Statistical Outliers

Single-test outliers in Pennsylvania 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

1,080

warning

917

info

10,885

Total

12,882

Outliers by Type

Severity Distribution

critical

1,080 (8.4%)

warning

917 (7.1%)

info

10,885 (84.5%)

9,233 results

criticalCost OutlierScore: 29.7

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

FRICK HOSPITAL (1255356911) bills $588.21/claim for D1110 (Prophylaxis - adult) vs avg $32.87 (+29.7σ). $22,940 across 39 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.

FRICK HOSPITALMT PLEASANTProvider total: $228.0K

criticalCost OutlierScore: 27.9

Cost-per-claim above average for D1208

STC OPCO LLC (1194368167) bills $1,169.38/claim for D1208 (Topical fluoride excluding varnish) vs avg $18.92 (+27.9σ). $194,117 across 166 claims.

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

STC OPCO LLCPHILADELPHIAProvider total: $69.2M

criticalCost OutlierScore: 23.9

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

FRICK HOSPITAL (1255356911) bills $375.81/claim for D0120 (Periodic oral evaluation) vs avg $20.06 (+23.9σ). $69,149 across 184 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.

FRICK HOSPITALMT PLEASANTProvider total: $228.0K

criticalCost OutlierScore: 23.6

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

GEISINGER BLOOMSBURG HOSPITAL (1821198755) bills $370.83/claim for D0120 (Periodic oral evaluation) vs avg $20.06 (+23.6σ). $28,554 across 77 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.

GEISINGER BLOOMSBURG HOSPITALBLOOMSBURGProvider total: $7.2M

criticalCost OutlierScore: 20.6

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

THE READING HOSPITAL SURGICENTER AT SPRING RIDGE LLC (1164490728) bills $946.07/claim for D2391 (Resin composite - one surface posterior) vs avg $49.88 (+20.6σ). $543,990 across 575 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 READING HOSPITAL SURGICENTER AT SPRING RIDGE LLCWYOMISSINGProvider total: $2.3M

criticalCost OutlierScore: 18.2

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

STC OPCO LLC (1194368167) bills $1,182.58/claim for D7140 (Extraction erupted tooth or exposed root) vs avg $64.86 (+18.2σ). $789,965 across 668 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.

STC OPCO LLCPHILADELPHIAProvider total: $69.2M

criticalCost OutlierScore: 18.1

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

CHILDRENS SURGERY CENTER OF MALVERN, LLC (1134499684) bills $661.48/claim for D1120 (Prophylaxis - child) vs avg $29.67 (+18.1σ). $228,209 across 345 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.

CHILDRENS SURGERY CENTER OF MALVERN, LLCMALVERNProvider total: $11.3M

criticalCost OutlierScore: 18.0

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

CENTER CITY HEALTHCARE, LLC (1437662384) bills $1,298.49/claim for 99285 (Emergency dept visit hi mdm) vs avg $92.40 (+18.0σ). $16,880 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.

CENTER CITY HEALTHCARE, LLCPHILADELPHIAProvider total: $33.3K

criticalCost OutlierScore: 17.5

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

CHILDRENS SURGERY CENTER, LLC (1619284536) bills $639.78/claim for D1120 (Prophylaxis - child) vs avg $29.67 (+17.5σ). $404,343 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.

CHILDRENS SURGERY CENTER, LLCLANCASTERProvider total: $8.1M

criticalCost OutlierScore: 15.9

Cost-per-claim above average for G0008 (Influenza Virus Vaccine Administration)

UPMC CHILDREN'S HOSPITAL OF PITTSBURGH (1164426896) bills $106.03/claim for G0008 (Admin influenza virus vac) vs avg $7.75 (+15.9σ). $53,862 across 508 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.

