Statistical Outliers

Single-test outliers in South Dakota 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

warning

102

info

649

Total

833

Outliers by Type

Severity Distribution

critical

82 (9.8%)

warning

102 (12.2%)

info

649 (77.9%)

514 results

criticalOverutilizationScore: 15.3

Unusually high claims-per-beneficiary ratio

AVERA MCKENNAN (1023413093): 60.4 claims/beneficiary (avg 2.2). 7,612 claims, 126 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.

AVERA MCKENNANMITCHELLProvider total: $70.2K

criticalOverutilizationScore: 12.9

Unusually high claims-per-beneficiary ratio

SANFORD MEDICAL CENTER (1912921438): 51.4 claims/beneficiary (avg 2.2). 6,887 claims, 134 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.

SANFORD MEDICAL CENTERSIOUX FALLSProvider total: $75.8K

criticalCost OutlierScore: 7.7

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

GREAT PLAINS TRIBAL CHAIRMEN'S HEALTH BOARD (1376105452) bills $408.80/claim for 99203 (Office o/p new low 30 min) vs avg $61.93 (+7.7σ). $144,715 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.

GREAT PLAINS TRIBAL CHAIRMEN'S HEALTH BOARDRAPID CITYProvider total: $36.4M

criticalOverutilizationScore: 7.7

Unusually high claims-per-beneficiary ratio

AURORA PLAINS ACADEMY LLC (1003942095): 31.5 claims/beneficiary (avg 2.2). 78,357 claims, 2,484 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.

AURORA PLAINS ACADEMY LLCPLANKINTONProvider total: $26.6M

criticalCost OutlierScore: 7.4

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

FLANDREAU SANTEE SIOUX TRIBE (1437188729) bills $620.61/claim for 90837 (Psytx w pt 60 minutes) vs avg $92.08 (+7.4σ). $20,480 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.

FLANDREAU SANTEE SIOUX TRIBEFLANDREAUProvider total: $2.9M

criticalCost OutlierScore: 7.0

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

GREAT PLAINS TRIBAL CHAIRMEN'S HEALTH BOARD (1376105452) bills $500.17/claim for D0150 (Comprehensive oral evaluation) vs avg $66.66 (+7.0σ). $34,512 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.

GREAT PLAINS TRIBAL CHAIRMEN'S HEALTH BOARDRAPID CITYProvider total: $36.4M

criticalCost OutlierScore: 6.8

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

WOODROW WILSON KEEBLE MEMORIAL HEALTH CARE CENTER (1366471666) bills $288.10/claim for D0120 (Periodic oral evaluation) vs avg $39.14 (+6.8σ). $64,534 across 224 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.

WOODROW WILSON KEEBLE MEMORIAL HEALTH CARE CENTERSISSETONProvider total: $6.8M

criticalCost OutlierScore: 6.8

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

GREAT PLAINS TRIBAL CHAIRMEN'S HEALTH BOARD (1376105452) bills $380.28/claim for 99202 (Office o/p new sf 15 min) vs avg $50.68 (+6.8σ). $164,279 across 432 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.

GREAT PLAINS TRIBAL CHAIRMEN'S HEALTH BOARDRAPID CITYProvider total: $36.4M

criticalCost OutlierScore: 6.8

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

FORT YATES INDIAN HEALTH SERVICE HOSPITAL (1710037288) bills $299.04/claim for D1110 (Prophylaxis - adult) vs avg $60.11 (+6.8σ). $51,135 across 171 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.

FORT YATES INDIAN HEALTH SERVICE HOSPITALMCLAUGHLINProvider total: $3.2M

criticalCost OutlierScore: 6.5

Cost-per-claim above average for 97112

CHILDREN'S CARE HOSPITAL AND SCHOOL (1558560904) bills $234.31/claim for 97112 (Neuromuscular reeducation) vs avg $21.88 (+6.5σ). $818,227 across 3,492 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.

