Statistical Outliers

Single-test outliers in Texas 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

1,109

warning

1,762

info

19,741

Total

22,612

Outliers by Type

Severity Distribution

critical

1,109 (4.9%)

warning

1,762 (7.8%)

info

19,741 (87.3%)

17,659 results

criticalOverutilizationScore: 45.7

Unusually high claims-per-beneficiary ratio

DAILY HOME CARE SERVICES (1417409509): 260.7 claims/beneficiary (avg 3.5). 140,266 claims, 538 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.

DAILY HOME CARE SERVICESHOUSTONProvider total: $548.6K

criticalCost OutlierScore: 32.1

Cost-per-claim above average for 90670

COOK CHILDREN'S MEDICAL CENTER (1891765178) bills $549.29/claim for 90670 (Pcv13 vaccine im) vs avg $1.26 (+32.1σ). $101,070 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.

COOK CHILDREN'S MEDICAL CENTERFORT WORTHProvider total: $286.7M

criticalCost OutlierScore: 28.7

Cost-per-claim above average for 85025 (Complete Blood Count (CBC) with Differential)

1457361024 (1457361024) bills $333.45/claim for 85025 (Complete cbc w/auto diff wbc) vs avg $4.48 (+28.7σ). $12,671 across 38 claims.

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

1457361024Provider total: $84.4K

criticalCost OutlierScore: 28.5

Cost-per-claim above average for 81025

1457361024 (1457361024) bills $457.22/claim for 81025 (Urine pregnancy test) vs avg $6.57 (+28.5σ). $10,516 across 23 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.

1457361024Provider total: $84.4K

criticalCost OutlierScore: 28.3

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

CHRISTUS SANTA ROSA HEALTH CARE CORPORATION (1447883301) bills $582.75/claim for 99213 (Office o/p est low 20 min) vs avg $29.28 (+28.2σ). $62,354 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.

CHRISTUS SANTA ROSA HEALTH CARE CORPORATIONSAN MARCOSProvider total: $4.1M

criticalCost OutlierScore: 26.2

Cost-per-claim above average for D2930

METHODIST CHILDREN'S HOSPITAL (1437171568) bills $1,157.96/claim for D2930 (Prefabricated stainless steel crown primary) vs avg $132.43 (+26.2σ). $13,896 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.

METHODIST CHILDREN'S HOSPITALLUBBOCKProvider total: $12.7M

criticalCost OutlierScore: 24.1

Cost-per-claim above average for 96110

UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON (1548226988) bills $122.18/claim for 96110 (Developmental screen w/score) vs avg $7.02 (+24.2σ). $31,034 across 254 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.

UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTONGALVESTONProvider total: $150.3M

criticalCost OutlierScore: 23.1

Cost-per-claim above average for G8427

CENSEO HEALTH LLC (1538441761) bills $1.86/claim for G8427 (Docrev cur meds by elig clin) vs avg $0.00 (+23.1σ). $27,556 across 14,854 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.

CENSEO HEALTH LLCDALLASProvider total: $1.8M

criticalCost OutlierScore: 22.0

Cost-per-claim above average for 90697

DALLAS COUNTY HOSPITAL DISTRICT (1932123247) bills $73.50/claim for 90697 (Dtap-ipv-hib-hepb vaccine im) vs avg $0.25 (+22.0σ). $16,905 across 230 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.

DALLAS COUNTY HOSPITAL DISTRICTDALLASProvider total: $152.6M

criticalCost OutlierScore: 21.7

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

1437215134 (1437215134) bills $22.69/claim for 36415 (Coll venous bld venipuncture) vs avg $0.25 (+21.7σ). $11,302 across 498 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.

FREDERIKSTED HEALTH CARE, INC.FREDERIKSTEDProvider total: $562.4K

criticalCost OutlierScore: 21.0

Cost-per-claim above average for 90680

JOSELITA RODRIGUEZ (1689692931) bills $46.76/claim for 90680 (Rv5 vacc 3 dose live oral) vs avg $0.22 (+21.0σ). $14,356 across 307 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.

