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 Ohio 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

760

warning

1,051

info

11,123

Total

12,934

Outliers by Type
Severity Distribution
critical
760 (5.9%)
warning
1,051 (8.1%)
info
11,123 (86.0%)
8,826 results
criticalCost OutlierScore: 32.0

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

MUSKINGUM VALLEY ORAL SURGERY, INC. (1013450014) bills $514.83/claim for D0150 (Comprehensive oral evaluation) vs avg $27.29 (+32.0Οƒ). $65,898 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.

MUSKINGUM VALLEY ORAL SURGERY, INC.MARIETTAProvider total: $447.1K
criticalCost OutlierScore: 19.8

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

THE METROHEALTH SYSTEM (1609043645) bills $392.34/claim for A0425 (Ground mileage) vs avg $15.08 (+19.8Οƒ). $3,162,623 across 8,061 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 METROHEALTH SYSTEMCLEVELANDProvider total: $27.3M
criticalCost OutlierScore: 18.6

Cost-per-claim above average for D2392 (Dental Filling, Composite/Resin (Two Surfaces, Posterior))

UH REGIONAL HOSPITALS (1669562864) bills $716.19/claim for D2392 (Resin composite - two surfaces posterior) vs avg $61.30 (+18.6Οƒ). $34,377 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.

UH REGIONAL HOSPITALSCHARDONProvider total: $23.2M
criticalCost OutlierScore: 18.0

Cost-per-claim above average for D2150 (Dental Filling, Amalgam (Two Surfaces))

UH REGIONAL HOSPITALS (1669562864) bills $749.06/claim for D2150 (Amalgam - two surfaces primary/permanent) vs avg $53.34 (+18.0Οƒ). $16,479 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.

UH REGIONAL HOSPITALSCHARDONProvider total: $23.2M
criticalCost OutlierScore: 17.5

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

LODI COMMUNITY HOSPITAL (1801807870) bills $584.82/claim for 96127 (Brief emotional/behav assmt) vs avg $8.86 (+17.5Οƒ). $160,242 across 274 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.

LODI COMMUNITY HOSPITALLODIProvider total: $17.5M
criticalCost OutlierScore: 17.2

Cost-per-claim above average for 1036F

MARIETTA HEALTH CARE PHYSICIANS, INC. (1912965732) bills $6.40/claim for 1036F vs avg $0.03 (+17.2Οƒ). $16,553 across 2,585 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.

MARIETTA HEALTH CARE PHYSICIANS, INC.MARIETTAProvider total: $5.2M
criticalCost OutlierScore: 16.4

Cost-per-claim above average for 98941

ST VINCENT CHARITY MEDICAL CENTER (1710951801) bills $86.38/claim for 98941 (Chiropract manj 3-4 regions) vs avg $17.58 (+16.4Οƒ). $23,842 across 276 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 VINCENT CHARITY MEDICAL CENTERCLEVELANDProvider total: $22.3M
criticalCost OutlierScore: 16.1

Cost-per-claim above average for H2020

MERAKEY ALLOS (1407208085) bills $1,747.88/claim for H2020 (Ther behav svc, per diem) vs avg $159.69 (+16.1Οƒ). $1,221,769 across 699 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.

MERAKEY ALLOSHAMILTONProvider total: $4.4M
criticalCost OutlierScore: 15.7

Cost-per-claim above average for A0427 (ALS Emergency Ambulance Transport)

THE METROHEALTH SYSTEM (1609043645) bills $668.79/claim for A0427 (Als1-emergency) vs avg $116.07 (+15.7Οƒ). $3,242,978 across 4,849 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 METROHEALTH SYSTEMCLEVELANDProvider total: $27.3M
criticalCost OutlierScore: 15.6

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

THE METROHEALTH SYSTEM (1700828852) bills $981.02/claim for D7140 (Extraction erupted tooth or exposed root) vs avg $64.09 (+15.6Οƒ). $1,368,520 across 1,395 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 METROHEALTH SYSTEMCLEVELANDProvider total: $574.1M
criticalCost OutlierScore: 15.3

Cost-per-claim above average for 99238 (Hospital Discharge Day (30 min or less))

CHILDREN'S HOSPITAL MEDICAL CENTER (1548212988) bills $290.82/claim for 99238 (Hosp ip/obs dschrg mgmt 30/<) vs avg $24.97 (+15.3Οƒ). $14,250 across 49 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.