UPMC CHILDREN'S HOSPITAL OF PITTSBURGHPITTSBURGHProvider total: $83.0M

criticalCost OutlierScore: 15.1

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

CHILDRENS HOSPITAL OF PHILADELPHIA (1215921457) bills $32.25/claim for J1100 (Dexamethasone sodium phos) vs avg $0.33 (+15.1σ). $450,037 across 13,953 claims.

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

CHILDRENS HOSPITAL OF PHILADELPHIAPHILADELPHIAProvider total: $286.9M

criticalCost OutlierScore: 14.7

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

LANCASTER GENERAL HOSPITAL (1457585119) bills $878.30/claim for 99284 (Emergency dept visit mod mdm) vs avg $85.78 (+14.7σ). $12,296 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.

LANCASTER GENERAL HOSPITALLANCASTERProvider total: $79.2K

criticalCost OutlierScore: 13.8

Cost-per-claim above average for 99499

PETTAWAY PURSUIT FOUNDATION (1154857589) bills $351.24/claim for 99499 (Unlisted e&m service) vs avg $16.53 (+13.8σ). $484,005 across 1,378 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.

PETTAWAY PURSUIT FOUNDATIONUPPER DARBYProvider total: $666.6K

criticalCost OutlierScore: 13.8

Cost-per-claim above average for J2250

CHILDRENS HOSPITAL OF PHILADELPHIA (1215921457) bills $11.99/claim for J2250 (Inj midazolam hydrochloride) vs avg $0.11 (+13.8σ). $85,138 across 7,103 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.

CHILDRENS HOSPITAL OF PHILADELPHIAPHILADELPHIAProvider total: $286.9M

criticalCost OutlierScore: 13.8

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

EVEREST URGENT CARE (1497113666) bills $30.43/claim for 36415 (Coll venous bld venipuncture) vs avg $1.18 (+13.8σ). $34,170 across 1,123 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.

EVEREST URGENT CAREUPPER DARBYProvider total: $17.7M

criticalCost OutlierScore: 13.2

Cost-per-claim above average for 90791 (Psychiatric Diagnostic Evaluation)

THE CENTER FOR AUTISM (1174129563) bills $4,511.66/claim for 90791 (Psych diagnostic evaluation) vs avg $178.46 (+13.2σ). $12,380,006 across 2,744 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.

THE CENTER FOR AUTISMPHILADELPHIAProvider total: $14.4M

criticalCost OutlierScore: 13.0

Cost-per-claim above average for 93306

ST. CHRISTOPHER'S HEALTHCARE, LLC (1922511864) bills $1,197.99/claim for 93306 (Tte w/doppler complete) vs avg $66.26 (+13.0σ). $56,306 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.

ST. CHRISTOPHER'S HEALTHCARE, LLCPHILADELPHIAProvider total: $2.1M

criticalCost OutlierScore: 12.7

Cost-per-claim above average for G8417

WMC PHYSICIAN PRACTICES LLC (1518303288) bills $2.51/claim for G8417 (Calc bmi abv up param f/u) vs avg $0.02 (+12.7σ). $22,081 across 8,807 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.

WMC PHYSICIAN PRACTICES LLCBURGETTSTOWNProvider total: $7.6M

criticalCost OutlierScore: 12.7

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

UPMC CHILDREN'S HOSPITAL OF PITTSBURGH (1164426896) bills $12.08/claim for J2405 (Ondansetron hcl injection) vs avg $0.18 (+12.7σ). $324,930 across 26,892 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.

UPMC CHILDREN'S HOSPITAL OF PITTSBURGHPITTSBURGHProvider total: $83.0M

criticalCost OutlierScore: 12.5

Cost-per-claim above average for J1170

PENTEC HEALTH INC (1770528994) bills $52.51/claim for J1170 (Injection, hydromorphone, up to 4 mg) vs avg $0.84 (+12.5σ). $88,947 across 1,694 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.

PENTEC HEALTH INCUPPER CHICHESTERProvider total: $40.2M

criticalOverutilizationScore: 12.4

Unusually high claims-per-beneficiary ratio

NORTHEAST ADULT DAY CARE INC. (1225106222): 45.0 claims/beneficiary (avg 2.1). 5,846 claims, 130 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.