CHILDREN'S CARE HOSPITAL AND SCHOOLSIOUX FALLSProvider total: $2.0M

criticalOverutilizationScore: 6.4

Unusually high claims-per-beneficiary ratio

AVERA MCKENNAN (1710316252): 26.7 claims/beneficiary (avg 2.2). 154,155 claims, 5,784 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.

AVERA MCKENNANSIOUX FALLSProvider total: $1.0M

criticalCost OutlierScore: 6.4

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

CHEYENNE RIVER DENTAL CLINIC (1851422596) bills $381.00/claim for D1120 (Prophylaxis - child) vs avg $49.07 (+6.4σ). $90,298 across 237 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.

CHEYENNE RIVER DENTAL CLINICEAGLE BUTTEProvider total: $1.6M

criticalCost OutlierScore: 6.4

Cost-per-claim above average for 92004

WOODROW WILSON KEEBLE MEMORIAL HEALTH CARE CENTER (1366471666) bills $432.50/claim for 92004 (Compre oph exam new pt 1/>) vs avg $115.23 (+6.4σ). $12,975 across 30 claims.

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

WOODROW WILSON KEEBLE MEMORIAL HEALTH CARE CENTERSISSETONProvider total: $6.8M

criticalCost OutlierScore: 6.1

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

CHEYENNE RIVER DENTAL CLINIC (1851422596) bills $275.99/claim for D1110 (Prophylaxis - adult) vs avg $60.11 (+6.1σ). $160,073 across 580 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.

CHEYENNE RIVER DENTAL CLINICEAGLE BUTTEProvider total: $1.6M

criticalCost OutlierScore: 6.1

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

WINNER REGIONAL HEALTHCARE CENTER (1538233549) bills $478.59/claim for 36415 (Coll venous bld venipuncture) vs avg $30.73 (+6.1σ). $30,630 across 64 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.

WINNER REGIONAL HEALTHCARE CENTERWINNERProvider total: $388.9K

criticalCost OutlierScore: 5.9

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

ROSEBUD INDIAN HEALTH SERVICE (1194757369) bills $516.84/claim for 90837 (Psytx w pt 60 minutes) vs avg $92.08 (+5.9σ). $377,291 across 730 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.

ROSEBUD INDIAN HEALTH SERVICEROSEBUDProvider total: $22.2M

criticalCost OutlierScore: 5.7

Cost-per-claim above average for D0272 (Dental X-rays (Bitewings, 2 Films))

WOODROW WILSON KEEBLE MEMORIAL HEALTH CARE CENTER (1366471666) bills $104.19/claim for D0272 (Bitewings - two radiographic images) vs avg $25.45 (+5.7σ). $30,631 across 294 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.

WOODROW WILSON KEEBLE MEMORIAL HEALTH CARE CENTERSISSETONProvider total: $6.8M

criticalCost OutlierScore: 5.5

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

PINE RIDGE INDIAN HEALTH SERVICE HOSPITAL (1497786412) bills $344.16/claim for D1206 (Topical fluoride varnish) vs avg $36.35 (+5.5σ). $1,275,799 across 3,707 claims.

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

PINE RIDGE INDIAN HEALTH SERVICE HOSPITALPINE RIDGEProvider total: $37.3M

criticalCost OutlierScore: 5.3

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

PINE RIDGE INDIAN HEALTH SERVICE HOSPITAL (1003963497) bills $623.82/claim for 90791 (Psych diagnostic evaluation) vs avg $113.37 (+5.4σ). $95,444 across 153 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.

PINE RIDGE INDIAN HEALTH SERVICE HOSPITALKYLEProvider total: $10.8M

criticalCost OutlierScore: 5.2

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

PINE RIDGE INDIAN HEALTH SERVICE HOSPITAL (1003963497) bills $466.81/claim for 90837 (Psytx w pt 60 minutes) vs avg $92.08 (+5.2σ). $201,193 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.