CHILDREN'S HOSPITAL MEDICAL CENTERCINCINNATIProvider total: $386.7M
criticalCost OutlierScore: 15.2

Cost-per-claim above average for 99232 (Subsequent Hospital Care (Moderate Complexity))

1366519027 (1366519027) bills $177.01/claim for 99232 (Sbsq hosp ip/obs moderate 35) vs avg $18.98 (+15.2Οƒ). $143,735 across 812 claims.

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

GUAM MEMORIAL HOSPITALOKA TAMUNINGProvider total: $257.2K
criticalCost OutlierScore: 14.1

Cost-per-claim above average for 99231 (Subsequent Hospital Care (Low Complexity))

1366519027 (1366519027) bills $112.21/claim for 99231 (Sbsq hosp ip/obs sf/low 25) vs avg $11.47 (+14.1Οƒ). $16,944 across 151 claims.

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

GUAM MEMORIAL HOSPITALOKA TAMUNINGProvider total: $257.2K
criticalCost OutlierScore: 14.1

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

PARVEENCO INTERNATIONAL LLC (1043376973) bills $30.83/claim for 81003 (Urinalysis auto w/o scope) vs avg $1.43 (+14.1Οƒ). $59,108 across 1,917 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.

PARVEENCO INTERNATIONAL LLCCOLUMBUSProvider total: $2.0M
criticalCost OutlierScore: 14.0

Cost-per-claim above average for 80048 (Basic Metabolic Panel (8 tests))

1326447939 (1326447939) bills $156.78/claim for 80048 (Metabolic panel total ca) vs avg $7.95 (+14.0Οƒ). $51,266 across 327 claims.

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

GUAM HEALTHCARE DEVELOPMENT INCORPORATEDDEDEDOProvider total: $853.2K
criticalCost OutlierScore: 13.9

Cost-per-claim above average for J3490

CHILDREN'S HOSPITAL MEDICAL CENTER (1629116645) bills $1,658.57/claim for J3490 (Drugs unclassified injection) vs avg $21.26 (+13.9Οƒ). $16,403,297 across 9,890 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.

CHILDREN'S HOSPITAL MEDICAL CENTERCINCINNATIProvider total: $57.0M
criticalCost OutlierScore: 13.8

Cost-per-claim above average for 99212 (Office Visit, Established Patient (10 min, Straightforward))

VPA PC (1558917443) bills $318.75/claim for 99212 (Office o/p est sf 10 min) vs avg $26.26 (+13.8Οƒ). $21,356 across 67 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.

VPA PCMAUMEEProvider total: $2.8M
criticalCost OutlierScore: 13.8

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

TRAVIS WHITE (1902002421) bills $104.18/claim for D0120 (Periodic oral evaluation) vs avg $17.80 (+13.8Οƒ). $637,894 across 6,123 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.

TRAVIS WHITECINCINNATIProvider total: $1.2M
criticalCost OutlierScore: 13.6

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

BUCYRUS COMMUNITY HOSPITAL LLC (1104914274) bills $18.18/claim for J1100 (Dexamethasone sodium phos) vs avg $0.52 (+13.6Οƒ). $53,201 across 2,927 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.

BUCYRUS COMMUNITY HOSPITAL LLCBUCYRUSProvider total: $10.2M
criticalCost OutlierScore: 13.6

Cost-per-claim above average for G0300

DDC GROUP INC. (1316273121) bills $206.03/claim for G0300 (Hhs/hospice of lpn ea 15 min) vs avg $37.48 (+13.6Οƒ). $16,688 across 81 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.