NORTHEAST ADULT DAY CARE INC.PHILADELPHIAProvider total: $224.8K

criticalCost OutlierScore: 12.4

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

STC OPCO LLC (1194368167) bills $461.15/claim for D1120 (Prophylaxis - child) vs avg $29.67 (+12.4σ). $379,991 across 824 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.

STC OPCO LLCPHILADELPHIAProvider total: $69.2M

criticalCost OutlierScore: 12.1

Cost-per-claim above average for J3490

PROCARE PHARMACY DIRECT, LLC. (1043382302) bills $2,432.06/claim for J3490 (Drugs unclassified injection) vs avg $21.14 (+12.1σ). $126,467 across 52 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.

PROCARE PHARMACY DIRECT, LLC.MONROEVILLEProvider total: $227.3M

criticalCost OutlierScore: 12.1

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

TRUENORTH WELLNESS SERVICES (1437455466) bills $294.02/claim for 99213 (Office o/p est low 20 min) vs avg $34.84 (+12.1σ). $478,960 across 1,629 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.

TRUENORTH WELLNESS SERVICESMC CONNELLSBURGProvider total: $2.0M

criticalCost OutlierScore: 11.8

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

PENN STATE HEALTH HAMPDEN MEDICAL CENTER (1164029658) bills $66.43/claim for 71045 (X-ray exam chest 1 view) vs avg $6.67 (+11.8σ). $13,353 across 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.

PENN STATE HEALTH HAMPDEN MEDICAL CENTERENOLAProvider total: $5.1M

criticalCost OutlierScore: 11.7

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

THE READING HOSPITAL SURGICENTER AT SPRING RIDGE LLC (1164490728) bills $783.03/claim for D7140 (Extraction erupted tooth or exposed root) vs avg $64.86 (+11.7σ). $25,840 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.

THE READING HOSPITAL SURGICENTER AT SPRING RIDGE LLCWYOMISSINGProvider total: $2.3M

criticalCost OutlierScore: 11.6

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

PENN STATE HEALTH LANCASTER MEDICAL CENTER (1013674266) bills $65.51/claim for 71045 (X-ray exam chest 1 view) vs avg $6.67 (+11.6σ). $52,344 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.

PENN STATE HEALTH LANCASTER MEDICAL CENTERLANCASTERProvider total: $5.4M

criticalCost OutlierScore: 11.6

Cost-per-claim above average for 97112

ALBERT EINSTEIN MEDICAL CENTER (1174522114) bills $170.26/claim for 97112 (Neuromuscular reeducation) vs avg $22.00 (+11.6σ). $440,804 across 2,589 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.

ALBERT EINSTEIN MEDICAL CENTERPHILAProvider total: $14.5M

criticalCost OutlierScore: 11.4

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

CHRISTIANNE SCHOEDEL (1841292851) bills $278.37/claim for 99213 (Office o/p est low 20 min) vs avg $34.84 (+11.4σ). $327,359 across 1,176 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.

CHRISTIANNE SCHOEDELYORKProvider total: $2.8M

criticalCost OutlierScore: 11.3

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

NATAN NEMIROVSKY (1881763332) bills $344.80/claim for 99203 (Office o/p new low 30 min) vs avg $54.72 (+11.3σ). $28,618 across 83 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.

NATAN NEMIROVSKYPHILADELPHIAProvider total: $226.8K

criticalCost OutlierScore: 11.0

Cost-per-claim above average for 99307 (Subsequent Nursing Facility Care (Straightforward))

TRUST BEHAVIORAL HEALTHCARE SERVICES INC (1831772755) bills $99.49/claim for 99307 (Sbsq nf care sf mdm 10) vs avg $7.56 (+11.0σ). $13,232 across 133 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.

