Statistical Outliers

Single-test outliers in Rhode Island 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

119

warning

265

info

1,638

Total

2,022

Outliers by Type

Severity Distribution

critical

119 (5.9%)

warning

265 (13.1%)

info

1,638 (81.0%)

1,329 results

criticalCost OutlierScore: 14.2

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

PROSPECT CHARTERCARE RWMC, LLC (1013332014) bills $145.53/claim for 87880 (Strep a assay w/optic) vs avg $11.65 (+14.2σ). $13,389 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.

PROSPECT CHARTERCARE RWMC, LLCPROVIDENCEProvider total: $57.1M

criticalCost OutlierScore: 12.9

Cost-per-claim above average for 90686 (Influenza Vaccine (Quadrivalent))

RHODE ISLAND HOSPITAL (1588659528) bills $70.56/claim for 90686 (Iiv4 vacc no prsv 0.5 ml im) vs avg $1.18 (+12.9σ). $67,595 across 958 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.

RHODE ISLAND HOSPITALPROVIDENCEProvider total: $380.8M

criticalCost OutlierScore: 11.6

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

KENT COUNTY MEMORIAL HOSPITAL (1386643294) bills $190.13/claim for 99212 (Office o/p est sf 10 min) vs avg $35.64 (+11.6σ). $596,243 across 3,136 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.

KENT COUNTY MEMORIAL HOSPITALWARWICKProvider total: $90.8M

criticalCost OutlierScore: 11.3

Cost-per-claim above average for 83036 (Hemoglobin A1c (Diabetes Monitoring))

RHODE ISLAND HOSPITAL (1083848980) bills $427.83/claim for 83036 (Hemoglobin glycosylated a1c) vs avg $24.20 (+11.3σ). $37,221 across 87 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.

RHODE ISLAND HOSPITALPROVIDENCEProvider total: $13.2M

criticalCost OutlierScore: 9.6

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

OLIVIA SHARKEY (1215575808) bills $190.85/claim for 97140 (Manual therapy 1/> regions) vs avg $21.86 (+9.6σ). $17,940 across 94 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.

OLIVIA SHARKEYPROVIDENCEProvider total: $17.9K

criticalCost OutlierScore: 9.5

Cost-per-claim above average for 92340

DAVID TIEN (1932215316) bills $35.85/claim for 92340 (Fit spectacles monofocal) vs avg $16.47 (+9.5σ). $120,562 across 3,363 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.

DAVID TIENPROVIDENCEProvider total: $1.0M

criticalCost OutlierScore: 9.3

Cost-per-claim above average for 87428

PRIME HEALTHCARE SERVICES LANDMARK LLC (1699752923) bills $156.95/claim for 87428 (Sarscov & inf vir a&b ag ia) vs avg $52.67 (+9.3σ). $31,547 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.

PRIME HEALTHCARE SERVICES LANDMARK LLCWOONSOCKETProvider total: $26.2M

criticalCost OutlierScore: 9.2

Cost-per-claim above average for 80053 (Comprehensive Metabolic Panel (14 tests))

SUSIE HU (1083651301) bills $1,963.66/claim for 80053 (Comprehen metabolic panel) vs avg $69.03 (+9.2σ). $23,564 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.

SUSIE HURIVERSIDEProvider total: $913.1K

criticalCost OutlierScore: 8.8

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

KAREN JOHNSON (1720296916) bills $302.32/claim for 99214 (Office o/p est mod 30 min) vs avg $71.81 (+8.8σ). $12,093 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.

KAREN JOHNSONWAKEFIELDProvider total: $20.3K

criticalCost OutlierScore: 8.6

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

ROBERT CASCI (1528010824) bills $297.26/claim for 99214 (Office o/p est mod 30 min) vs avg $71.81 (+8.6σ). $251,186 across 845 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.

ROBERT CASCICHARLESTOWNProvider total: $264.0K

criticalCost OutlierScore: 8.6

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

JEFFREY HIGBEE (1942565486) bills $93.25/claim for D0120 (Periodic oral evaluation) vs avg $15.65 (+8.6σ). $465,675 across 4,994 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.

JEFFREY HIGBEEPROVIDENCEProvider total: $971.4K

criticalCost OutlierScore: 8.4

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

LAURIE ANDERSON (1194769539) bills $184.36/claim for 99213 (Office o/p est low 20 min) vs avg $52.37 (+8.4σ). $25,258 across 137 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.

