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 Oklahoma 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

223

warning

154

info

4,806

Total

5,183

Outliers by Type
Severity Distribution
critical
223 (4.3%)
warning
154 (3.0%)
info
4,806 (92.7%)
4,262 results
criticalCost OutlierScore: 17.2

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

JAMISON METCALF (1679829477) bills $445.72/claim for D0150 (Comprehensive oral evaluation) vs avg $30.00 (+17.2Οƒ). $18,274 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.

JAMISON METCALFOKLAHOMA CITYProvider total: $83.7K
criticalCost OutlierScore: 17.0

Cost-per-claim above average for D0330 (Dental Panoramic X-ray)

SHAWN DAVIS (1518000421) bills $350.54/claim for D0330 (Panoramic radiographic image) vs avg $46.73 (+17.0Οƒ). $33,301 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.

SHAWN DAVISOKLAHOMA CITYProvider total: $99.5K
criticalCost OutlierScore: 16.2

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

GRADY MEMORIAL HOSPITAL (1164859260) bills $179.36/claim for 90471 (Immunization admin) vs avg $16.70 (+16.2Οƒ). $434,939 across 2,425 claims.

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

GRADY MEMORIAL HOSPITALCHICKASHAProvider total: $4.4M
criticalCost OutlierScore: 16.1

Cost-per-claim above average for D9230

NICHOLAS J SCHELLATI DDS PLLC (1669777389) bills $143.06/claim for D9230 (Inhalation of nitrous oxide/analgesia) vs avg $26.31 (+16.1Οƒ). $96,423 across 674 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.

NICHOLAS J SCHELLATI DDS PLLCOKLAHOMA CITYProvider total: $544.9K
criticalCost OutlierScore: 15.6

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

ANADARKO INDIAN HEALTH CENTER (1881637403) bills $298.16/claim for 96127 (Brief emotional/behav assmt) vs avg $5.83 (+15.5Οƒ). $488,089 across 1,637 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.

ANADARKO INDIAN HEALTH CENTERANADARKOProvider total: $20.4M
criticalOverutilizationScore: 15.3

Unusually high claims-per-beneficiary ratio

INDEPENDENT OPPORTUNITIES, INC. (1881719276): 32.5 claims/beneficiary (avg 1.8). 31,513 claims, 970 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.

INDEPENDENT OPPORTUNITIES, INC.TULSAProvider total: $6.8M
criticalOverutilizationScore: 13.7

Unusually high claims-per-beneficiary ratio

HERITAGE ASSISTED LIVING CENTER L.L.C. (1588872428): 29.2 claims/beneficiary (avg 1.8). 92,712 claims, 3,174 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.

HERITAGE ASSISTED LIVING CENTER L.L.C.YUKONProvider total: $7.4M
criticalOverutilizationScore: 13.7

Unusually high claims-per-beneficiary ratio

CHISHOLM TRAIL RETIREMENT COMMUNITY (1104151877): 29.2 claims/beneficiary (avg 1.8). 44,627 claims, 1,530 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.

CHISHOLM TRAIL RETIREMENT COMMUNITYDUNCANProvider total: $3.5M
criticalCost OutlierScore: 13.6

Cost-per-claim above average for 90670

OU MEDICINE INC. (1649794157) bills $241.56/claim for 90670 (Pcv13 vaccine im) vs avg $1.66 (+13.6Οƒ). $66,429 across 275 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.

OU MEDICINE INC.OKLAHOMA CITYProvider total: $63.0M
criticalOverutilizationScore: 13.3

Unusually high claims-per-beneficiary ratio

COMMUNITY ACCESS, INCORPORATED (1740600436): 28.4 claims/beneficiary (avg 1.8). 11,913 claims, 420 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.

COMMUNITY ACCESS, INCORPORATEDLAWTONProvider total: $2.4M
criticalCost OutlierScore: 12.5

Cost-per-claim above average for 96110

JACKSON COUNTY MEMORIAL HOSPITAL AUTHORITY (1407230790) bills $146.68/claim for 96110 (Developmental screen w/score) vs avg $10.11 (+12.5Οƒ). $452,346 across 3,084 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.

JACKSON COUNTY MEMORIAL HOSPITAL AUTHORITYALTUSProvider total: $4.2M
criticalCost OutlierScore: 11.8

Cost-per-claim above average for 96160

CENTRAL OKLAHOMA AMERICAN INDIAN HEALTH COUNCIL, INC. (1407969728) bills $532.89/claim for 96160 (Pt-focused hlth risk assmt) vs avg $6.61 (+11.8Οƒ). $15,987 across 30 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.

