Statistical Outliers

Single-test outliers in New York 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

1,581

warning

2,926

info

19,589

Total

24,096

Outliers by Type

Severity Distribution

critical

1,581 (6.6%)

warning

2,926 (12.1%)

info

19,589 (81.3%)

Hide FQHC / RHC436Hide tribal915,402 results

criticalCost OutlierScore: 40.9

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

ILLUMINATE ABA SERVICES LLC (1457926560) bills $1,279.16/claim for 96127 (Brief emotional/behav assmt) vs avg $4.46 (+40.9σ). $278,857 across 218 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.

ILLUMINATE ABA SERVICES LLCBROOKLYNProvider total: $4.5M

criticalCost OutlierScore: 40.2

Cost-per-claim above average for 1160F

NIAGARA FALLS MEMORIAL MEDICAL CENTER (1285717298) bills $44.86/claim for 1160F vs avg $0.06 (+40.2σ). $31,136 across 694 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.

NIAGARA FALLS MEMORIAL MEDICAL CENTERNIAGARA FALLSProvider total: $59.9M

criticalCost OutlierScore: 36.7

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

ST REGIS MOHAWK TRIBE (1659521052) bills $403.67/claim for 90471 (Immunization admin) vs avg $11.63 (+36.7σ). $125,139 across 310 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 REGIS MOHAWK TRIBETribalAKWESASNEProvider total: $10.3M

criticalCost OutlierScore: 31.0

Cost-per-claim above average for 1159F

NIAGARA FALLS MEMORIAL MEDICAL CENTER (1285717298) bills $21.90/claim for 1159F vs avg $0.06 (+31.0σ). $112,767 across 5,149 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.

NIAGARA FALLS MEMORIAL MEDICAL CENTERNIAGARA FALLSProvider total: $59.9M

criticalCost OutlierScore: 29.2

Cost-per-claim above average for 3074F

THE INSTITUTE FOR FAMILY HEALTH (1477827624) bills $71.98/claim for 3074F vs avg $0.61 (+29.2σ). $21,665 across 301 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 INSTITUTE FOR FAMILY HEALTHKINGSTONProvider total: $4.5M

criticalCost OutlierScore: 26.9

Cost-per-claim above average for T1019

111 ENSMINGER ROAD OPERATING COMPANY, LLC (1467814632) bills $3,086.77/claim for T1019 (Personal care ser per 15 min) vs avg $152.26 (+26.9σ). $40,128 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.

111 ENSMINGER ROAD OPERATING COMPANY, LLCTONAWANDAProvider total: $40.1K

criticalCost OutlierScore: 26.7

Cost-per-claim above average for D0210 (Full Mouth X-rays)

NEW YORK CITY HEALTH AND HOSPITALS CORPORATION (1073535027) bills $718.75/claim for D0210 (Intraoral - complete series) vs avg $28.06 (+26.7σ). $347,874 across 484 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.

NEW YORK CITY HEALTH AND HOSPITALS CORPORATIONNEW YORKProvider total: $176.3M

criticalCost OutlierScore: 26.6

Cost-per-claim above average for 3074F

THE INSTITUTE FOR FAMILY HEALTH (1609373158) bills $65.53/claim for 3074F vs avg $0.61 (+26.6σ). $15,268 across 233 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 INSTITUTE FOR FAMILY HEALTHBRONXProvider total: $110.8K

criticalCost OutlierScore: 26.5

Cost-per-claim above average for 1126F

WYCKOFF HEIGHTS MEDICAL CENTER (1700886322) bills $21.70/claim for 1126F vs avg $0.09 (+26.5σ). $291,043 across 13,411 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.

WYCKOFF HEIGHTS MEDICAL CENTERBROOKLYNProvider total: $117.8M

criticalCost OutlierScore: 25.0

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

ST REGIS MOHAWK TRIBE (1659521052) bills $187.32/claim for 81003 (Urinalysis auto w/o scope) vs avg $1.82 (+25.0σ). $22,853 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.

ST REGIS MOHAWK TRIBETribalAKWESASNEProvider total: $10.3M

criticalCost OutlierScore: 24.0

Cost-per-claim above average for 1159F

WYCKOFF HEIGHTS MEDICAL CENTER (1700886322) bills $16.97/claim for 1159F vs avg $0.06 (+24.0σ). $296,740 across 17,486 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.

WYCKOFF HEIGHTS MEDICAL CENTERBROOKLYNProvider total: $117.8M

criticalCost OutlierScore: 23.9

Cost-per-claim above average for 3008F

EAST HARLEM COUNCIL FOR HUMAN SERVICES INC (1467486449) bills $29.99/claim for 3008F vs avg $0.06 (+23.9σ). $3,934,990 across 131,209 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.

