Statistical Outliers

Single-test outliers in North Carolina 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

370

warning

560

info

10,854

Total

11,784

Outliers by Type

Severity Distribution

critical

370 (3.1%)

warning

560 (4.8%)

info

10,854 (92.1%)

9,262 results

criticalCost OutlierScore: 36.7

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

CHEROKEE INDIAN HOSPITAL AUTHORITY (1770662348) bills $695.59/claim for D0120 (Periodic oral evaluation) vs avg $23.93 (+36.7σ). $3,443,187 across 4,950 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.

CHEROKEE INDIAN HOSPITAL AUTHORITYCHEROKEEProvider total: $86.7M

criticalCost OutlierScore: 36.5

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

CHEROKEE INDIAN HOSPITAL AUTHORITY (1770662348) bills $507.22/claim for 90471 (Immunization admin) vs avg $12.78 (+36.5σ). $251,582 across 496 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.

CHEROKEE INDIAN HOSPITAL AUTHORITYCHEROKEEProvider total: $86.7M

criticalCost OutlierScore: 32.4

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

NORTH CAROLINA BAPTIST HOSPITAL (1144211301) bills $658.18/claim for D0150 (Comprehensive oral evaluation) vs avg $39.27 (+32.4σ). $312,636 across 475 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 CAROLINA BAPTIST HOSPITALWINSTON SALEMProvider total: $138.2M

criticalCost OutlierScore: 30.4

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

NORTH CAROLINA BAPTIST HOSPITAL (1144211301) bills $522.45/claim for D0274 (Bitewings - four radiographic images) vs avg $28.08 (+30.4σ). $21,420 across 41 claims.

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

NORTH CAROLINA BAPTIST HOSPITALWINSTON SALEMProvider total: $138.2M

criticalCost OutlierScore: 27.9

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

NOVANT HEALTH NEW HANOVER REGIONAL MEDICAL CENTER LLC (1376139139) bills $211.34/claim for D1206 (Topical fluoride varnish) vs avg $14.74 (+27.9σ). $26,417 across 125 claims.

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

NOVANT HEALTH NEW HANOVER REGIONAL MEDICAL CENTER LLCWILMINGTONProvider total: $57.5M

criticalCost OutlierScore: 26.6

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

CHEROKEE INDIAN HOSPITAL AUTHORITY (1770662348) bills $580.03/claim for 99213 (Office o/p est low 20 min) vs avg $38.43 (+26.6σ). $5,053,201 across 8,712 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.

CHEROKEE INDIAN HOSPITAL AUTHORITYCHEROKEEProvider total: $86.7M

criticalCost OutlierScore: 25.2

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

NORTH CAROLINA BAPTIST HOSPITAL (1144211301) bills $461.70/claim for D0230 (Intraoral - periapical each addl image) vs avg $12.12 (+25.2σ). $185,143 across 401 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 CAROLINA BAPTIST HOSPITALWINSTON SALEMProvider total: $138.2M

criticalCost OutlierScore: 24.8

Cost-per-claim above average for 99199

ONE TO ONE WITH YOUTH, INC. (1861587867) bills $598.12/claim for 99199 (Unlisted special svc px/rprt) vs avg $6.62 (+24.8σ). $443,205 across 741 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.

ONE TO ONE WITH YOUTH, INC.GOLDSBOROProvider total: $16.9M

criticalCost OutlierScore: 23.9

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

ST. LUKE'S HOSPITAL INC. (1245373455) bills $41.99/claim for 36415 (Coll venous bld venipuncture) vs avg $1.78 (+23.9σ). $31,745 across 756 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. LUKE'S HOSPITAL INC.COLUMBUSProvider total: $1.2M

criticalCost OutlierScore: 23.5

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

NOVANT HEALTH NEW HANOVER REGIONAL MEDICAL CENTER LLC (1376139139) bills $256.49/claim for D0272 (Bitewings - two radiographic images) vs avg $17.01 (+23.5σ). $33,857 across 132 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.

NOVANT HEALTH NEW HANOVER REGIONAL MEDICAL CENTER LLCWILMINGTONProvider total: $57.5M

criticalCost OutlierScore: 21.5

Cost-per-claim above average for 99199

SIXTH AVENUE PSYCHIATRIC REHABILITATION PARTNERS, INC. (1801948674) bills $520.07/claim for 99199 (Unlisted special svc px/rprt) vs avg $6.62 (+21.5σ). $713,018 across 1,371 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.

SIXTH AVENUE PSYCHIATRIC REHABILITATION PARTNERS, INC.HENDERSONVILLEProvider total: $713.0K

criticalCost OutlierScore: 21.0

Cost-per-claim above average for 99199

GOLDEN LITTLE STAR CHILD CARE (1558073031) bills $507.69/claim for 99199 (Unlisted special svc px/rprt) vs avg $6.62 (+21.0σ). $4,600,669 across 9,062 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.