CENTRAL OKLAHOMA AMERICAN INDIAN HEALTH COUNCIL, INC.OKLAHOMA CITYProvider total: $79.5M
criticalCost OutlierScore: 11.8

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

1437215134 (1437215134) bills $149.75/claim for D7140 (Extraction erupted tooth or exposed root) vs avg $65.44 (+11.8Οƒ). $87,007 across 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.

FREDERIKSTED HEALTH CARE, INC.FREDERIKSTEDProvider total: $1.8M
criticalCost OutlierScore: 11.4

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

1437215134 (1437215134) bills $142.58/claim for D2391 (Resin composite - one surface posterior) vs avg $58.09 (+11.5Οƒ). $90,110 across 632 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: $1.8M
criticalOverutilizationScore: 11.4

Unusually high claims-per-beneficiary ratio

YCO WEST, INC TFC (1669809745): 24.7 claims/beneficiary (avg 1.8). 26,459 claims, 1,073 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.

YCO WEST, INC TFCOKLAHOMA CITYProvider total: $1.4M
criticalCost OutlierScore: 11.3

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

KEETOOWAH CHEROKEE TREATMENT SERVICES (1225647746) bills $719.00/claim for 99213 (Office o/p est low 20 min) vs avg $68.19 (+11.3Οƒ). $40,983 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.

KEETOOWAH CHEROKEE TREATMENT SERVICESTULSAProvider total: $1.7M
criticalCost OutlierScore: 11.3

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

ANADARKO INDIAN HEALTH CENTER (1881637403) bills $719.00/claim for 99213 (Office o/p est low 20 min) vs avg $68.19 (+11.3Οƒ). $44,578 across 62 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.

ANADARKO INDIAN HEALTH CENTERANADARKOProvider total: $20.4M
criticalCost OutlierScore: 11.3

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

MODOC TRIBE OF OKLAHOMA (1265083380) bills $719.00/claim for 99213 (Office o/p est low 20 min) vs avg $68.19 (+11.3Οƒ). $18,694 across 26 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.

MODOC TRIBE OF OKLAHOMAWYANDOTTEProvider total: $2.7M
criticalOverutilizationScore: 10.3

Unusually high claims-per-beneficiary ratio

PERSONAL NURSING CARE, INC (1144433426): 22.5 claims/beneficiary (avg 1.8). 16,929 claims, 753 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.

PERSONAL NURSING CARE, INCOKLAHOMA CITYProvider total: $5.6M
criticalCost OutlierScore: 10.1

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

PAWNEE INDIAN HEALTH CENTER (1629174081) bills $676.01/claim for 99214 (Office o/p est mod 30 min) vs avg $89.04 (+10.1Οƒ). $89,234 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.

PAWNEE INDIAN HEALTH CENTERPAWNEEProvider total: $502.0K
criticalCost OutlierScore: 10.1

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

CENTRAL OKLAHOMA AMERICAN INDIAN HEALTH COUNCIL, INC. (1407969728) bills $639.33/claim for 90837 (Psytx w pt 60 minutes) vs avg $62.20 (+10.1Οƒ). $36,442 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.

CENTRAL OKLAHOMA AMERICAN INDIAN HEALTH COUNCIL, INC.OKLAHOMA CITYProvider total: $79.5M
criticalCost OutlierScore: 10.1

Cost-per-claim above average for H0031

MODOC NATION BEHAVIORAL HEALTH (1821636358) bills $686.50/claim for H0031 (Mh health assess by non-md) vs avg $96.64 (+10.1Οƒ). $16,476 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.

MODOC NATION BEHAVIORAL HEALTHMIAMIProvider total: $6.5M
criticalOverutilizationScore: 10.1

Unusually high claims-per-beneficiary ratio

SPECIALIZED HOME NURSING, INC. (1376655670): 22.0 claims/beneficiary (avg 1.8). 59,006 claims, 2,684 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.

SPECIALIZED HOME NURSING, INC.TULSAProvider total: $21.5M
criticalCost OutlierScore: 10.1

Cost-per-claim above average for 92340

OSU CENTER FOR HEALTH SCIENCES (1306561709) bills $52.58/claim for 92340 (Fit spectacles monofocal) vs avg $30.13 (+10.1Οƒ). $29,758 across 566 claims.

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

OSU CENTER FOR HEALTH SCIENCESTULSAProvider total: $547.5K
criticalCost OutlierScore: 9.6

Cost-per-claim above average for 99406

CHEROKEE NATION (1326054081) bills $453.33/claim for 99406 (Behav chng smoking 3-10 min) vs avg $19.29 (+9.6Οƒ). $21,760 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.

