Single-test outliers in Rhode Island 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
167
warning
217
info
1,638
Total
2,022
PROSPECT CHARTERCARE RWMC, LLC (1013332014) bills $145.53/claim for 87880 (Strep a assay w/optic) vs avg $11.65 (+14.2Ο). $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.
RHODE ISLAND HOSPITAL (1588659528) bills $70.56/claim for 90686 (Iiv4 vacc no prsv 0.5 ml im) vs avg $1.18 (+12.9Ο). $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.
MENTOR ABI (1639476617): 31.7 claims/beneficiary (avg 2.0). 45,469 claims, 1,433 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.
EMMA PENDLETON BRADLEY HOSPITAL (1659576858): 30.1 claims/beneficiary (avg 2.0). 77,477 claims, 2,575 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.
KENT COUNTY MEMORIAL HOSPITAL (1386643294) bills $190.13/claim for 99212 (Office o/p est sf 10 min) vs avg $35.64 (+11.6Ο). $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.
LIKE HOME ADULT DAYCARE HEALTH CENTER, LLC (1518435882): 29.5 claims/beneficiary (avg 2.0). 40,773 claims, 1,383 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.
RHODE ISLAND HOSPITAL (1083848980) bills $427.83/claim for 83036 (Hemoglobin glycosylated a1c) vs avg $24.20 (+11.3Ο). $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.
GATEWAY HEALTHCARE, INC (1952699985): 27.2 claims/beneficiary (avg 2.0). 13,825 claims, 508 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.
CAREGIVERS RI, LLC (1003472747): 27.1 claims/beneficiary (avg 2.0). 50,632 claims, 1,865 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.
PERSPECTIVES CORPORATION (1689940371): 26.4 claims/beneficiary (avg 2.0). 142,398 claims, 5,386 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.
OLIVIA SHARKEY (1215575808) bills $190.85/claim for 97140 (Manual therapy 1/> regions) vs avg $21.86 (+9.6Ο). $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.
DAVID TIEN (1932215316) bills $35.85/claim for 92340 (Fit spectacles monofocal) vs avg $16.47 (+9.5Ο). $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.
PRIME HEALTHCARE SERVICES LANDMARK LLC (1699752923) bills $156.95/claim for 87428 (Sarscov & inf vir a&b ag ia) vs avg $52.67 (+9.3Ο). $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.
SUSIE HU (1083651301) bills $1,963.66/claim for 80053 (Comprehen metabolic panel) vs avg $69.03 (+9.2Ο). $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.
BRITTANY BOULEY (1124532437): 23.9 claims/beneficiary (avg 2.0). 11,015 claims, 461 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.
CAREGIVER HOMES OF RHODE ISLAND INC. (1255655502): 23.7 claims/beneficiary (avg 2.0). 1,137,501 claims, 47,959 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.
KAREN JOHNSON (1720296916) bills $302.32/claim for 99214 (Office o/p est mod 30 min) vs avg $71.81 (+8.8Ο). $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.
ROBERT CASCI (1528010824) bills $297.26/claim for 99214 (Office o/p est mod 30 min) vs avg $71.81 (+8.6Ο). $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.
JEFFREY HIGBEE (1942565486) bills $93.25/claim for D0120 (Periodic oral evaluation) vs avg $15.65 (+8.6Ο). $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.
HOMECARE ADVANTAGE INC. (1104948439): 22.2 claims/beneficiary (avg 2.0). 144,410 claims, 6,504 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.
LAURIE ANDERSON (1194769539) bills $184.36/claim for 99213 (Office o/p est low 20 min) vs avg $52.37 (+8.4Ο). $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.
A CARING EXPERIENCE NURSING SERVICES, INC. (1326250572): 21.9 claims/beneficiary (avg 2.0). 737,012 claims, 33,606 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.
LONGLIFE HOME CARE LLC (1134871353): 21.6 claims/beneficiary (avg 2.0). 1,707 claims, 79 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.
MAP BEHAVIORAL HEALTH SERVICES INC. (1821218587): 21.6 claims/beneficiary (avg 2.0). 1,597 claims, 74 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.
ONE STONE L.L.C. (1043885981): 21.4 claims/beneficiary (avg 2.0). 48,448 claims, 2,263 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.