GOLDEN LITTLE STAR CHILD CARECONCORDProvider total: $4.6M

criticalCost OutlierScore: 19.8

Cost-per-claim above average for G8427

OPEN WATER MEDICAL, PA (1750482493) bills $10.37/claim for G8427 (Docrev cur meds by elig clin) vs avg $0.03 (+19.8σ). $190,190 across 18,347 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.

OPEN WATER MEDICAL, PABEAUFORTProvider total: $2.3M

criticalCost OutlierScore: 19.1

Cost-per-claim above average for 99199

EDEN OF ABUNDANCE (1033844295) bills $462.21/claim for 99199 (Unlisted special svc px/rprt) vs avg $6.62 (+19.1σ). $903,618 across 1,955 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.

EDEN OF ABUNDANCERUTHERFORDTONProvider total: $903.6K

criticalCost OutlierScore: 18.4

Cost-per-claim above average for 99199

ATCAM LLC (1942527049) bills $444.25/claim for 99199 (Unlisted special svc px/rprt) vs avg $6.62 (+18.4σ). $1,296,309 across 2,918 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.

ATCAM LLCROCKY MOUNTProvider total: $1.3M

criticalCost OutlierScore: 18.1

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

VALLEYGATE DENTAL SURGERY CENTER OF CHARLOTTE LLC (1720573587) bills $439.49/claim for D1120 (Prophylaxis - child) vs avg $26.76 (+18.1σ). $2,012,442 across 4,579 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.

VALLEYGATE DENTAL SURGERY CENTER OF CHARLOTTE LLCCHARLOTTEProvider total: $26.3M

criticalCost OutlierScore: 17.7

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

VALLEYGATE DENTAL SURGERY CENTERS OF THE WEST, LLC (1194230573) bills $429.89/claim for D1120 (Prophylaxis - child) vs avg $26.76 (+17.7σ). $785,839 across 1,828 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.

VALLEYGATE DENTAL SURGERY CENTERS OF THE WEST, LLCGREENSBOROProvider total: $14.2M

criticalCost OutlierScore: 17.6

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

VALLEYGATE DENTAL SURGERY CENTER OF FAYETTEVILLE, LLC (1003321365) bills $426.62/claim for D1120 (Prophylaxis - child) vs avg $26.76 (+17.5σ). $2,261,087 across 5,300 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.

VALLEYGATE DENTAL SURGERY CENTER OF FAYETTEVILLE, LLCFAYETTEVILLEProvider total: $26.5M

criticalCost OutlierScore: 16.0

Cost-per-claim above average for 3044F

EDWIN AVBUERE (1013019470) bills $17.31/claim for 3044F vs avg $0.09 (+16.0σ). $14,141 across 817 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.

EDWIN AVBUEREGREENSBOROProvider total: $263.4K

criticalCost OutlierScore: 16.0

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

CAROLINAS MEDICAL CENTER (1295789907) bills $28.74/claim for 36415 (Coll venous bld venipuncture) vs avg $1.78 (+16.0σ). $2,099,815 across 73,058 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.

CAROLINAS MEDICAL CENTERCHARLOTTEProvider total: $177.7M

criticalCost OutlierScore: 16.0

Cost-per-claim above average for 99509

CYRUS MAX INC (1952980260) bills $2,189.83/claim for 99509 (Home visit day life activity) vs avg $71.84 (+16.0σ). $783,961 across 358 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.

CYRUS MAX INCCONOVERProvider total: $784.0K

criticalCost OutlierScore: 15.8

Cost-per-claim above average for D1208

DUKE UNIVERSITY HEALTH SYSTEM, INC. (1992703540) bills $82.30/claim for D1208 (Topical fluoride excluding varnish) vs avg $15.33 (+15.8σ). $33,333 across 405 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.

DUKE UNIVERSITY HEALTH SYSTEM, INC.DURHAMProvider total: $44.4M

criticalCost OutlierScore: 15.2

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

BRUNSWICK COMMUNITY HOSPITAL, LLC (1710915756) bills $172.02/claim for D0272 (Bitewings - two radiographic images) vs avg $17.01 (+15.2σ). $30,103 across 175 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.

BRUNSWICK COMMUNITY HOSPITAL, LLCBOLIVIAProvider total: $15.0M

criticalCost OutlierScore: 14.2

Cost-per-claim above average for 92551

JOHN PECORAK (1174571632) bills $31.55/claim for 92551 (Pure tone hearing test air) vs avg $1.32 (+14.2σ). $15,367 across 487 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.