EAST HARLEM COUNCIL FOR HUMAN SERVICES INCNEW YORKProvider total: $17.4M

criticalCost OutlierScore: 22.5

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

RIVER HOSPITAL, INC. (1003814641) bills $142.40/claim for 36415 (Coll venous bld venipuncture) vs avg $1.68 (+22.5σ). $880,899 across 6,186 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.

RIVER HOSPITAL, INC.ALEXANDRIA BAYProvider total: $13.5M

criticalCost OutlierScore: 22.5

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

COMMUNITY MEMORIAL HOSPITAL (1609303692) bills $142.35/claim for 36415 (Coll venous bld venipuncture) vs avg $1.68 (+22.5σ). $33,737 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.

COMMUNITY MEMORIAL HOSPITALRHCHAMILTONProvider total: $598.4K

criticalCost OutlierScore: 22.4

Cost-per-claim above average for 99285 (Emergency Dept Visit (High Complexity))

CHELSY CAREN (1346207602) bills $1,254.83/claim for 99285 (Emergency dept visit hi mdm) vs avg $56.35 (+22.3σ). $247,201 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.

CHELSY CARENSLINGERLANDSProvider total: $2.3M

criticalCost OutlierScore: 21.9

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

ST REGIS MOHAWK TRIBE (1457344558) bills $514.67/claim for 80061 (Lipid panel) vs avg $8.96 (+21.9σ). $206,382 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.

ST REGIS MOHAWK TRIBEFQHCAKWESASNEProvider total: $9.6M

criticalCost OutlierScore: 21.7

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

CHELSY CAREN (1346207602) bills $1,161.84/claim for 99284 (Emergency dept visit mod mdm) vs avg $55.18 (+21.7σ). $1,791,560 across 1,542 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.

CHELSY CARENSLINGERLANDSProvider total: $2.3M

criticalCost OutlierScore: 20.8

Cost-per-claim above average for 91301

ST REGIS MOHAWK TRIBE (1659521052) bills $511.20/claim for 91301 (Code 91301) vs avg $1.38 (+20.8σ). $442,188 across 865 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 REGIS MOHAWK TRIBETribalAKWESASNEProvider total: $10.3M

criticalCost OutlierScore: 20.6

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

SENECA NATION OF INDIANS (1477562288) bills $708.56/claim for 99213 (Office o/p est low 20 min) vs avg $45.38 (+20.6σ). $90,696 across 128 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.

SENECA NATION OF INDIANSFQHCIRVINGProvider total: $956.6K

criticalCost OutlierScore: 20.6

Cost-per-claim above average for 1000F

HARMONY HEALTH CARE LONG ISLAND (1881028108) bills $8.84/claim for 1000F vs avg $0.04 (+20.5σ). $15,904 across 1,799 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.

HARMONY HEALTH CARE LONG ISLANDFQHCFREEPORTProvider total: $5.4M

criticalCost OutlierScore: 20.3

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

NEW YORK CITY HEALTH AND HOSPITALS CORPORATION (1508985052) bills $697.06/claim for 99213 (Office o/p est low 20 min) vs avg $45.38 (+20.3σ). $464,240 across 666 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.

NEW YORK CITY HEALTH AND HOSPITALS CORPORATIONNEW YORKProvider total: $2.3M

criticalCost OutlierScore: 20.0

Cost-per-claim above average for 99000

CARTHAGE AREA HOSPITAL, INC. (1104234376) bills $257.33/claim for 99000 (Specimen handling office-lab) vs avg $1.63 (+20.0σ). $263,760 across 1,025 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.

CARTHAGE AREA HOSPITAL, INC.CARTHAGEProvider total: $16.1M

criticalCost OutlierScore: 19.9

Cost-per-claim above average for 0011A

ST REGIS MOHAWK TRIBE (1457344558) bills $408.04/claim for 0011A vs avg $28.96 (+19.9σ). $122,004 across 299 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 REGIS MOHAWK TRIBEFQHCAKWESASNEProvider total: $9.6M

criticalCost OutlierScore: 19.7

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

CLIFTON-FINE HEALTHCARE CORPORATION (1235184649) bills $125.10/claim for 36415 (Coll venous bld venipuncture) vs avg $1.68 (+19.7σ). $322,874 across 2,581 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.

CLIFTON-FINE HEALTHCARE CORPORATIONSTAR LAKEProvider total: $1.2M

criticalCost OutlierScore: 19.7

Cost-per-claim above average for 0012A

ST REGIS MOHAWK TRIBE (1457344558) bills $403.22/claim for 0012A vs avg $34.00 (+19.7σ). $143,546 across 356 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 REGIS MOHAWK TRIBEFQHCAKWESASNEProvider total: $9.6M

criticalCost OutlierScore: 19.3

Cost-per-claim above average for 85025 (Complete Blood Count (CBC) with Differential)

JASON BOULWARE (1013211168) bills $105.80/claim for 85025 (Complete cbc w/auto diff wbc) vs avg $3.30 (+19.3σ). $24,546 across 232 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.