JOSELITA RODRIGUEZDESOTOProvider total: $755.3K

criticalCost OutlierScore: 19.8

Cost-per-claim above average for G0439 (Annual Wellness Visit (Subsequent))

GONZALO GONZALEZ (1730182700) bills $120.00/claim for G0439 (Ppps, subseq visit) vs avg $0.41 (+19.8σ). $14,640 across 122 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.

GONZALO GONZALEZBAYTOWNProvider total: $78.8K

criticalCost OutlierScore: 19.8

Cost-per-claim above average for 93000

COOK CHILDREN'S MEDICAL CENTER (1891765178) bills $232.75/claim for 93000 (Electrocardiogram complete) vs avg $7.10 (+19.8σ). $3,889,709 across 16,712 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.

COOK CHILDREN'S MEDICAL CENTERFORT WORTHProvider total: $286.7M

criticalCost OutlierScore: 18.8

Cost-per-claim above average for 3078F

CENSEO HEALTH LLC (1538441761) bills $1.91/claim for 3078F vs avg $0.01 (+18.8σ). $18,555 across 9,709 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.

CENSEO HEALTH LLCDALLASProvider total: $1.8M

criticalCost OutlierScore: 18.3

Cost-per-claim above average for 3074F

CENSEO HEALTH LLC (1538441761) bills $1.89/claim for 3074F vs avg $0.01 (+18.3σ). $11,562 across 6,110 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.

CENSEO HEALTH LLCDALLASProvider total: $1.8M

criticalCost OutlierScore: 18.0

Cost-per-claim above average for 81002 (Urinalysis without Microscopy)

DRISCOLL CHILDRENS HOSPITAL (1548286172) bills $49.91/claim for 81002 (Urinalysis nonauto w/o scope) vs avg $2.35 (+18.0σ). $107,806 across 2,160 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.

DRISCOLL CHILDRENS HOSPITALCORPUS CHRISTIProvider total: $133.1M

criticalCost OutlierScore: 17.1

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

BETTYES HEALTHCARE NETWORK, INC. (1679820674) bills $1,453.08/claim for D0120 (Periodic oral evaluation) vs avg $38.74 (+17.1σ). $17,437 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.

BETTYES HEALTHCARE NETWORK, INC.ARLINGTONProvider total: $12.1M

criticalCost OutlierScore: 16.9

Cost-per-claim above average for 96110

DRISCOLL CHILDRENS HOSPITAL (1548286172) bills $87.59/claim for 96110 (Developmental screen w/score) vs avg $7.02 (+16.9σ). $148,905 across 1,700 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.

DRISCOLL CHILDRENS HOSPITALCORPUS CHRISTIProvider total: $133.1M

criticalCost OutlierScore: 16.8

Cost-per-claim above average for 36416 (Capillary Blood Collection (Finger/Heel Stick))

NORTHWEST TEXAS HEALTHCARE SYSTEM INC (1467442418) bills $26.70/claim for 36416 (Collj capillary blood spec) vs avg $0.18 (+16.8σ). $43,143 across 1,616 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.

NORTHWEST TEXAS HEALTHCARE SYSTEM INCAMARILLOProvider total: $44.8M

criticalCost OutlierScore: 16.6

Cost-per-claim above average for 87635

1326447939 (1326447939) bills $445.37/claim for 87635 (Sars-cov-2 covid-19 amp prb) vs avg $33.14 (+16.6σ). $26,722 across 60 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.

GUAM HEALTHCARE DEVELOPMENT INCORPORATEDDEDEDOProvider total: $1.6M

criticalCost OutlierScore: 16.6

Cost-per-claim above average for T2003

DISABILITY SERVICES OF THE SOUTHWEST, INC (1700960580) bills $196.57/claim for T2003 (N-et; encounter/trip) vs avg $7.04 (+16.6σ). $53,861 across 274 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.