JOHN PECORAKASHEVILLEProvider total: $172.6K

criticalCost OutlierScore: 13.7

Cost-per-claim above average for 99205 (Office Visit, New Patient (60 min, High Complexity))

STEPHENS OUTREACH CENTER, INC (1407977390) bills $968.96/claim for 99205 (Office o/p new hi 60 min) vs avg $118.04 (+13.7σ). $12,596 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.

STEPHENS OUTREACH CENTER, INCLUMBERTONProvider total: $17.4M

criticalCost OutlierScore: 13.6

Cost-per-claim above average for 81003 (Urinalysis by Dipstick (Automated))

MERCY HOSPITAL, INC (1497792550) bills $18.01/claim for 81003 (Urinalysis auto w/o scope) vs avg $1.79 (+13.6σ). $27,147 across 1,507 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.

MERCY HOSPITAL, INCCHARLOTTEProvider total: $2.6M

criticalCost OutlierScore: 13.5

Cost-per-claim above average for 96110

WAKEMED (1972579837) bills $74.21/claim for 96110 (Developmental screen w/score) vs avg $7.97 (+13.5σ). $543,604 across 7,325 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.

WAKEMEDRALEIGHProvider total: $140.7M

criticalCost OutlierScore: 13.4

Cost-per-claim above average for 99199

WALKERS GROUP HOME (1639492796) bills $325.95/claim for 99199 (Unlisted special svc px/rprt) vs avg $6.62 (+13.4σ). $984,047 across 3,019 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.

WALKERS GROUP HOMEMORGANTONProvider total: $1.7M

criticalOverutilizationScore: 13.3

Unusually high claims-per-beneficiary ratio

DEEPLY DEVOTED HOME CARE, LLC (1467227744): 114.0 claims/beneficiary (avg 5.2). 5,018 claims, 44 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.

DEEPLY DEVOTED HOME CARE, LLCRIEGELWOODProvider total: $54.0K

criticalCost OutlierScore: 13.2

Cost-per-claim above average for 99072

OPEN WATER MEDICAL, PA (1750482493) bills $17.05/claim for 99072 (Addl supl matrl&staf tm phe) vs avg $0.11 (+13.2σ). $67,963 across 3,987 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.

OPEN WATER MEDICAL, PABEAUFORTProvider total: $2.3M

criticalCost OutlierScore: 13.0

Cost-per-claim above average for 82962

THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY (1396790325) bills $53.75/claim for 82962 (Glucose blood test) vs avg $2.10 (+13.0σ). $94,338 across 1,755 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 CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITYMONROEProvider total: $38.2M

criticalCost OutlierScore: 13.0

Cost-per-claim above average for 94640

AMERICAN HEALTHCARE SYSTEMS, LLC (1942895081) bills $309.15/claim for 94640 (Airway inhalation treatment) vs avg $15.94 (+13.0σ). $73,269 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.

AMERICAN HEALTHCARE SYSTEMS, LLCASHEBOROProvider total: $20.9M

criticalCost OutlierScore: 12.9

Cost-per-claim above average for D0240

WRMC HOSPITAL OPERATING CORPORATION (1881614071) bills $169.49/claim for D0240 (Intraoral - occlusal radiographic image) vs avg $16.83 (+12.9σ). $44,914 across 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.

WRMC HOSPITAL OPERATING CORPORATIONNORTH WILKESBOROProvider total: $9.4M

criticalCost OutlierScore: 12.7

Cost-per-claim above average for 90696

SUNSHINE PEDIATRICS, PA (1093096141) bills $25.69/claim for 90696 (Dtap-ipv vaccine 4-6 yrs im) vs avg $0.29 (+12.7σ). $24,481 across 953 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.

SUNSHINE PEDIATRICS, PASMITHFIELDProvider total: $11.5M

criticalCost OutlierScore: 12.6

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

SCOTLAND MEMORIAL HOSPITAL INC (1457345597) bills $23.05/claim for 36415 (Coll venous bld venipuncture) vs avg $1.78 (+12.6σ). $557,755 across 24,196 claims.

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

SCOTLAND MEMORIAL HOSPITAL INCLAURINBURGProvider total: $39.4M

criticalCost OutlierScore: 12.5

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

SURGICENTER OF EASTERN CAROLINA LLC (1124285515) bills $226.36/claim for D1351 (Sealant per tooth) vs avg $27.47 (+12.5σ). $28,295 across 125 claims.

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

SURGICENTER OF EASTERN CAROLINA LLCGREENVILLEProvider total: $4.6M

criticalCost OutlierScore: 12.0

Cost-per-claim above average for D2330 (Dental Filling, Composite/Resin (One Surface, Anterior))

DUKE UNIVERSITY HEALTH SYSTEM, INC. (1992703540) bills $412.99/claim for D2330 (Resin composite - one surface anterior) vs avg $64.66 (+12.0σ). $28,496 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.