JASON BOULWAREBRONXProvider total: $811.2K

criticalCost OutlierScore: 19.1

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

SENECA NATION OF INDIANS (1609882976) bills $659.54/claim for 99213 (Office o/p est low 20 min) vs avg $45.38 (+19.1σ). $31,658 across 48 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.

SENECA NATION OF INDIANSFQHCSALAMANCAProvider total: $1.2M

criticalCost OutlierScore: 19.1

Cost-per-claim above average for D0210 (Full Mouth X-rays)

MARK DAWOUD (1013277037) bills $521.72/claim for D0210 (Intraoral - complete series) vs avg $28.06 (+19.1σ). $42,781 across 82 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.

MARK DAWOUDMIDDLETOWNProvider total: $753.2K

criticalCost OutlierScore: 18.6

Cost-per-claim above average for 81025

ST. JOHN'S RIVERSIDE HOSPITAL (1578526695) bills $484.91/claim for 81025 (Urine pregnancy test) vs avg $8.83 (+18.6σ). $828,712 across 1,709 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.

ST. JOHN'S RIVERSIDE HOSPITALYONKERSProvider total: $66.3M

criticalCost OutlierScore: 18.4

Cost-per-claim above average for 94760

BRONXCARE DR. MARTIN LUTHER KING JR. HEALTH CENTER (1700184116) bills $80.48/claim for 94760 (Measure blood oxygen level) vs avg $0.91 (+18.4σ). $102,365 across 1,272 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.

BRONXCARE DR. MARTIN LUTHER KING JR. HEALTH CENTERFQHCBRONXProvider total: $7.3M

criticalCost OutlierScore: 18.3

Cost-per-claim above average for J3420

UNION COMMUNITY HEALTH CENTER, INC. (1437255155) bills $34.76/claim for J3420 (Vitamin b12 injection) vs avg $1.03 (+18.3σ). $30,482 across 877 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.

UNION COMMUNITY HEALTH CENTER, INC.BRONXProvider total: $88.7M

criticalCost OutlierScore: 18.2

Cost-per-claim above average for 92015

DAMIAN FAMILY CARE CENTERS, INC. (1346629995) bills $212.25/claim for 92015 (Determine refractive state) vs avg $8.57 (+18.2σ). $129,900 across 612 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.

DAMIAN FAMILY CARE CENTERS, INC.FQHCRHINEBECKProvider total: $2.4M

criticalCost OutlierScore: 18.1

Cost-per-claim above average for 99051

PANI FAMILY MEDICINE LLC (1548827876) bills $191.92/claim for 99051 (Med serv eve/wkend/holiday) vs avg $7.36 (+18.1σ). $616,461 across 3,212 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.

PANI FAMILY MEDICINE LLCOSSININGProvider total: $1.1M

criticalCost OutlierScore: 17.9

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

NEW YORK CITY HEALTH AND HOSPITALS CORPORATION (1508985052) bills $740.74/claim for 99214 (Office o/p est mod 30 min) vs avg $57.84 (+17.9σ). $346,664 across 468 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.

NEW YORK CITY HEALTH AND HOSPITALS CORPORATIONNEW YORKProvider total: $2.3M

criticalCost OutlierScore: 17.7

Cost-per-claim above average for 87880 (Rapid Strep A Test (Optical/Immunoassay))

COMMUNITY MEMORIAL HOSPITAL (1609303692) bills $134.42/claim for 87880 (Strep a assay w/optic) vs avg $7.25 (+17.7σ). $58,070 across 432 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 MEMORIAL HOSPITALRHCHAMILTONProvider total: $598.4K

criticalCost OutlierScore: 17.6

Cost-per-claim above average for 96372

NEW YORK CITY HEALTH AND HOSPITALS CORPORATION (1114133477) bills $444.92/claim for 96372 (Ther/proph/diag inj sc/im) vs avg $13.88 (+17.5σ). $605,984 across 1,362 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.

NEW YORK CITY HEALTH AND HOSPITALS CORPORATIONBROOKLYNProvider total: $5.5M

criticalCost OutlierScore: 17.6

Cost-per-claim above average for 1125F

WYCKOFF HEIGHTS MEDICAL CENTER (1700886322) bills $25.42/claim for 1125F vs avg $0.15 (+17.5σ). $126,946 across 4,993 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.

WYCKOFF HEIGHTS MEDICAL CENTERBROOKLYNProvider total: $117.8M

criticalCost OutlierScore: 17.4

Cost-per-claim above average for 99000

CREST TRANSPORTATION SERVICES, INC. (1649356791) bills $225.00/claim for 99000 (Specimen handling office-lab) vs avg $1.63 (+17.4σ). $32,400 across 144 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.