CHEROKEE NATIONSALINAProvider total: $119.0K
criticalCost OutlierScore: 9.4

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

KEETOOWAH - CHEROKEE TREATMENT SERVICES (1124228127) bills $612.14/claim for 99213 (Office o/p est low 20 min) vs avg $68.19 (+9.4Οƒ). $431,562 across 705 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.

KEETOOWAH - CHEROKEE TREATMENT SERVICESTULSAProvider total: $29.0M
criticalCost OutlierScore: 9.3

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

INDIAN HEALTH CARE RESOURCE CENTER (1427034958) bills $629.24/claim for 99214 (Office o/p est mod 30 min) vs avg $89.04 (+9.3Οƒ). $574,498 across 913 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.

INDIAN HEALTH CARE RESOURCE CENTERTULSAProvider total: $2.4M
criticalOverutilizationScore: 9.2

Unusually high claims-per-beneficiary ratio

SPECIALTY CARE PEDIATRICS, INC. (1477034395): 20.2 claims/beneficiary (avg 1.8). 111,682 claims, 5,526 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.

SPECIALTY CARE PEDIATRICS, INC.EDMONDProvider total: $44.8M
criticalCost OutlierScore: 9.2

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

DEPT OF HEALTH AND HUMAN SERVICES PHS INDIAN HEALTH SERVICE (1578708475) bills $619.97/claim for 99214 (Office o/p est mod 30 min) vs avg $89.04 (+9.2Οƒ). $88,036 across 142 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.

DEPT OF HEALTH AND HUMAN SERVICES PHS INDIAN HEALTH SERVICEOKLAHOMA CITYProvider total: $1.3M
criticalCost OutlierScore: 8.9

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

INDIAN HEALTH CARE RESOURCE CENTER (1427034958) bills $567.72/claim for 90837 (Psytx w pt 60 minutes) vs avg $62.20 (+8.9Οƒ). $52,798 across 93 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.

INDIAN HEALTH CARE RESOURCE CENTERTULSAProvider total: $2.4M
criticalCost OutlierScore: 8.9

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

AHS CLAREMORE REGIONAL HOSPITAL LLC (1356974687) bills $501.04/claim for 99203 (Office o/p new low 30 min) vs avg $91.29 (+8.9Οƒ). $27,056 across 54 claims.

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

AHS CLAREMORE REGIONAL HOSPITAL LLCCLAREMOREProvider total: $1.5M
criticalOverutilizationScore: 8.8

Unusually high claims-per-beneficiary ratio

NORTH OKLAHOMA COUNTY MENTAL HEALTH CENTER (1225527575): 19.5 claims/beneficiary (avg 1.8). 9,561 claims, 490 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.

NORTH OKLAHOMA COUNTY MENTAL HEALTH CENTERPIEDMONTProvider total: $1.5M
criticalOverutilizationScore: 8.8

Unusually high claims-per-beneficiary ratio

OKLAHOMA FAMILIES FIRST INC. (1437251576): 19.5 claims/beneficiary (avg 1.8). 27,860 claims, 1,429 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.

OKLAHOMA FAMILIES FIRST INC.NORMANProvider total: $1.6M
criticalOverutilizationScore: 8.8

Unusually high claims-per-beneficiary ratio

D & D SERVICES INC (1629080254): 19.3 claims/beneficiary (avg 1.8). 366,566 claims, 18,959 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.

D & D SERVICES INCTULSAProvider total: $119.3M
criticalCost OutlierScore: 8.7

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

DEPT OF HEALTH AND HUMAN SERVICES PHS INDIAN HEALTH SERVICE (1578708475) bills $572.91/claim for 99213 (Office o/p est low 20 min) vs avg $68.19 (+8.7Οƒ). $984,266 across 1,718 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.

DEPT OF HEALTH AND HUMAN SERVICES PHS INDIAN HEALTH SERVICEOKLAHOMA CITYProvider total: $1.3M
criticalCost OutlierScore: 8.7

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

SHAWN DAVIS (1518000421) bills $239.98/claim for D0150 (Comprehensive oral evaluation) vs avg $30.00 (+8.7Οƒ). $32,637 across 136 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.

SHAWN DAVISOKLAHOMA CITYProvider total: $99.5K
criticalOverutilizationScore: 8.7

Unusually high claims-per-beneficiary ratio

ECKERD YOUTH ALTERNATIVES, INC., DBA ECKERD CONNECTS (1104263797): 19.2 claims/beneficiary (avg 1.8). 14,497 claims, 756 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.