DISABILITY SERVICES OF THE SOUTHWEST, INCSAN ANTONIOProvider total: $302.3M

criticalCost OutlierScore: 16.2

Cost-per-claim above average for 88305

DRISCOLL CHILDRENS HOSPITAL (1548286172) bills $4,546.63/claim for 88305 (Tissue exam by pathologist) vs avg $63.87 (+16.2σ). $286,438 across 63 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.

DRISCOLL CHILDRENS HOSPITALCORPUS CHRISTIProvider total: $133.1M

criticalCost OutlierScore: 15.6

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

LAURA FISHER (1255778247) bills $163.63/claim for D0150 (Comprehensive oral evaluation) vs avg $29.65 (+15.6σ). $19,963 across 122 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.

LAURA FISHERDENTONProvider total: $34.2K

criticalCost OutlierScore: 15.4

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

DRISCOLL CHILDRENS HOSPITAL (1124796081) bills $148.96/claim for 87804 (Influenza assay w/optic) vs avg $12.73 (+15.4σ). $145,385 across 976 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.

DRISCOLL CHILDRENS HOSPITALEDINBURGProvider total: $4.2M

criticalCost OutlierScore: 15.1

Cost-per-claim above average for 96127 (Brief Emotional/Behavioral Assessment)

HUNT MEMORIAL HOSPITAL DISTRICT (1598750721) bills $61.52/claim for 96127 (Brief emotional/behav assmt) vs avg $0.60 (+15.1σ). $11,012 across 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.

HUNT MEMORIAL HOSPITAL DISTRICTGREENVILLEProvider total: $13.6M

criticalCost OutlierScore: 15.0

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

TEXAS CHILDREN'S HOSPITAL (1477643690) bills $93.91/claim for 97150 (Group therapeutic procedures) vs avg $3.24 (+15.0σ). $14,838 across 158 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.

TEXAS CHILDREN'S HOSPITALHOUSTONProvider total: $277.3M

criticalCost OutlierScore: 15.0

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

ADAPTIVE AIDS, LLC (1639495294) bills $1,274.92/claim for D0120 (Periodic oral evaluation) vs avg $38.74 (+15.0σ). $15,299 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.

ADAPTIVE AIDS, LLCHOUSTONProvider total: $7.6M

criticalCost OutlierScore: 14.9

Cost-per-claim above average for 84484

1326447939 (1326447939) bills $170.20/claim for 84484 (Assay of troponin quant) vs avg $5.46 (+14.9σ). $29,274 across 172 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.

GUAM HEALTHCARE DEVELOPMENT INCORPORATEDDEDEDOProvider total: $1.6M

criticalCost OutlierScore: 14.8

Cost-per-claim above average for 85610

CHILDREN'S HEALTH SYSTEM OF TEXAS (1194743013) bills $51.70/claim for 85610 (Prothrombin time) vs avg $1.64 (+14.8σ). $160,413 across 3,103 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.

CHILDREN'S HEALTH SYSTEM OF TEXASDALLASProvider total: $263.8M

criticalCost OutlierScore: 14.5

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

CHILDREN'S HEALTH SYSTEM OF TEXAS (1194743013) bills $756.77/claim for A0425 (Ground mileage) vs avg $40.90 (+14.5σ). $6,754,937 across 8,926 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 HEALTH SYSTEM OF TEXASDALLASProvider total: $263.8M

criticalCost OutlierScore: 14.3

Cost-per-claim above average for 90700

OSAMA NAGA MD PA (1396080867) bills $9.41/claim for 90700 (Dtap vaccine < 7 yrs im) vs avg $0.09 (+14.3σ). $13,522 across 1,437 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.

OSAMA NAGA MD PAEL PASOProvider total: $5.1M

criticalCost OutlierScore: 14.3

Cost-per-claim above average for 87807 (RSV (Respiratory Syncytial Virus) Rapid Test)

DRISCOLL CHILDRENS HOSPITAL (1124796081) bills $114.26/claim for 87807 (Rsv assay w/optic) vs avg $10.11 (+14.3σ). $54,958 across 481 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.

