Statistical Outliers

Single-test outliers in Oregon 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

286

warning

274

info

3,891

Total

4,451

Outliers by Type

Severity Distribution

critical

286 (6.4%)

warning

274 (6.2%)

info

3,891 (87.4%)

3,222 results

criticalOverutilizationScore: 21.4

Unusually high claims-per-beneficiary ratio

CLATSOP BEHAVIORAL HEALTHCARE (1760833313): 37.7 claims/beneficiary (avg 1.9). 42,988 claims, 1,141 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.

CLATSOP BEHAVIORAL HEALTHCAREWARRENTONProvider total: $4.5M

criticalCost OutlierScore: 21.1

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

LEGACY EMANUEL HOSPITAL & HEALTH CENTER (1831112358) bills $311.34/claim for D0220 (Intraoral - periapical first image) vs avg $9.51 (+21.1σ). $11,831 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.

LEGACY EMANUEL HOSPITAL & HEALTH CENTERPORTLANDProvider total: $64.2M

criticalCost OutlierScore: 17.3

Cost-per-claim above average for D1330

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (1689980740) bills $72.64/claim for D1330 (Oral hygiene instructions) vs avg $0.95 (+17.3σ). $340,051 across 4,681 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.

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWESTPORTLANDProvider total: $6.9M

criticalCost OutlierScore: 16.1

Cost-per-claim above average for 96160

CHEMAWA INDIAN HEALTH CENTER DHHS IHS WESTERN OREGON SERV UNIT (1578565347) bills $334.03/claim for 96160 (Pt-focused hlth risk assmt) vs avg $3.90 (+16.1σ). $105,554 across 316 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.

CHEMAWA INDIAN HEALTH CENTER DHHS IHS WESTERN OREGON SERV UNITSALEMProvider total: $15.8M

criticalOverutilizationScore: 15.2

Unusually high claims-per-beneficiary ratio

CASCADIA HEALTH (1003993270): 27.3 claims/beneficiary (avg 1.9). 33,192 claims, 1,217 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.

CASCADIA HEALTHPORTLANDProvider total: $8.1M

criticalOverutilizationScore: 14.7

Unusually high claims-per-beneficiary ratio

CASCADIA HEALTH (1972878031): 26.6 claims/beneficiary (avg 1.9). 12,086 claims, 455 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.

CASCADIA HEALTHOREGON CITYProvider total: $2.3M

criticalCost OutlierScore: 14.6

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

PROVIDENCE HEALTH & SERVICES - OREGON (1114015971) bills $1,862.72/claim for D7140 (Extraction erupted tooth or exposed root) vs avg $71.99 (+14.6σ). $33,529 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.

PROVIDENCE HEALTH & SERVICES - OREGONPORTLANDProvider total: $36.9M

criticalOverutilizationScore: 13.9

Unusually high claims-per-beneficiary ratio

CASCADIA HEALTH (1447337753): 25.1 claims/beneficiary (avg 1.9). 29,404 claims, 1,170 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.

CASCADIA HEALTHPORTLANDProvider total: $7.8M

criticalCost OutlierScore: 13.5

Cost-per-claim above average for D1354

CONFEDERATED TRIBES OF SILETZ (1316040249) bills $719.00/claim for D1354 (Interim caries arresting medicament) vs avg $8.63 (+13.5σ). $10,066 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.

CONFEDERATED TRIBES OF SILETZSILETZProvider total: $8.0M

criticalCost OutlierScore: 13.4

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

CHEMAWA INDIAN HEALTH CENTER DHHS IHS WESTERN OREGON SERV UNIT (1578565347) bills $521.14/claim for 99213 (Office o/p est low 20 min) vs avg $48.05 (+13.4σ). $1,742,699 across 3,344 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.

CHEMAWA INDIAN HEALTH CENTER DHHS IHS WESTERN OREGON SERV UNITSALEMProvider total: $15.8M

criticalCost OutlierScore: 13.4

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

SALEM PAIN AND SPINE SPECIALISTS PC (1124316567) bills $520.10/claim for 99213 (Office o/p est low 20 min) vs avg $48.05 (+13.4σ). $797,832 across 1,534 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.

SALEM PAIN AND SPINE SPECIALISTS PCSALEMProvider total: $1.0M

criticalOverutilizationScore: 12.6

Unusually high claims-per-beneficiary ratio

ATCHISON DIALYSIS, LLC (1932568912): 22.9 claims/beneficiary (avg 1.9). 5,390 claims, 235 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.

ATCHISON DIALYSIS, LLCGRESHAMProvider total: $146.3K

criticalOverutilizationScore: 12.4

Unusually high claims-per-beneficiary ratio

CASCADIA HEALTH (1043397219): 22.7 claims/beneficiary (avg 1.9). 24,992 claims, 1,099 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.