PINE RIDGE INDIAN HEALTH SERVICE HOSPITALKYLEProvider total: $10.8M

criticalCost OutlierScore: 5.2

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

WHITE HORSE TRIBAL HEALTH CENTER (1588806806) bills $589.88/claim for 99213 (Office o/p est low 20 min) vs avg $70.99 (+5.2σ). $33,033 across 56 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.

WHITE HORSE TRIBAL HEALTH CENTERWHITE HORSEProvider total: $33.0K

criticalCost OutlierScore: 5.1

Cost-per-claim above average for 99308 (Subsequent Nursing Facility Care (Low Complexity))

COTEAU DES PRAIRIES HOSPITAL (1881740629) bills $110.26/claim for 99308 (Sbsq nf care low mdm 20) vs avg $25.55 (+5.1σ). $392,757 across 3,562 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.

COTEAU DES PRAIRIES HOSPITALSISSETONProvider total: $2.9M

criticalCost OutlierScore: 5.0

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

EAGLE BUTTE INDIAN HEALTH SERVICE HOSPITAL (1558395848) bills $548.77/claim for 97110 (Therapeutic exercises) vs avg $41.37 (+5.0σ). $344,630 across 628 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.

EAGLE BUTTE INDIAN HEALTH SERVICE HOSPITALEAGLE BUTTEProvider total: $19.2M

criticalCost OutlierScore: 5.0

Cost-per-claim above average for 81003 (Urinalysis by Dipstick (Automated))

RAPID CITY INDIAN HEALTH SERVICE HOSPITAL (1316900327) bills $481.15/claim for 81003 (Urinalysis auto w/o scope) vs avg $39.24 (+5.0σ). $12,991 across 27 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.

RAPID CITY INDIAN HEALTH SERVICE HOSPITALRAPID CITYProvider total: $985.4K

criticalCost OutlierScore: 5.0

Cost-per-claim above average for 93010

MOBRIDGE REGIONAL HOSPITAL (1275502577) bills $78.46/claim for 93010 (Electrocardiogram report) vs avg $9.56 (+5.0σ). $13,181 across 168 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.

MOBRIDGE REGIONAL HOSPITALMOBRIDGEProvider total: $2.8M

criticalCost OutlierScore: 5.0

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

PINE RIDGE INDIAN HEALTH SERVICE HOSPITAL (1003208257) bills $632.45/claim for 90471 (Immunization admin) vs avg $65.96 (+5.0σ). $27,828 across 44 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.

PINE RIDGE INDIAN HEALTH SERVICE HOSPITALMARTINProvider total: $861.7K

criticalCost OutlierScore: 4.9

Cost-per-claim above average for 80048 (Basic Metabolic Panel (8 tests))

AVERA MCKENNAN (1568460772) bills $149.91/claim for 80048 (Metabolic panel total ca) vs avg $13.52 (+4.9σ). $22,036 across 147 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.

AVERA MCKENNANSIOUX FALLSProvider total: $3.7M

criticalCost OutlierScore: 4.8

Cost-per-claim above average for U0002

SIOUX FALLS SPECIALTY HOSPITAL, LLP (1316946809) bills $482.87/claim for U0002 (2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple) vs avg $58.26 (+4.8σ). $102,852 across 213 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.

SIOUX FALLS SPECIALTY HOSPITAL, LLPSIOUX FALLSProvider total: $1.3M

criticalCost OutlierScore: 4.8

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

FLANDREAU SANTEE SIOUX TRIBE (1437188729) bills $229.54/claim for D1110 (Prophylaxis - adult) vs avg $60.11 (+4.8σ). $35,809 across 156 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.

FLANDREAU SANTEE SIOUX TRIBEFLANDREAUProvider total: $2.9M

criticalCost OutlierScore: 4.8

Cost-per-claim above average for 90710

HORIZON HEALTH CARE, INC (1578672846) bills $19.89/claim for 90710 (Mmrv vaccine sc) vs avg $0.96 (+4.8σ). $12,633 across 635 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.