PERSPECTIVES CORPORATION (1477679629) bills $1,031.53/claim for T1024 (Team evaluation & management) vs avg $158.56 (+8.1Ο). $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.
CBS THERAPY (1982075495): 21.0 claims/beneficiary (avg 2.0). 18,477 claims, 879 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.
SEVEN HILLS RHODE ISLAND INC (1598080699): 20.9 claims/beneficiary (avg 2.0). 216,027 claims, 10,320 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.
YOUR CHOICE OF HOME CARE LLC (1235777228): 20.9 claims/beneficiary (avg 2.0). 368,432 claims, 17,630 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.
JOY HOME CARE INC. (1427531359): 20.3 claims/beneficiary (avg 2.0). 533,525 claims, 26,250 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.
PRIME HEALTHCARE SERVICES LANDMARK LLC (1699752923) bills $64.01/claim for 87804 (Influenza assay w/optic) vs avg $13.96 (+7.6Ο). $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.
LISA DONAHUE (1093742777) bills $200.51/claim for 97110 (Therapeutic exercises) vs avg $31.71 (+7.4Ο). $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.
WOMEN AND INFANTS HOSPITAL (1629218094) bills $1,023.35/claim for 99283 (Emergency dept visit low mdm) vs avg $132.27 (+7.3Ο). $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.
BRANDON LENTINE (1124413380) bills $197.68/claim for 97110 (Therapeutic exercises) vs avg $31.71 (+7.3Ο). $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.
CARING PATH HOME HEALTH SERVICES LLC (1558092882): 18.8 claims/beneficiary (avg 2.0). 13,674 claims, 727 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.
SENIOR HELPERS OF RHODE ISLAND, LLC (1316125453): 18.8 claims/beneficiary (avg 2.0). 20,932 claims, 1,112 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.
CHILD INC. (1760547582): 18.7 claims/beneficiary (avg 2.0). 7,869 claims, 421 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.
JEFFREY HIGBEE (1942565486) bills $126.68/claim for D0150 (Comprehensive oral evaluation) vs avg $23.41 (+6.9Ο). $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.
STEPHEN LAMMERS (1093278285) bills $1,649.50/claim for 99284 (Emergency dept visit mod mdm) vs avg $172.84 (+6.8Ο). $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.
LMW HEALTHCARE INC. (1447595368) bills $84.97/claim for 80305 (Drug test prsmv dir opt obs) vs avg $9.63 (+6.8Ο). $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.
KAYDOLLY HOME HEALTH CARE LLC (1578141909) bills $873.47/claim for S5125 (Attendant care service /15m) vs avg $120.79 (+6.8Ο). $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.
SPECIALTY HOME CARE SERVICES, INC. (1649300526): 18.1 claims/beneficiary (avg 2.0). 11,776 claims, 649 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.
JUSTICE RESOURCE INSTITUTE (1851624399) bills $174.15/claim for 90834 (Psytx w pt 45 minutes) vs avg $69.75 (+6.7Ο). $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.
GOLDEN ROADS ADULT DAY CENTER LLC (1730697343): 18.0 claims/beneficiary (avg 2.0). 20,430 claims, 1,136 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.
ABRAHAM HOME CARE PROVIDER LLC (1922750173): 17.9 claims/beneficiary (avg 2.0). 97,449 claims, 5,430 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.
CITY OF PROVIDENCE RHODE ISLAND (1356557458): 17.9 claims/beneficiary (avg 2.0). 92,864 claims, 5,187 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.
WESTBAY COMMUNITY ACTION, INC. (1245456532) bills $1,946.72/claim for 97150 (Group therapeutic procedures) vs avg $70.79 (+6.6Ο). $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.
DEPENDABLE HEALTHCARE SERVICES, LLC. (1821325366): 17.5 claims/beneficiary (avg 2.0). 10,884 claims, 622 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.
PERSPECTIVES CORPORATION (1477679629) bills $202.24/claim for T1016 (Case management) vs avg $32.68 (+6.4Ο). $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.
DAVID TIEN (1932215316) bills $66.74/claim for V2020 (Vision svcs frames purchases) vs avg $18.91 (+6.3Ο). $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.