CASCADIA HEALTHPORTLANDProvider total: $14.2M

criticalOverutilizationScore: 12.3

Unusually high claims-per-beneficiary ratio

CASCADIA HEALTH (1568531952): 22.4 claims/beneficiary (avg 1.9). 20,246 claims, 903 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.

CASCADIA HEALTHPORTLANDProvider total: $12.2M

criticalCost OutlierScore: 11.6

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

CONFEDERATED TRIBES OF THE WARM SPRINGS RESERVATION OF OREGON (1700027927) bills $588.65/claim for 99214 (Office o/p est mod 30 min) vs avg $67.70 (+11.5σ). $400,279 across 680 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.

CONFEDERATED TRIBES OF THE WARM SPRINGS RESERVATION OF OREGONWARM SPRINGSProvider total: $7.6M

criticalCost OutlierScore: 11.5

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

KLAMATH TRIBAL HEALTH & FAMILY SERVICES (1629078274) bills $451.50/claim for 99213 (Office o/p est low 20 min) vs avg $48.05 (+11.5σ). $2,883,723 across 6,387 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.

KLAMATH TRIBAL HEALTH & FAMILY SERVICESCHILOQUINProvider total: $8.6M

criticalCost OutlierScore: 11.2

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

CONFEDERATED TRIBES OF THE GRAND RONDE COMMUNITY OF OREGON (1174666358) bills $561.93/claim for D0120 (Periodic oral evaluation) vs avg $25.19 (+11.2σ). $310,183 across 552 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.

CONFEDERATED TRIBES OF THE GRAND RONDE COMMUNITY OF OREGONGRAND RONDEProvider total: $18.6M

criticalOverutilizationScore: 11.1

Unusually high claims-per-beneficiary ratio

MID-VALLEY HEALTHCARE, INC. (1669000865): 20.4 claims/beneficiary (avg 1.9). 7,085 claims, 347 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.

MID-VALLEY HEALTHCARE, INC.LEBANONProvider total: $2.8M

criticalCost OutlierScore: 11.0

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

CONFEDERATED TRIBES OF THE WARM SPRINGS RESERVATION OF OREGON (1700027927) bills $435.08/claim for 99213 (Office o/p est low 20 min) vs avg $48.05 (+11.0σ). $268,444 across 617 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.

CONFEDERATED TRIBES OF THE WARM SPRINGS RESERVATION OF OREGONWARM SPRINGSProvider total: $7.6M

criticalCost OutlierScore: 10.9

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

CONFEDERATED TRIBES OF THE WARM SPRINGS RESERVATION OF OREGON (1700027927) bills $491.26/claim for 99212 (Office o/p est sf 10 min) vs avg $36.23 (+10.9σ). $370,412 across 754 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.

CONFEDERATED TRIBES OF THE WARM SPRINGS RESERVATION OF OREGONWARM SPRINGSProvider total: $7.6M

criticalCost OutlierScore: 10.8

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

KLAMATH TRIBAL HEALTH & FAMILY SERVICES (1629078274) bills $542.49/claim for D1120 (Prophylaxis - child) vs avg $31.76 (+10.8σ). $122,602 across 226 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.

KLAMATH TRIBAL HEALTH & FAMILY SERVICESCHILOQUINProvider total: $8.6M

criticalCost OutlierScore: 10.7

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

LEGACY EMANUEL HOSPITAL & HEALTH CENTER (1831112358) bills $131.77/claim for D1206 (Topical fluoride varnish) vs avg $11.73 (+10.7σ). $12,123 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.

LEGACY EMANUEL HOSPITAL & HEALTH CENTERPORTLANDProvider total: $64.2M

criticalCost OutlierScore: 10.6

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

YELLOWHAWK TRIBAL HEALTH CENTER (1346283488) bills $671.07/claim for D0150 (Comprehensive oral evaluation) vs avg $34.14 (+10.6σ). $10,066 across 15 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.

YELLOWHAWK TRIBAL HEALTH CENTERPENDLETONProvider total: $5.1M

criticalCost OutlierScore: 10.4

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

CONFEDERATED TRIBES OF COOS, LOWER UMPQUA & SIUSLAW INDIANS (1780755454) bills $657.46/claim for D0150 (Comprehensive oral evaluation) vs avg $34.14 (+10.4σ). $16,436 across 25 claims.

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

CONFEDERATED TRIBES OF COOS, LOWER UMPQUA & SIUSLAW INDIANSCOOS BAYProvider total: $593.6K

criticalCost OutlierScore: 10.2

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

COQUILLE INDIAN TRIBE (1376592287) bills $478.42/claim for 90471 (Immunization admin) vs avg $18.87 (+10.2σ). $15,788 across 33 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.