DDC GROUP INC.CENTERVILLEProvider total: $263.1K
criticalCost OutlierScore: 13.5

Cost-per-claim above average for 93005

1326447939 (1326447939) bills $192.35/claim for 93005 (Electrocardiogram tracing) vs avg $4.57 (+13.5Οƒ). $26,929 across 140 claims.

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

GUAM HEALTHCARE DEVELOPMENT INCORPORATEDDEDEDOProvider total: $853.2K
criticalCost OutlierScore: 12.9

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

LODI COMMUNITY HOSPITAL (1801807870) bills $650.52/claim for 99285 (Emergency dept visit hi mdm) vs avg $94.53 (+12.9Οƒ). $2,833,001 across 4,355 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.

LODI COMMUNITY HOSPITALLODIProvider total: $17.5M
criticalCost OutlierScore: 12.7

Cost-per-claim above average for 97150 (Group Therapeutic Procedure)

CLEVELAND CLINIC CHILDREN'S HOSPITAL FOR REHABILITATION (1033161948) bills $141.11/claim for 97150 (Group therapeutic procedures) vs avg $13.59 (+12.7Οƒ). $125,869 across 892 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.

CLEVELAND CLINIC CHILDREN'S HOSPITAL FOR REHABILITATIONCLEVELANDProvider total: $36.4M
criticalCost OutlierScore: 12.6

Cost-per-claim above average for D2140 (Dental Filling, Amalgam (One Surface))

DAYTON CHILDREN'S HOSPITAL (1457379448) bills $720.64/claim for D2140 (Amalgam - one surface primary/permanent) vs avg $42.47 (+12.6Οƒ). $10,089 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.

DAYTON CHILDREN'S HOSPITALDAYTONProvider total: $290.6M
criticalCost OutlierScore: 12.4

Cost-per-claim above average for 97140 (Manual Therapy (per 15 min))

LODI COMMUNITY HOSPITAL (1801807870) bills $290.25/claim for 97140 (Manual therapy 1/> regions) vs avg $19.93 (+12.4Οƒ). $29,606 across 102 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.

LODI COMMUNITY HOSPITALLODIProvider total: $17.5M
criticalCost OutlierScore: 12.4

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

OPTION CARE ENTERPRISES, INC. (1376631457) bills $30.08/claim for J2405 (Ondansetron hcl injection) vs avg $0.41 (+12.4Οƒ). $18,829 across 626 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.

OPTION CARE ENTERPRISES, INC.MILFORDProvider total: $18.9M
criticalCost OutlierScore: 12.3

Cost-per-claim above average for J1644

MARIETTA MEMORIAL HOSPITAL (1215936927) bills $26.71/claim for J1644 (Inj heparin sodium per 1000u) vs avg $0.40 (+12.3Οƒ). $66,605 across 2,494 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.

MARIETTA MEMORIAL HOSPITALMARIETTAProvider total: $102.3M
criticalCost OutlierScore: 12.2

Cost-per-claim above average for J2250

MARIETTA MEMORIAL HOSPITAL (1215936927) bills $28.88/claim for J2250 (Inj midazolam hydrochloride) vs avg $0.35 (+12.2Οƒ). $174,758 across 6,052 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.

MARIETTA MEMORIAL HOSPITALMARIETTAProvider total: $102.3M
criticalCost OutlierScore: 12.1

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

CLEVELAND CLINIC CHILDREN'S HOSPITAL FOR REHABILITATION (1033161948) bills $263.98/claim for 92507 (Tx sp lang voice comm indiv) vs avg $43.62 (+12.1Οƒ). $15,232,138 across 57,702 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.

CLEVELAND CLINIC CHILDREN'S HOSPITAL FOR REHABILITATIONCLEVELANDProvider total: $36.4M
criticalCost OutlierScore: 12.1

Cost-per-claim above average for S0209

VIZION ONE INC (1568911717) bills $298.83/claim for S0209 (Wc van mileage per mi) vs avg $9.64 (+12.1Οƒ). $91,442 across 306 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.