TRUST BEHAVIORAL HEALTHCARE SERVICES INCPHILADELPHIAProvider total: $32.0K

criticalCost OutlierScore: 10.9

Cost-per-claim above average for 93005

ST. CHRISTOPHER'S HEALTHCARE, LLC (1922511864) bills $375.09/claim for 93005 (Electrocardiogram tracing) vs avg $11.21 (+10.9σ). $214,178 across 571 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. CHRISTOPHER'S HEALTHCARE, LLCPHILADELPHIAProvider total: $2.1M

criticalCost OutlierScore: 10.8

Cost-per-claim above average for S9088

MEDEXPRESS URGENT CARE, PC - PENNSYLVANIA (1467744375) bills $127.20/claim for S9088 (Services provided in urgent) vs avg $29.40 (+10.8σ). $15,900 across 125 claims.

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

MEDEXPRESS URGENT CARE, PC - PENNSYLVANIAWILLIAMSPORTProvider total: $20.0K

criticalCost OutlierScore: 10.7

Cost-per-claim above average for 96372

PRIME HEALTHCARE SERVICES-SUBURBAN HOSPITAL LLC (1124495239) bills $135.48/claim for 96372 (Ther/proph/diag inj sc/im) vs avg $11.73 (+10.7σ). $44,032 across 325 claims.

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

PRIME HEALTHCARE SERVICES-SUBURBAN HOSPITAL LLCEAST NORRITONProvider total: $4.5M

criticalCost OutlierScore: 10.7

Cost-per-claim above average for 96372

PRIME HEALTHCARE SERVICES LOWER BUCKS LLC (1528319621) bills $135.55/claim for 96372 (Ther/proph/diag inj sc/im) vs avg $11.73 (+10.7σ). $214,310 across 1,581 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.

PRIME HEALTHCARE SERVICES LOWER BUCKS LLCBRISTOLProvider total: $8.7M

criticalCost OutlierScore: 10.6

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

AMERICAN ONCOLOGIC HOSPITAL (1730195017) bills $146.46/claim for 97140 (Manual therapy 1/> regions) vs avg $20.44 (+10.6σ). $32,513 across 222 claims.

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

AMERICAN ONCOLOGIC HOSPITALPHILADELPHIAProvider total: $1.5M

criticalCost OutlierScore: 10.6

Cost-per-claim above average for 96372

PRIME HEALTHCARE SERVICES ROXBOROUGH LLC (1083986129) bills $133.98/claim for 96372 (Ther/proph/diag inj sc/im) vs avg $11.73 (+10.5σ). $264,470 across 1,974 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.

PRIME HEALTHCARE SERVICES ROXBOROUGH LLCPHILADELPHIAProvider total: $8.8M

criticalCost OutlierScore: 10.5

Cost-per-claim above average for 73564

CHESTNUT HILL HOSPITAL, LLC (1184148959) bills $231.97/claim for 73564 (X-ray exam knee 4 or more) vs avg $20.78 (+10.5σ). $99,978 across 431 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.

CHESTNUT HILL HOSPITAL, LLCPHILADELPHIAProvider total: $9.5M

criticalCost OutlierScore: 10.4

Cost-per-claim above average for G0480 (Drug Test, Definitive (1-7 classes))

UPMC CHILDREN'S HOSPITAL OF PITTSBURGH (1164426896) bills $591.59/claim for G0480 (Drug test def 1-7 classes) vs avg $48.46 (+10.4σ). $375,069 across 634 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.

UPMC CHILDREN'S HOSPITAL OF PITTSBURGHPITTSBURGHProvider total: $83.0M

criticalOverutilizationScore: 10.3

Unusually high claims-per-beneficiary ratio

THE BEHAVIORAL WELLNESS CENTER AT GIRARD (1417302993): 37.5 claims/beneficiary (avg 2.1). 10,546 claims, 281 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.