ECKERD YOUTH ALTERNATIVES, INC., DBA ECKERD CONNECTSOKLAHOMA CITYProvider total: $725.0K
criticalCost OutlierScore: 8.6

Cost-per-claim above average for T1017

ECHOTA BEHAVIORAL HEALTH SERVICES, LLC (1437914777) bills $719.00/claim for T1017 (Targeted case management) vs avg $39.79 (+8.6Οƒ). $26,603 across 37 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.

ECHOTA BEHAVIORAL HEALTH SERVICES, LLCJAYProvider total: $286.2K
criticalCost OutlierScore: 8.6

Cost-per-claim above average for T1017

KEETOOWAH CHEROKEE TREATMENT SERVICES (1225647746) bills $719.00/claim for T1017 (Targeted case management) vs avg $39.79 (+8.6Οƒ). $47,454 across 66 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.

KEETOOWAH CHEROKEE TREATMENT SERVICESTULSAProvider total: $1.7M
criticalCost OutlierScore: 8.5

Cost-per-claim above average for G2211

CHEROKEE NATION (1275799645) bills $612.31/claim for G2211 (Complex e/m visit add on) vs avg $10.47 (+8.5Οƒ). $45,311 across 74 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 NATIONTAHLEQUAHProvider total: $6.4M
criticalCost OutlierScore: 8.3

Cost-per-claim above average for H0032

CHEROKEE NATION (1841207156) bills $617.14/claim for H0032 (Mh svc plan dev by non-md) vs avg $70.06 (+8.3Οƒ). $17,280 across 28 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 NATIONMUSKOGEEProvider total: $608.7K
criticalOverutilizationScore: 8.2

Unusually high claims-per-beneficiary ratio

ADVANCED BEHAVIORAL SOLUTIONS, LLC (1447803275): 18.2 claims/beneficiary (avg 1.8). 437 claims, 24 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.

ADVANCED BEHAVIORAL SOLUTIONS, LLCOKLAHOMA CITYProvider total: $144.1K
criticalCost OutlierScore: 8.1

Cost-per-claim above average for 83690

INTEGRIS GROVE HOSPITAL (1467473579) bills $26.75/claim for 83690 (Assay of lipase) vs avg $6.03 (+8.1Οƒ). $17,975 across 672 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.

INTEGRIS GROVE HOSPITALGROVEProvider total: $5.8M
criticalCost OutlierScore: 7.8

Cost-per-claim above average for T1017

OSAGE NATION (1659615904) bills $654.00/claim for T1017 (Targeted case management) vs avg $39.79 (+7.8Οƒ). $24,852 across 38 claims.

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

OSAGE NATIONPAWHUSKAProvider total: $3.9M
criticalCost OutlierScore: 7.8

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

LAWTON INDIAN HOSPITAL (1760489223) bills $517.31/claim for 99213 (Office o/p est low 20 min) vs avg $68.19 (+7.8Οƒ). $474,895 across 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.

LAWTON INDIAN HOSPITALLAWTONProvider total: $1.1M
criticalOverutilizationScore: 7.3

Unusually high claims-per-beneficiary ratio

FRESENIUS MEDICAL CARE TULSA, LLC (1437590015): 16.5 claims/beneficiary (avg 1.8). 14,721 claims, 890 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.

FRESENIUS MEDICAL CARE TULSA, LLCTULSAProvider total: $148.9K
criticalCost OutlierScore: 7.3

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

SALLISAW PUBLIC SCHOOL (1053511337) bills $30.49/claim for 92508 (Tx sp lang voice comm group) vs avg $21.03 (+7.3Οƒ). $21,555 across 707 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.

SALLISAW PUBLIC SCHOOLSALLISAWProvider total: $31.9K
criticalOverutilizationScore: 7.3

Unusually high claims-per-beneficiary ratio

SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM, LLC (1821105263): 16.4 claims/beneficiary (avg 1.8). 2,264 claims, 138 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.

SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM, LLCTULSAProvider total: $113.6K
criticalCost OutlierScore: 7.2

Cost-per-claim above average for 92551

JACKSON COUNTY MEMORIAL HOSPITAL AUTHORITY (1407230790) bills $171.00/claim for 92551 (Pure tone hearing test air) vs avg $13.33 (+7.2Οƒ). $451,269 across 2,639 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.

JACKSON COUNTY MEMORIAL HOSPITAL AUTHORITYALTUSProvider total: $4.2M
criticalCost OutlierScore: 7.1

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

PAWNEE INDIAN HEALTH CENTER (1629174081) bills $479.00/claim for 99213 (Office o/p est low 20 min) vs avg $68.19 (+7.1Οƒ). $19,160 across 40 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.

PAWNEE INDIAN HEALTH CENTERPAWNEEProvider total: $502.0K
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