VIZION ONE INCDAYTONProvider total: $95.0K
criticalCost OutlierScore: 12.1

Cost-per-claim above average for H2019 (Therapeutic Behavioral Services (per 15 min))

THRIVE HOLISTIC COUNSELING AND THERAPY CENTER (1629773189) bills $691.47/claim for H2019 (Ther behav svc, per 15 min) vs avg $87.26 (+12.1Οƒ). $251,004 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.

THRIVE HOLISTIC COUNSELING AND THERAPY CENTERTWINSBURGProvider total: $251.0K
criticalCost OutlierScore: 11.9

Cost-per-claim above average for G0378

ARTHUR G JAMES CANCER HOSPITAL AND RESEARCH INSTITUTE (1124127683) bills $848.04/claim for G0378 (Hospital observation per hr) vs avg $70.07 (+11.9Οƒ). $1,568,867 across 1,850 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.

ARTHUR G JAMES CANCER HOSPITAL AND RESEARCH INSTITUTECOLUMBUSProvider total: $140.7M
criticalCost OutlierScore: 11.9

Cost-per-claim above average for J1200

MARIETTA MEMORIAL HOSPITAL (1215936927) bills $30.41/claim for J1200 (Diphenhydramine hcl injectio) vs avg $0.43 (+11.9Οƒ). $76,925 across 2,530 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.

MARIETTA MEMORIAL HOSPITALMARIETTAProvider total: $102.3M
criticalCost OutlierScore: 11.9

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

IGOR KANTOROVICH (1619012267) bills $137.90/claim for D0140 (Limited oral evaluation - problem focused) vs avg $22.68 (+11.9Οƒ). $11,170 across 81 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.

IGOR KANTOROVICHBROADVIEW HEIGHTSProvider total: $22.2K
criticalCost OutlierScore: 11.8

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

1326447939 (1326447939) bills $690.93/claim for 99283 (Emergency dept visit low mdm) vs avg $64.83 (+11.8Οƒ). $262,553 across 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.

GUAM HEALTHCARE DEVELOPMENT INCORPORATEDDEDEDOProvider total: $853.2K
criticalCost OutlierScore: 11.7

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

DAYTON CHILDREN'S HOSPITAL (1457379448) bills $663.12/claim for D1351 (Sealant per tooth) vs avg $28.62 (+11.7Οƒ). $796,413 across 1,201 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.

DAYTON CHILDREN'S HOSPITALDAYTONProvider total: $290.6M
criticalCost OutlierScore: 11.6

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

STEWARD HILLSIDE REHABILITATION HOSPITAL, INC. (1487187191) bills $273.69/claim for 97530 (Therapeutic activities) vs avg $22.58 (+11.6Οƒ). $932,461 across 3,407 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.

STEWARD HILLSIDE REHABILITATION HOSPITAL, INC.WARRENProvider total: $2.7M
criticalCost OutlierScore: 11.6

Cost-per-claim above average for 92508 (Speech-Language Therapy (Group))

DAYTON CHILDREN'S HOSPITAL (1457379448) bills $142.61/claim for 92508 (Tx sp lang voice comm group) vs avg $21.58 (+11.6Οƒ). $113,942 across 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.

DAYTON CHILDREN'S HOSPITALDAYTONProvider total: $290.6M
criticalCost OutlierScore: 11.5

Cost-per-claim above average for H0015 (Alcohol/Drug Services (Intensive Outpatient))

DAVID GUARDIOLA (1376829986) bills $778.43/claim for H0015 (Alcohol and/or drug services; intensive outpatient (treatment program that) vs avg $137.25 (+11.5Οƒ). $73,951 across 95 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.

DAVID GUARDIOLAFREMONTProvider total: $93.2K
criticalCost OutlierScore: 11.4

Cost-per-claim above average for H2036

GLENBEIGH (1790761922) bills $5,685.70/claim for H2036 (A/d tx program, per diem) vs avg $244.96 (+11.4Οƒ). $16,778,490 across 2,951 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.