COQUILLE INDIAN TRIBECOOS BAYProvider total: $2.1M

criticalOverutilizationScore: 10.1

Unusually high claims-per-beneficiary ratio

WEST LINN CLEMENTINE, INC (1023562147): 18.8 claims/beneficiary (avg 1.9). 451 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.

WEST LINN CLEMENTINE, INCWEST LINNProvider total: $510.2K

criticalCost OutlierScore: 10.0

Cost-per-claim above average for H0048

CONFEDERATED TRIBES OF SILETZ (1316040249) bills $147.70/claim for H0048 (Spec coll non-blood:a/d test) vs avg $14.27 (+10.0σ). $69,714 across 472 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.

CONFEDERATED TRIBES OF SILETZSILETZProvider total: $8.0M

criticalCost OutlierScore: 10.0

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

KLAMATH TRIBAL HEALTH & FAMILY SERVICES (1629078274) bills $469.71/claim for 90471 (Immunization admin) vs avg $18.87 (+10.0σ). $149,838 across 319 claims.

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

KLAMATH TRIBAL HEALTH & FAMILY SERVICESCHILOQUINProvider total: $8.6M

criticalOverutilizationScore: 9.4

Unusually high claims-per-beneficiary ratio

CARSON HOLDINGS, LLC (1356820906): 17.7 claims/beneficiary (avg 1.9). 79,329 claims, 4,475 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.

CARSON HOLDINGS, LLCPORTLANDProvider total: $6.6M

criticalCost OutlierScore: 9.4

Cost-per-claim above average for 0002A

WARM SPRINGS HEALTH AND WELLNESS DHHS IHS WARM SPRINGS SERVICE UNIT (1417084708) bills $508.19/claim for 0002A vs avg $31.49 (+9.4σ). $24,393 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.

WARM SPRINGS HEALTH AND WELLNESS DHHS IHS WARM SPRINGS SERVICE UNITWARM SPRINGSProvider total: $21.1M

criticalCost OutlierScore: 9.4

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

CONFEDERATED TRIBES OF THE GRAND RONDE COMMUNITY OF OREGON (1174666358) bills $479.81/claim for D1120 (Prophylaxis - child) vs avg $31.76 (+9.4σ). $574,815 across 1,198 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.

CONFEDERATED TRIBES OF THE GRAND RONDE COMMUNITY OF OREGONGRAND RONDEProvider total: $18.6M

criticalCost OutlierScore: 9.4

Cost-per-claim above average for 0001A

WARM SPRINGS HEALTH AND WELLNESS DHHS IHS WARM SPRINGS SERVICE UNIT (1417084708) bills $507.96/claim for 0001A vs avg $27.79 (+9.4σ). $23,874 across 47 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.

WARM SPRINGS HEALTH AND WELLNESS DHHS IHS WARM SPRINGS SERVICE UNITWARM SPRINGSProvider total: $21.1M

criticalCost OutlierScore: 9.3

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

PEACEHEALTH (1902892391) bills $25.23/claim for 36415 (Coll venous bld venipuncture) vs avg $2.46 (+9.3σ). $388,069 across 15,379 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.

PEACEHEALTHCOTTAGE GROVEProvider total: $17.2M

criticalCost OutlierScore: 9.2

Cost-per-claim above average for D1110 (Adult Dental Prophylaxis (Teeth Cleaning))

CONFEDERATED TRIBES OF THE GRAND RONDE COMMUNITY OF OREGON (1174666358) bills $497.36/claim for D1110 (Prophylaxis - adult) vs avg $36.83 (+9.2σ). $593,355 across 1,193 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.

CONFEDERATED TRIBES OF THE GRAND RONDE COMMUNITY OF OREGONGRAND RONDEProvider total: $18.6M

criticalCost OutlierScore: 9.2

Cost-per-claim above average for 90853 (Group Psychotherapy)

COW CREEK BAND OF UMPQUA TRIBE OF INDIANS (1063502714) bills $693.32/claim for 90853 (Group psychotherapy) vs avg $44.37 (+9.2σ). $19,413 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.

COW CREEK BAND OF UMPQUA TRIBE OF INDIANSROSEBURGProvider total: $3.4M

criticalOverutilizationScore: 9.0

Unusually high claims-per-beneficiary ratio

1447481858 (1447481858): 17.0 claims/beneficiary (avg 1.9). 1,498 claims, 88 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.

1447481858Provider total: $153.8K

criticalOverutilizationScore: 9.0

Unusually high claims-per-beneficiary ratio

RAINROCK TREATMENT CENTER, LLC (1255932059): 16.9 claims/beneficiary (avg 1.9). 423 claims, 25 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.