HORIZON HEALTH CARE, INCMISSIONProvider total: $9.7M

criticalCost OutlierScore: 4.8

Cost-per-claim above average for 74018

SANFORD MEDICAL CENTER (1821017880) bills $79.40/claim for 74018 (Radex abdomen 1 view) vs avg $13.28 (+4.8σ). $28,903 across 364 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.

SANFORD MEDICAL CENTERSIOUX FALLSProvider total: $24.4M

criticalCost OutlierScore: 4.8

Cost-per-claim above average for 81025

OGLALA SIOUX TRIBE (1164503421) bills $456.00/claim for 81025 (Urine pregnancy test) vs avg $38.20 (+4.8σ). $151,848 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.

OGLALA SIOUX TRIBERAPID CITYProvider total: $5.2M

criticalCost OutlierScore: 4.7

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

RAPID CITY INDIAN HEALTH SERVICE HOSPITAL (1316900327) bills $300.72/claim for D1206 (Topical fluoride varnish) vs avg $36.35 (+4.7σ). $49,919 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.

RAPID CITY INDIAN HEALTH SERVICE HOSPITALRAPID CITYProvider total: $985.4K

criticalCost OutlierScore: 4.7

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

SANFORD HEALTH NETWORK (1134140825) bills $374.72/claim for 36415 (Coll venous bld venipuncture) vs avg $30.73 (+4.7σ). $53,585 across 143 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.

SANFORD HEALTH NETWORKCHAMBERLAINProvider total: $1.5M

criticalCost OutlierScore: 4.7

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

WAGNER INDIAN HEALTH SERVICE HEALTH CENTER (1326066796) bills $508.78/claim for 99214 (Office o/p est mod 30 min) vs avg $75.53 (+4.7σ). $1,333,519 across 2,621 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.

WAGNER INDIAN HEALTH SERVICE HEALTH CENTERWAGNERProvider total: $8.8M

criticalCost OutlierScore: 4.7

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

HORIZON HEALTH CARE, INC (1578672846) bills $150.93/claim for 83036 (Hemoglobin glycosylated a1c) vs avg $14.40 (+4.7σ). $29,130 across 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.

HORIZON HEALTH CARE, INCMISSIONProvider total: $9.7M

criticalCost OutlierScore: 4.6

Cost-per-claim above average for 85018

HORIZON HEALTH CARE, INC (1578672846) bills $176.60/claim for 85018 (Hemoglobin) vs avg $10.86 (+4.6σ). $113,198 across 641 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.

HORIZON HEALTH CARE, INCMISSIONProvider total: $9.7M

criticalCost OutlierScore: 4.6

Cost-per-claim above average for A9270

AVERA QUEEN OF PEACE (1992466635) bills $128.09/claim for A9270 (Non-covered item or service) vs avg $18.20 (+4.6σ). $329,067 across 2,569 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.

AVERA QUEEN OF PEACEMITCHELLProvider total: $1.3M

criticalCost OutlierScore: 4.6

Cost-per-claim above average for 92014

FLANDREAU SANTEE SIOUX TRIBE (1437188729) bills $565.31/claim for 92014 (Compre oph exam est pt 1/>) vs avg $103.01 (+4.6σ). $111,365 across 197 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.

FLANDREAU SANTEE SIOUX TRIBEFLANDREAUProvider total: $2.9M

criticalCost OutlierScore: 4.5

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

WAGNER INDIAN HEALTH SERVICE HEALTH CENTER (1326066796) bills $335.59/claim for D7140 (Extraction erupted tooth or exposed root) vs avg $93.13 (+4.6σ). $11,410 across 34 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.

WAGNER INDIAN HEALTH SERVICE HEALTH CENTERWAGNERProvider total: $8.8M

criticalCost OutlierScore: 4.5

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

CHEYENNE RIVER SIOUX TRIBE FIELD HEALTH CLINIC (1457593725) bills $525.25/claim for 99213 (Office o/p est low 20 min) vs avg $70.99 (+4.5σ). $7,972,727 across 15,179 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.