GLENBEIGHROCK CREEKProvider total: $26.5M
criticalCost OutlierScore: 11.4

Cost-per-claim above average for 92508 (Speech-Language Therapy (Group))

CLEVELAND CLINIC CHILDREN'S HOSPITAL FOR REHABILITATION (1033161948) bills $140.65/claim for 92508 (Tx sp lang voice comm group) vs avg $21.58 (+11.4Οƒ). $17,018 across 121 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.

CLEVELAND CLINIC CHILDREN'S HOSPITAL FOR REHABILITATIONCLEVELANDProvider total: $36.4M
criticalCost OutlierScore: 11.3

Cost-per-claim above average for 99233 (Subsequent Hospital Care (High Complexity))

CLAIRE SEGUIN (1659733483) bills $186.69/claim for 99233 (Sbsq hosp ip/obs high 50) vs avg $27.00 (+11.3Οƒ). $12,135 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.

CLAIRE SEGUINCOLUMBUSProvider total: $32.6K
criticalCost OutlierScore: 11.2

Cost-per-claim above average for 71045 (Chest X-ray (Single View))

ARTHUR G JAMES CANCER HOSPITAL AND RESEARCH INSTITUTE (1124127683) bills $50.18/claim for 71045 (X-ray exam chest 1 view) vs avg $4.63 (+11.2Οƒ). $36,533 across 728 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.

ARTHUR G JAMES CANCER HOSPITAL AND RESEARCH INSTITUTECOLUMBUSProvider total: $140.7M
criticalOverutilizationScore: 10.7

Unusually high claims-per-beneficiary ratio

PRESTIGE HOME HEALTH SERVICES LLC (1609321710): 61.7 claims/beneficiary (avg 3.3). 63,639 claims, 1,031 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.

PRESTIGE HOME HEALTH SERVICES LLCWESTERVILLEProvider total: $2.4M
criticalOverutilizationScore: 10.7

Unusually high claims-per-beneficiary ratio

STONERISE RELIABLE HEALTHCARE LLC (1679092902): 61.6 claims/beneficiary (avg 3.3). 739 claims, 12 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.

STONERISE RELIABLE HEALTHCARE LLCSAINT CLAIRSVILLEProvider total: $59.8K
criticalCost OutlierScore: 10.4

Cost-per-claim above average for 99202 (Office Visit, New Patient (15 min, Straightforward))

VPA PC (1558917443) bills $301.95/claim for 99202 (Office o/p new sf 15 min) vs avg $32.00 (+10.4Οƒ). $1,046,566 across 3,466 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.

VPA PCMAUMEEProvider total: $2.8M
criticalCost OutlierScore: 10.4

Cost-per-claim above average for D2391 (Dental Filling, Composite/Resin (One Surface, Posterior))

UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER (1043397292) bills $476.53/claim for D2391 (Resin composite - one surface posterior) vs avg $57.56 (+10.4Οƒ). $90,065 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.

UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTERCLEVELANDProvider total: $156.8M
criticalCost OutlierScore: 10.3

Cost-per-claim above average for 82108

DIALYSIS CLINIC INC. (1851329403) bills $65.34/claim for 82108 (Assay of aluminum) vs avg $1.00 (+10.2Οƒ). $12,937 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.

DIALYSIS CLINIC INC.CINCINNATIProvider total: $4.3M
criticalCost OutlierScore: 10.2

Cost-per-claim above average for D2391 (Dental Filling, Composite/Resin (One Surface, Posterior))

UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER (1518042175) bills $470.70/claim for D2391 (Resin composite - one surface posterior) vs avg $57.56 (+10.2Οƒ). $715,937 across 1,521 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.

UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTERCLEVELANDProvider total: $76.7M
criticalCost OutlierScore: 10.2

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

GALION COMMUNITY HOSPITAL (1215907522) bills $38.44/claim for 80305 (Drug test prsmv dir opt obs) vs avg $5.73 (+10.2Οƒ). $501,004 across 13,035 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.

GALION COMMUNITY HOSPITALGALIONProvider total: $25.2M
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