RAINROCK TREATMENT CENTER, LLCWEST LINNProvider total: $460.1K

criticalCost OutlierScore: 8.8

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

CENTRAL OREGON INTERGOVERNMENTAL COUNCIL (COIC) (1124426291) bills $417.97/claim for A0425 (Ground mileage) vs avg $23.14 (+8.8σ). $117,448 across 281 claims.

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

CENTRAL OREGON INTERGOVERNMENTAL COUNCIL (COIC)BENDProvider total: $2.7M

criticalCost OutlierScore: 8.7

Cost-per-claim above average for H2014

ST MARY HEALTH LLC (1720767254) bills $843.51/claim for H2014 (Skills train and dev, 15 min) vs avg $66.74 (+8.7σ). $221,000 across 262 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 MARY HEALTH LLCPORTLANDProvider total: $739.5K

criticalCost OutlierScore: 8.4

Cost-per-claim above average for 90785

MORRISON CHILD AND FAMILY SERVICES (1346382975) bills $140.41/claim for 90785 (Psytx complex interactive) vs avg $11.73 (+8.4σ). $288,684 across 2,056 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.

MORRISON CHILD AND FAMILY SERVICESPORTLANDProvider total: $15.4M

criticalCost OutlierScore: 8.4

Cost-per-claim above average for H0038

ST MARY HEALTH LLC (1720767254) bills $843.51/claim for H0038 (Self-help/peer svc per 15min) vs avg $67.93 (+8.4σ). $221,000 across 262 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 MARY HEALTH LLCPORTLANDProvider total: $739.5K

criticalCost OutlierScore: 8.3

Cost-per-claim above average for 96110

OREGON HEALTH & SCIENCE UNIVERSITY (1609824010) bills $63.20/claim for 96110 (Developmental screen w/score) vs avg $9.74 (+8.3σ). $21,237 across 336 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.

OREGON HEALTH & SCIENCE UNIVERSITYPORTLANDProvider total: $70.8M

criticalOverutilizationScore: 8.3

Unusually high claims-per-beneficiary ratio

PELTON PROJECT, INC. (1053559765): 15.8 claims/beneficiary (avg 1.9). 64,304 claims, 4,080 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.

PELTON PROJECT, INC.KEIZERProvider total: $4.0M

criticalCost OutlierScore: 8.2

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

CONFEDERATED TRIBES OF COOS, LOWER UMPQUA & SIUSLAW INDIANS (1780755454) bills $497.11/claim for D0140 (Limited oral evaluation - problem focused) vs avg $36.68 (+8.2σ). $55,677 across 112 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.

CONFEDERATED TRIBES OF COOS, LOWER UMPQUA & SIUSLAW INDIANSCOOS BAYProvider total: $593.6K

criticalCost OutlierScore: 8.2

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

LIBERTY HOUSE (1639244056) bills $1,689.35/claim for 99205 (Office o/p new hi 60 min) vs avg $180.15 (+8.2σ). $1,011,922 across 599 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 HOUSESALEMProvider total: $2.1M

criticalOverutilizationScore: 7.9

Unusually high claims-per-beneficiary ratio

TELECARE MENTAL HEALTH SERVICES OF OREGON, INC (1073601647): 15.2 claims/beneficiary (avg 1.9). 40,312 claims, 2,660 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.

TELECARE MENTAL HEALTH SERVICES OF OREGON, INCWOODBURNProvider total: $11.0M

criticalCost OutlierScore: 7.9

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

CONFEDERATED TRIBES OF COOS, LOWER UMPQUA & SIUSLAW INDIANS (1780755454) bills $402.79/claim for D0120 (Periodic oral evaluation) vs avg $25.19 (+7.9σ). $287,190 across 713 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.

CONFEDERATED TRIBES OF COOS, LOWER UMPQUA & SIUSLAW INDIANSCOOS BAYProvider total: $593.6K

criticalCost OutlierScore: 7.8

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

VPA PC (1790309474) bills $259.23/claim for 99202 (Office o/p new sf 15 min) vs avg $53.72 (+7.8σ). $365,512 across 1,410 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 PCTIGARDProvider total: $858.5K

criticalOverutilizationScore: 7.6

Unusually high claims-per-beneficiary ratio

RAINROCK TREATMENT CENTER, LLC (1629119086): 14.7 claims/beneficiary (avg 1.9). 13,843 claims, 942 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.

RAINROCK TREATMENT CENTER, LLCSPRINGFIELDProvider total: $11.4M

criticalCost OutlierScore: 7.3

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

YELLOWHAWK TRIBAL HEALTH CENTER (1346283488) bills $444.27/claim for D0140 (Limited oral evaluation - problem focused) vs avg $36.68 (+7.3σ). $690,846 across 1,555 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.

YELLOWHAWK TRIBAL HEALTH CENTERPENDLETONProvider total: $5.1M

Page 1 of 65

Statistical Outliers

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