CREST TRANSPORTATION SERVICES, INC.BROOKLYNProvider total: $27.4M

criticalCost OutlierScore: 17.3

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

SENECA NATION OF INDIANS (1609882976) bills $719.00/claim for 99214 (Office o/p est mod 30 min) vs avg $57.84 (+17.3σ). $12,942 across 18 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.

SENECA NATION OF INDIANSFQHCSALAMANCAProvider total: $1.2M

criticalCost OutlierScore: 16.6

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

NASSAU HEALTH CARE CORPORATION (1891712485) bills $1,135.20/claim for 99283 (Emergency dept visit low mdm) vs avg $51.17 (+16.6σ). $51,084 across 45 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.

NASSAU HEALTH CARE CORPORATIONEAST MEADOWProvider total: $58.4K

criticalCost OutlierScore: 16.6

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

SENECA NATION OF INDIANS (1477562288) bills $690.92/claim for 99214 (Office o/p est mod 30 min) vs avg $57.84 (+16.6σ). $34,546 across 50 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.

SENECA NATION OF INDIANSFQHCIRVINGProvider total: $956.6K

criticalCost OutlierScore: 16.3

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

NEW YORK CITY HEALTH AND HOSPITALS CORPORATION (1063535193) bills $568.69/claim for 99213 (Office o/p est low 20 min) vs avg $45.38 (+16.3σ). $13,649 across 24 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.

NEW YORK CITY HEALTH AND HOSPITALS CORPORATIONNEW YORKProvider total: $6.7M

criticalCost OutlierScore: 15.6

Cost-per-claim above average for 96372

NEW YORK CITY HEALTH AND HOSPITALS CORPORATION (1710105200) bills $397.47/claim for 96372 (Ther/proph/diag inj sc/im) vs avg $13.88 (+15.6σ). $988,511 across 2,487 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.

NEW YORK CITY HEALTH AND HOSPITALS CORPORATIONJAMAICAProvider total: $9.2M

criticalCost OutlierScore: 15.4

Cost-per-claim above average for D1330

DAMIAN FAMILY CARE CENTER, INC. (1619415288) bills $216.90/claim for D1330 (Oral hygiene instructions) vs avg $2.34 (+15.5σ). $12,363 across 57 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.

DAMIAN FAMILY CARE CENTER, INC.FQHCLONG ISLAND CITYProvider total: $43.5K

criticalCost OutlierScore: 15.3

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

CHARLES EVANS CENTER, INC. (1972982007) bills $160.89/claim for D0120 (Periodic oral evaluation) vs avg $21.92 (+15.3σ). $41,188 across 256 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.

CHARLES EVANS CENTER, INC.FQHCBETHPAGEProvider total: $9.9M

criticalCost OutlierScore: 15.2

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

DAMIAN FAMILY CARE CENTERS, INC. (1104908557) bills $194.30/claim for D0150 (Comprehensive oral evaluation) vs avg $24.27 (+15.2σ). $54,016 across 278 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.

DAMIAN FAMILY CARE CENTERS, INC.FQHCBRONXProvider total: $968.4K

criticalCost OutlierScore: 15.1

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

LONG ISLAND SELECT HEALTHCARE, INC. (1295188357) bills $159.00/claim for D0120 (Periodic oral evaluation) vs avg $21.92 (+15.1σ). $277,292 across 1,744 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.

LONG ISLAND SELECT HEALTHCARE, INC.FQHCRIVERHEADProvider total: $6.0M

criticalCost OutlierScore: 14.9

Cost-per-claim above average for 96372

NEW YORK CITY HEALTH AND HOSPITALS CORPORATION (1245458926) bills $380.01/claim for 96372 (Ther/proph/diag inj sc/im) vs avg $13.88 (+14.9σ). $41,802 across 110 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.

NEW YORK CITY HEALTH AND HOSPITALS CORPORATIONBROOKLYNProvider total: $1.7M

criticalCost OutlierScore: 14.8

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

SCHUYLER HOSPITAL INC (1639150477) bills $94.39/claim for 36415 (Coll venous bld venipuncture) vs avg $1.68 (+14.8σ). $400,602 across 4,244 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.

SCHUYLER HOSPITAL INCMONTOUR FALLSProvider total: $10.8M

criticalCost OutlierScore: 14.7

Cost-per-claim above average for G0283

COMMUNITY HEALTH INITIATIVES, INC. (1033581608) bills $99.93/claim for G0283 (Elec stim other than wound) vs avg $4.92 (+14.7σ). $587,512 across 5,879 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 INITIATIVES, INC.FQHCBROOKLYNProvider total: $8.9M

Page 1 of 309