LAURIE ANDERSONEAST GREENWICHProvider total: $25.3K

criticalCost OutlierScore: 8.1

Cost-per-claim above average for T1024

PERSPECTIVES CORPORATION (1477679629) bills $1,031.53/claim for T1024 (Team evaluation & management) vs avg $158.56 (+8.1σ). $2,075,444 across 2,012 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.

PERSPECTIVES CORPORATIONNORTH KINGSTOWNProvider total: $13.2M

criticalCost OutlierScore: 7.6

Cost-per-claim above average for 87804 (Rapid Influenza Test (Optical/Immunoassay))

PRIME HEALTHCARE SERVICES LANDMARK LLC (1699752923) bills $64.01/claim for 87804 (Influenza assay w/optic) vs avg $13.96 (+7.6σ). $92,620 across 1,447 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 LANDMARK LLCWOONSOCKETProvider total: $26.2M

criticalCost OutlierScore: 7.4

Cost-per-claim above average for 97110 (Therapeutic Exercise (per 15 min))

LISA DONAHUE (1093742777) bills $200.51/claim for 97110 (Therapeutic exercises) vs avg $31.71 (+7.4σ). $269,680 across 1,345 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.

LISA DONAHUEPROVIDENCEProvider total: $631.8K

criticalCost OutlierScore: 7.3

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

WOMEN AND INFANTS HOSPITAL (1629218094) bills $1,023.35/claim for 99283 (Emergency dept visit low mdm) vs avg $132.27 (+7.3σ). $1,374,360 across 1,343 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.

WOMEN AND INFANTS HOSPITALPROVIDENCEProvider total: $12.6M

criticalCost OutlierScore: 7.3

Cost-per-claim above average for 97110 (Therapeutic Exercise (per 15 min))

BRANDON LENTINE (1124413380) bills $197.68/claim for 97110 (Therapeutic exercises) vs avg $31.71 (+7.3σ). $54,560 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.

BRANDON LENTINEWARWICKProvider total: $230.3K

criticalCost OutlierScore: 6.9

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

JEFFREY HIGBEE (1942565486) bills $126.68/claim for D0150 (Comprehensive oral evaluation) vs avg $23.41 (+6.9σ). $117,688 across 929 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.

JEFFREY HIGBEEPROVIDENCEProvider total: $971.4K

criticalCost OutlierScore: 6.8

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

STEPHEN LAMMERS (1093278285) bills $1,649.50/claim for 99284 (Emergency dept visit mod mdm) vs avg $172.84 (+6.8σ). $19,794 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.

STEPHEN LAMMERSPROVIDENCEProvider total: $19.8K

criticalCost OutlierScore: 6.8

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

LMW HEALTHCARE INC. (1447595368) bills $84.97/claim for 80305 (Drug test prsmv dir opt obs) vs avg $9.63 (+6.8σ). $17,079 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.

LMW HEALTHCARE INC.WESTERLYProvider total: $13.1M

criticalCost OutlierScore: 6.8

Cost-per-claim above average for S5125

KAYDOLLY HOME HEALTH CARE LLC (1578141909) bills $873.47/claim for S5125 (Attendant care service /15m) vs avg $120.79 (+6.8σ). $5,508,084 across 6,306 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.

KAYDOLLY HOME HEALTH CARE LLCPAWTUCKETProvider total: $5.5M

criticalCost OutlierScore: 6.7

Cost-per-claim above average for 90834 (Psychotherapy (45 min))

JUSTICE RESOURCE INSTITUTE (1851624399) bills $174.15/claim for 90834 (Psytx w pt 45 minutes) vs avg $69.75 (+6.7σ). $18,634 across 107 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.

JUSTICE RESOURCE INSTITUTEWARWICKProvider total: $148.4K

criticalCost OutlierScore: 6.6

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

WESTBAY COMMUNITY ACTION, INC. (1245456532) bills $1,946.72/claim for 97150 (Group therapeutic procedures) vs avg $70.79 (+6.6σ). $149,898 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.

WESTBAY COMMUNITY ACTION, INC.WARWICKProvider total: $2.3M

criticalCost OutlierScore: 6.4

Cost-per-claim above average for T1016 (Case Management (per 15 min))

PERSPECTIVES CORPORATION (1477679629) bills $202.24/claim for T1016 (Case management) vs avg $32.68 (+6.4σ). $1,874,777 across 9,270 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.

