5Οƒ). $11,786 across 598 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.

KING'S DAUGHTERS MEDICAL CENTERBROOKHAVENProvider total: $32.2M
criticalCost OutlierScore: 6.5

Cost-per-claim above average for J2930

SOUTH CENTRAL REGIONAL MEDICAL CENTER (1619973542) bills $8.57/claim for J2930 (Injection, methylprednisolone sodium succinate, up to 125 mg) vs avg $0.50 (+6.5Οƒ). $20,510 across 2,394 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.

SOUTH CENTRAL REGIONAL MEDICAL CENTERLAURELProvider total: $48.0M
criticalCost OutlierScore: 6.3

Cost-per-claim above average for D0272 (Dental X-rays (Bitewings, 2 Films))

BAPTIST MEMORIAL HOSPITAL-DESOTO, INC, (1194789818) bills $637.02/claim for D0272 (Bitewings - two radiographic images) vs avg $29.28 (+6.3Οƒ). $717,920 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.

BAPTIST MEMORIAL HOSPITAL-DESOTO, INC,SOUTHAVENProvider total: $41.7M
criticalCost OutlierScore: 6.3

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

MS STATE DEPARTMENT OF HEALTH (1053489260) bills $229.79/claim for 99213 (Office o/p est low 20 min) vs avg $43.05 (+6.3Οƒ). $5,909,027 across 25,715 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.

MS STATE DEPARTMENT OF HEALTHJACKSONProvider total: $14.4M
criticalCost OutlierScore: 6.3

Cost-per-claim above average for T1019

NEVAEH HOSPICE (1639890957) bills $2,071.74/claim for T1019 (Personal care ser per 15 min) vs avg $197.46 (+6.3Οƒ). $486,858 across 235 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.

NEVAEH HOSPICEMOUND BAYOUProvider total: $486.9K
criticalOverutilizationScore: 6.3

Unusually high claims-per-beneficiary ratio

MARY DARBY-MCLAURIN (1144579400): 24.1 claims/beneficiary (avg 2.6). 46,951 claims, 1,947 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.

MARY DARBY-MCLAURINLAURELProvider total: $2.8M
criticalCost OutlierScore: 6.2

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

PHYLLIS HAMMOND (1639354418) bills $249.54/claim for 90834 (Psytx w pt 45 minutes) vs avg $58.60 (+6.2Οƒ). $34,187 across 137 claims.

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

PHYLLIS HAMMONDCANTONProvider total: $127.5K
criticalCost OutlierScore: 6.2

Cost-per-claim above average for J2360

VICKSBURG HEALTHCARE LLC (1215981303) bills $44.32/claim for J2360 (Orphenadrine injection) vs avg $1.28 (+6.1Οƒ). $16,619 across 375 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.

VICKSBURG HEALTHCARE LLCVICKSBURGProvider total: $23.0M
criticalCost OutlierScore: 6.1

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

LOUISE USHER (1851693840) bills $41.65/claim for 96127 (Brief emotional/behav assmt) vs avg $3.22 (+6.1Οƒ). $32,111 across 771 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.

LOUISE USHEROCEAN SPRINGSProvider total: $200.2K
criticalCost OutlierScore: 6.0

Cost-per-claim above average for J3420

WEBSTER HEALTH SERVICES, INC. (1639584352) bills $6.58/claim for J3420 (Vitamin b12 injection) vs avg $0.52 (+6.0Οƒ). $14,930 across 2,268 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.

WEBSTER HEALTH SERVICES, INC.EUPORAProvider total: $2.8M
criticalCost OutlierScore: 6.0

Cost-per-claim above average for D0272 (Dental X-rays (Bitewings, 2 Films))

BAPTIST MEMORIAL HOSPITAL UNION COUNTY, INC. (1780648352) bills $605.55/claim for D0272 (Bitewings - two radiographic images) vs avg $29.28 (+6.0Οƒ). $89,621 across 148 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.

BAPTIST MEMORIAL HOSPITAL UNION COUNTY, INC.NEW ALBANYProvider total: $32.8M
criticalCost OutlierScore: 6.0

Cost-per-claim above average for D7240 (Tooth Extraction (Impacted, Completely Bony))

BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC (1285164046) bills $1,181.04/claim for D7240 (Removal of impacted tooth - completely bony) vs avg $228.40 (+6.0Οƒ). $25,983 across 22 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.

BOA VIDA HOSPITAL OF ABERDEEN, MS, LLCABERDEENProvider total: $5.0M
criticalCost OutlierScore: 6.0

Cost-per-claim above average for 93010

COPIAH COUNTY MEDICAL CENTER (1588667281) bills $17.82/claim for 93010 (Electrocardiogram report) vs avg $3.08 (+6.0Οƒ). $18,034 across 1,012 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.

COPIAH COUNTY MEDICAL CENTERHAZLEHURSTProvider total: $9.9M
criticalCost OutlierScore: 6.0

Cost-per-claim above average for 99152

VIVEK BARCLAY (1578594586) bills $35.98/claim for 99152 (Mod sed same phys/qhp 5/>yrs) vs avg $3.11 (+6.0Οƒ). $11,549 across 321 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.

VIVEK BARCLAYLAURELProvider total: $329.0K
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