CHEYENNE RIVER SIOUX TRIBE FIELD HEALTH CLINICEAGLE BUTTEProvider total: $8.0M

criticalCost OutlierScore: 4.5

Cost-per-claim above average for 86140

BENNETT COUNTY HOSPITAL AND NURSING HOME (1437187044) bills $136.34/claim for 86140 (C-reactive protein) vs avg $9.36 (+4.5σ). $53,992 across 396 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.

BENNETT COUNTY HOSPITAL AND NURSING HOMEMARTINProvider total: $1.3M

criticalCost OutlierScore: 4.5

Cost-per-claim above average for S5130

FIRST CHOICE HOME CARE,LLC (1578960019) bills $281.44/claim for S5130 (Homaker service nos per 15m) vs avg $78.30 (+4.5σ). $147,192 across 523 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.

FIRST CHOICE HOME CARE,LLCSIOUX FALLSProvider total: $147.2K

criticalCost OutlierScore: 4.5

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

FORT THOMPSON INDIAN HEALTH SERVICE (1710995907) bills $494.90/claim for 99214 (Office o/p est mod 30 min) vs avg $75.53 (+4.5σ). $1,186,270 across 2,397 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.

FORT THOMPSON INDIAN HEALTH SERVICEFORT THOMPSONProvider total: $10.8M

criticalCost OutlierScore: 4.5

Cost-per-claim above average for 92014

EAGLE BUTTE INDIAN HEALTH SERVICE HOSPITAL (1558395848) bills $552.91/claim for 92014 (Compre oph exam est pt 1/>) vs avg $103.01 (+4.4σ). $301,335 across 545 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.

EAGLE BUTTE INDIAN HEALTH SERVICE HOSPITALEAGLE BUTTEProvider total: $19.2M

criticalCost OutlierScore: 4.4

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

FORT THOMPSON INDIAN HEALTH SERVICE (1710995907) bills $282.84/claim for D1206 (Topical fluoride varnish) vs avg $36.35 (+4.4σ). $329,792 across 1,166 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.

FORT THOMPSON INDIAN HEALTH SERVICEFORT THOMPSONProvider total: $10.8M

criticalCost OutlierScore: 4.4

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

LOWER BRULE HEALTH CENTER IHS (1881719425) bills $482.66/claim for 99214 (Office o/p est mod 30 min) vs avg $75.53 (+4.4σ). $39,578 across 82 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.

LOWER BRULE HEALTH CENTER IHSLOWER BRULEProvider total: $6.3M

criticalCost OutlierScore: 4.4

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

CHERRY CREEK TRIBAL HEALTH CENTER (1295977510) bills $509.58/claim for 99213 (Office o/p est low 20 min) vs avg $70.99 (+4.4σ). $1,087,442 across 2,134 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.

CHERRY CREEK TRIBAL HEALTH CENTERCHERRY CREEKProvider total: $1.1M

criticalCost OutlierScore: 4.3

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

PINE RIDGE INDIAN HEALTH SERVICE HOSPITAL (1962559518) bills $556.72/claim for 90471 (Immunization admin) vs avg $65.96 (+4.3σ). $188,172 across 338 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.

PINE RIDGE INDIAN HEALTH SERVICE HOSPITALWANBLEEProvider total: $4.6M

criticalCost OutlierScore: 4.2

Cost-per-claim above average for 96110

COMMUNITY HEALTH CENTER OF THE BLACK HILLS INC (1669508677) bills $142.08/claim for 96110 (Developmental screen w/score) vs avg $14.48 (+4.2σ). $14,634 across 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.

COMMUNITY HEALTH CENTER OF THE BLACK HILLS INCRAPID CITYProvider total: $10.3M

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Statistical Outliers

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