PERSPECTIVES CORPORATIONNORTH KINGSTOWNProvider total: $13.2M

criticalCost OutlierScore: 6.3

Cost-per-claim above average for V2020

DAVID TIEN (1932215316) bills $66.74/claim for V2020 (Vision svcs frames purchases) vs avg $18.91 (+6.3σ). $215,889 across 3,235 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 TIENPROVIDENCEProvider total: $1.0M

criticalCost OutlierScore: 6.3

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

WOMEN AND INFANTS HOSPITAL (1629218094) bills $1,540.59/claim for 99284 (Emergency dept visit mod mdm) vs avg $172.84 (+6.3σ). $1,882,601 across 1,222 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.

WOMEN AND INFANTS HOSPITALPROVIDENCEProvider total: $12.6M

criticalCost OutlierScore: 6.3

Cost-per-claim above average for H0046

PERSPECTIVES CORPORATION (1477679629) bills $643.25/claim for H0046 (Mental health service, nos) vs avg $81.31 (+6.3σ). $2,178,698 across 3,387 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.

PERSPECTIVES CORPORATIONNORTH KINGSTOWNProvider total: $13.2M

criticalCost OutlierScore: 6.2

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

DAVID ASHLEY (1477523488) bills $118.20/claim for 99212 (Office o/p est sf 10 min) vs avg $35.64 (+6.2σ). $215,238 across 1,821 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 ASHLEYPROVIDENCEProvider total: $954.4K

criticalCost OutlierScore: 5.9

Cost-per-claim above average for 92014

LIFESPAN PHYSICIAN GROUP, INC. (1407116643) bills $146.03/claim for 92014 (Compre oph exam est pt 1/>) vs avg $40.97 (+5.9σ). $104,846 across 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.

LIFESPAN PHYSICIAN GROUP, INC.PROVIDENCEProvider total: $5.6M

criticalCost OutlierScore: 5.7

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

KYLE JOHNSON (1972846293) bills $221.28/claim for 99214 (Office o/p est mod 30 min) vs avg $71.81 (+5.7σ). $211,325 across 955 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.

KYLE JOHNSONEAST PROVIDENCEProvider total: $246.7K

criticalCost OutlierScore: 5.7

Cost-per-claim above average for 90832 (Psychotherapy (30 min))

BUTLER HOSPITAL (1104801349) bills $178.15/claim for 90832 (Psytx w pt 30 minutes) vs avg $44.46 (+5.7σ). $89,610 across 503 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.

BUTLER HOSPITALPROVIDENCEProvider total: $9.6M

criticalCost OutlierScore: 5.6

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

HEATHER SMITH (1023209145) bills $1,307.93/claim for 99285 (Emergency dept visit hi mdm) vs avg $216.18 (+5.6σ). $136,025 across 104 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.

HEATHER SMITHPROVIDENCEProvider total: $1.2M

criticalCost OutlierScore: 5.5

Cost-per-claim above average for 84450 (AST (Liver Enzyme))

NNA OF RHODE ISLAND, INC. (1215946272) bills $156.62/claim for 84450 (Transferase (ast) (sgot)) vs avg $19.28 (+5.5σ). $36,335 across 232 claims.

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

NNA OF RHODE ISLAND, INC.PAWTUCKETProvider total: $4.5M

criticalCost OutlierScore: 5.5

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

AMY SNYDER (1265535355) bills $1,369.16/claim for 99284 (Emergency dept visit mod mdm) vs avg $172.84 (+5.5σ). $19,168 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.

AMY SNYDERPROVIDENCEProvider total: $48.6K

criticalCost OutlierScore: 5.4

Cost-per-claim above average for 80053 (Comprehensive Metabolic Panel (14 tests))

BUTLER HOSPITAL (1104801349) bills $1,181.85/claim for 80053 (Comprehen metabolic panel) vs avg $69.03 (+5.4σ). $15,364 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.

BUTLER HOSPITALPROVIDENCEProvider total: $9.6M

criticalCost OutlierScore: 5.3

Cost-per-claim above average for 74177 (CT Abdomen and Pelvis with Contrast)

NEWPORT HOSPITAL (1457346413) bills $576.97/claim for 74177 (Ct abd & pelvis w/contrast) vs avg $103.61 (+5.3σ). $439,647 across 762 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.

NEWPORT HOSPITALNEWPORTProvider total: $15.8M

criticalCost OutlierScore: 5.3

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

MICHAEL SISITSKY (1316046063) bills $1,244.23/claim for 99285 (Emergency dept visit hi mdm) vs avg $216.18 (+5.3σ). $75,898 across 61 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.