DUKE UNIVERSITY HEALTH SYSTEM, INC.DURHAMProvider total: $44.4M

criticalCost OutlierScore: 11.6

Cost-per-claim above average for 90698

JOHN PECORAK (1174571632) bills $28.76/claim for 90698 (Dtap-ipv/hib vaccine im) vs avg $0.48 (+11.6σ). $11,534 across 401 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.

JOHN PECORAKASHEVILLEProvider total: $172.6K

criticalCost OutlierScore: 11.3

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

MERCY HOSPITAL, INC (1497792550) bills $157.75/claim for J1100 (Dexamethasone sodium phos) vs avg $3.20 (+11.3σ). $52,374 across 332 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.

MERCY HOSPITAL, INCCHARLOTTEProvider total: $2.6M

criticalCost OutlierScore: 11.2

Cost-per-claim above average for 99177

CAROLINAS MEDICAL CENTER (1295789907) bills $58.78/claim for 99177 (Ocular instrumnt screen bil) vs avg $0.84 (+11.2σ). $141,722 across 2,411 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.

CAROLINAS MEDICAL CENTERCHARLOTTEProvider total: $177.7M

criticalCost OutlierScore: 11.2

Cost-per-claim above average for 80061 (Lipid Panel (Cholesterol, HDL, LDL, Triglycerides))

1891799763 (1891799763) bills $86.23/claim for 80061 (Lipid panel) vs avg $10.95 (+11.2σ). $16,988 across 197 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 ST THOMAS EAST END MEDICAL CENTER CORPORATIONST THOMASProvider total: $858.1K

criticalCost OutlierScore: 10.7

Cost-per-claim above average for 99509

CATAWBA OPERATOR LLC (1134970320) bills $1,484.58/claim for 99509 (Home visit day life activity) vs avg $71.84 (+10.6σ). $32,661 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.

CATAWBA OPERATOR LLCCLAREMONTProvider total: $32.7K

criticalCost OutlierScore: 10.5

Cost-per-claim above average for 99509

ST. GALE'S MANOR (1861690877) bills $1,464.83/claim for 99509 (Home visit day life activity) vs avg $71.84 (+10.5σ). $1,996,558 across 1,363 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.

ST. GALE'S MANORGREENSBOROProvider total: $2.0M

criticalCost OutlierScore: 10.5

Cost-per-claim above average for J0696

CAROLINAS MEDICAL CENTER (1295789907) bills $148.29/claim for J0696 (Ceftriaxone sodium injection) vs avg $4.91 (+10.5σ). $84,971 across 573 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.

CAROLINAS MEDICAL CENTERCHARLOTTEProvider total: $177.7M

criticalCost OutlierScore: 10.2

Cost-per-claim above average for 99509

LIBERTY HEALTHCARE GROUP, LLC (1578118089) bills $1,430.43/claim for 99509 (Home visit day life activity) vs avg $71.84 (+10.2σ). $639,402 across 447 claims.

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

LIBERTY HEALTHCARE GROUP, LLCLOUISBURGProvider total: $639.4K

criticalCost OutlierScore: 10.2

Cost-per-claim above average for G8754

OPEN WATER MEDICAL, PA (1750482493) bills $8.40/claim for G8754 (Dias bp less 90) vs avg $0.08 (+10.2σ). $18,200 across 2,166 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.

OPEN WATER MEDICAL, PABEAUFORTProvider total: $2.3M

criticalCost OutlierScore: 10.2

Cost-per-claim above average for E0260 (Hospital Bed, Semi-Electric)

CAROLINA RESPICARE PHARMACY,INC (1609958362) bills $470.04/claim for E0260 (Hospital bed, semi-electric (head and foot adjustment), with any type side) vs avg $25.67 (+10.2σ). $124,091 across 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.

CAROLINA RESPICARE PHARMACY,INCLUMBERTONProvider total: $363.9K

criticalCost OutlierScore: 9.9

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

1437215134 (1437215134) bills $305.02/claim for 90837 (Psytx w pt 60 minutes) vs avg $75.61 (+9.9σ). $19,826 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.

FREDERIKSTED HEALTH CARE, INC.FREDERIKSTEDProvider total: $24.9K

criticalCost OutlierScore: 9.6

Cost-per-claim above average for 81003 (Urinalysis by Dipstick (Automated))

THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY (1396790325) bills $13.23/claim for 81003 (Urinalysis auto w/o scope) vs avg $1.79 (+9.6σ). $31,273 across 2,364 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 CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITYMONROEProvider total: $38.2M

criticalCost OutlierScore: 9.6

Cost-per-claim above average for D0145

TIFFANY CHEN (1871957019) bills $135.89/claim for D0145 (Oral evaluation for patient under 3) vs avg $30.57 (+9.5σ). $12,502 across 92 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.

TIFFANY CHENCHARLOTTEProvider total: $415.7K

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Statistical Outliers

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