THE BEHAVIORAL WELLNESS CENTER AT GIRARDPHILADELPHIAProvider total: $4.0M

criticalCost OutlierScore: 10.2

Cost-per-claim above average for 99072

NISHANT GANDHI (1477734986) bills $61.62/claim for 99072 (Addl supl matrl&staf tm phe) vs avg $2.65 (+10.2σ). $134,330 across 2,180 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.

NISHANT GANDHICONNELLSVILLEProvider total: $1.0M

criticalCost OutlierScore: 10.0

Cost-per-claim above average for G0299

RACHEAL HOME HEALTH CARE INC (1760864151) bills $522.86/claim for G0299 (Hhs/hospice of rn ea 15 min) vs avg $88.86 (+10.0σ). $768,600 across 1,470 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.

RACHEAL HOME HEALTH CARE INCYORKProvider total: $768.6K

criticalCost OutlierScore: 10.0

Cost-per-claim above average for 94010

ST. CHRISTOPHER'S HEALTHCARE, LLC (1922511864) bills $850.70/claim for 94010 (Breathing capacity test) vs avg $21.45 (+10.0σ). $178,646 across 210 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. CHRISTOPHER'S HEALTHCARE, LLCPHILADELPHIAProvider total: $2.1M

criticalCost OutlierScore: 9.9

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

ALBERT EINSTEIN MEDICAL CENTER (1174522114) bills $137.71/claim for 97140 (Manual therapy 1/> regions) vs avg $20.44 (+9.9σ). $614,331 across 4,461 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.

ALBERT EINSTEIN MEDICAL CENTERPHILAProvider total: $14.5M

criticalCost OutlierScore: 9.6

Cost-per-claim above average for 90847 (Family Psychotherapy with Patient (50 min))

HELP SERVICES INC (1376725325) bills $506.63/claim for 90847 (Family psytx w/pt 50 min) vs avg $72.34 (+9.6σ). $50,156 across 99 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.

HELP SERVICES INCHUMMELSTOWNProvider total: $82.5K

criticalCost OutlierScore: 9.5

Cost-per-claim above average for 85027 (Complete Blood Count (CBC) without Differential)

CHESTNUT HILL HOSPITAL, LLC (1184148959) bills $45.27/claim for 85027 (Complete cbc automated) vs avg $5.56 (+9.5σ). $11,544 across 255 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.

CHESTNUT HILL HOSPITAL, LLCPHILADELPHIAProvider total: $9.5M

criticalCost OutlierScore: 9.3

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

CHILDRENS SURGERY CENTER, LLC (1619284536) bills $1,459.33/claim for D2330 (Resin composite - one surface anterior) vs avg $62.84 (+9.3σ). $17,512 across 12 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.

CHILDRENS SURGERY CENTER, LLCLANCASTERProvider total: $8.1M

criticalCost OutlierScore: 9.3

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

DIRECT MOBILE DENTAL SERVICES, INC. (1699809954) bills $53.87/claim for D0230 (Intraoral - periapical each addl image) vs avg $8.06 (+9.3σ). $186,779 across 3,467 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.

DIRECT MOBILE DENTAL SERVICES, INC.BALA CYNWYDProvider total: $4.9M

criticalCost OutlierScore: 9.3

Cost-per-claim above average for H0046

YAPA APARTMENT LIVING PROGRAM, INC. (1174769442) bills $1,198.46/claim for H0046 (Mental health service, nos) vs avg $107.35 (+9.3σ). $3,388,043 across 2,827 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.

YAPA APARTMENT LIVING PROGRAM, INC.PHILADELPHIAProvider total: $3.4M

criticalOverutilizationScore: 9.2

Unusually high claims-per-beneficiary ratio

ANGELS OF CARE LLC (1861966509): 34.0 claims/beneficiary (avg 2.1). 35,289 claims, 1,038 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.

ANGELS OF CARE LLCPHILADELPHIAProvider total: $6.4M

Page 1 of 185

Statistical Outliers

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