MICHAEL SISITSKYPROVIDENCEProvider total: $722.0K

criticalCost OutlierScore: 5.3

Cost-per-claim above average for 81025

PROSPECT CHARTERCARE RWMC, LLC (1013332014) bills $123.27/claim for 81025 (Urine pregnancy test) vs avg $13.07 (+5.3σ). $183,423 across 1,488 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.

PROSPECT CHARTERCARE RWMC, LLCPROVIDENCEProvider total: $57.1M

criticalCost OutlierScore: 5.2

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

NEWPORT HOSPITAL (1457346413) bills $138.18/claim for 97530 (Therapeutic activities) vs avg $30.19 (+5.2σ). $40,348 across 292 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.

NEWPORT HOSPITALNEWPORTProvider total: $15.8M

criticalCost OutlierScore: 5.2

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

LIBERTAD FLORES (1437564028) bills $1,234.55/claim for 99285 (Emergency dept visit hi mdm) vs avg $216.18 (+5.2σ). $59,258 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.

LIBERTAD FLORESPROVIDENCEProvider total: $1.1M

criticalCost OutlierScore: 5.2

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

BENJAMIN BROWN (1184986705) bills $1,231.00/claim for 99285 (Emergency dept visit hi mdm) vs avg $216.18 (+5.2σ). $125,562 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.

BENJAMIN BROWNPROVIDENCEProvider total: $1.1M

criticalCost OutlierScore: 5.2

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

RHODE ISLAND HOSPITAL (1578817136) bills $227.89/claim for 85027 (Complete cbc automated) vs avg $26.36 (+5.2σ). $47,172 across 207 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.

RHODE ISLAND HOSPITALEAST PROVIDENCEProvider total: $2.6M

criticalCost OutlierScore: 5.2

Cost-per-claim above average for 96372

PRIME HEALTHCARE SERVICES-LANDMARK LLC (1396722666) bills $343.38/claim for 96372 (Ther/proph/diag inj sc/im) vs avg $35.63 (+5.2σ). $23,694 across 69 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-LANDMARK LLCWOONSOCKETProvider total: $648.8K

criticalCost OutlierScore: 5.1

Cost-per-claim above average for 92014

DAVID TIEN (1932215316) bills $131.46/claim for 92014 (Compre oph exam est pt 1/>) vs avg $40.97 (+5.1σ). $46,536 across 354 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 TIENPROVIDENCEProvider total: $1.0M

criticalCost OutlierScore: 5.0

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

GILLIAN CHASE (1336708635) bills $1,246.17/claim for 99284 (Emergency dept visit mod mdm) vs avg $172.84 (+5.0σ). $158,264 across 127 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.

GILLIAN CHASEWARWICKProvider total: $158.3K

criticalCost OutlierScore: 4.9

Cost-per-claim above average for 92014

TINEKE CHAN (1689840068) bills $128.65/claim for 92014 (Compre oph exam est pt 1/>) vs avg $40.97 (+4.9σ). $95,585 across 743 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.

TINEKE CHANPROVIDENCEProvider total: $341.6K

criticalCost OutlierScore: 4.9

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

SHIRLEY MENGALLE DIONE (1235624891) bills $1,232.02/claim for 99284 (Emergency dept visit mod mdm) vs avg $172.84 (+4.9σ). $672,684 across 546 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.

SHIRLEY MENGALLE DIONEPROVIDENCEProvider total: $679.5K

criticalCost OutlierScore: 4.9

Cost-per-claim above average for 87389 (HIV-1 Antigen with Antibody Test)

MEGHAN GEARY (1073925988) bills $175.18/claim for 87389 (Hiv-1 ag w/hiv-1&-2 ab ag ia) vs avg $57.67 (+4.9σ). $24,174 across 138 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.

MEGHAN GEARYPROVIDENCEProvider total: $618.5K

criticalCost OutlierScore: 4.8

Cost-per-claim above average for D9230

JEFFREY HIGBEE (1942565486) bills $135.45/claim for D9230 (Inhalation of nitrous oxide/analgesia) vs avg $31.86 (+4.8σ). $45,104 across 333 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.

JEFFREY HIGBEEPROVIDENCEProvider total: $971.4K

criticalCost OutlierScore: 4.7

Cost-per-claim above average for 97110 (Therapeutic Exercise (per 15 min))

ANDREW MATSON (1134462393) bills $139.70/claim for 97110 (Therapeutic exercises) vs avg $31.71 (+4.7σ). $292,244 across 2,092 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.

ANDREW MATSONWARWICKProvider total: $746.1K

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