DRISCOLL CHILDRENS HOSPITALEDINBURGProvider total: $4.2M

criticalCost OutlierScore: 13.9

Cost-per-claim above average for 94640

STEWARD TEXAS HOSPITAL HOLDINGS LLC (1285191452) bills $942.97/claim for 94640 (Airway inhalation treatment) vs avg $23.28 (+13.9σ). $25,460 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.

STEWARD TEXAS HOSPITAL HOLDINGS LLCBIG SPRINGProvider total: $5.1M

criticalCost OutlierScore: 13.4

Cost-per-claim above average for V2100

FOCUS VISION & EYE CARE, PLLC (1427596907) bills $159.68/claim for V2100 (Lens spher single plano 4.00) vs avg $19.81 (+13.4σ). $10,699 across 67 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.

FOCUS VISION & EYE CARE, PLLCHUTTOProvider total: $21.1K

criticalCost OutlierScore: 13.3

Cost-per-claim above average for S5125

VITAL AMBULATORY HEALTHCARE,INC (1962405977) bills $1,149.06/claim for S5125 (Attendant care service /15m) vs avg $82.44 (+13.3σ). $129,843 across 113 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.

VITAL AMBULATORY HEALTHCARE,INCHOUSTONProvider total: $129.8K

criticalCost OutlierScore: 13.3

Cost-per-claim above average for 81002 (Urinalysis without Microscopy)

JACKSONVILLE HOSPITAL LLC (1861991226) bills $37.38/claim for 81002 (Urinalysis nonauto w/o scope) vs avg $2.35 (+13.3σ). $16,449 across 440 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.

JACKSONVILLE HOSPITAL LLCJACKSONVILLEProvider total: $9.4M

criticalCost OutlierScore: 13.2

Cost-per-claim above average for 99051

LITTLE SPURS PEDIATRIC URGENT CARE, PLLC (1780673319) bills $121.17/claim for 99051 (Med serv eve/wkend/holiday) vs avg $3.96 (+13.2σ). $15,204,608 across 125,481 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.

LITTLE SPURS PEDIATRIC URGENT CARE, PLLCSAN ANTONIOProvider total: $58.5M

criticalCost OutlierScore: 13.0

Cost-per-claim above average for 86901

MATAGORDA COUNTY HOSPITAL DISTRICT (1679678767) bills $127.30/claim for 86901 (Blood typing serologic rh(d)) vs avg $3.22 (+13.0σ). $65,686 across 516 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.

MATAGORDA COUNTY HOSPITAL DISTRICTBAY CITYProvider total: $3.9M

criticalCost OutlierScore: 13.0

Cost-per-claim above average for 90698

NORTH CENTRAL TEXAS COMMUNITY HEALTH CARE CENTER INC. (1790284552) bills $11.63/claim for 90698 (Dtap-ipv/hib vaccine im) vs avg $0.10 (+13.0σ). $34,263 across 2,946 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.

NORTH CENTRAL TEXAS COMMUNITY HEALTH CARE CENTER INC.WICHITA FALLSProvider total: $17.6M

criticalCost OutlierScore: 13.0

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

CHCA CLEAR LAKE LP (1063466035) bills $325.32/claim for 99214 (Office o/p est mod 30 min) vs avg $38.21 (+13.0σ). $14,639 across 45 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.

CHCA CLEAR LAKE LPWEBSTERProvider total: $17.5M

criticalCost OutlierScore: 12.9

Cost-per-claim above average for T1003

CONSUMER DIRECTED SERVICES IN TEXAS, INC. (1801027404) bills $939.22/claim for T1003 (Lpn/lvn services up to 15min) vs avg $24.54 (+12.9σ). $492,149 across 524 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.

CONSUMER DIRECTED SERVICES IN TEXAS, INC.SAN ANTONIOProvider total: $624.8M

criticalCost OutlierScore: 12.9

Cost-per-claim above average for 94640

NORTHWEST TEXAS HEALTHCARE SYSTEM INC (1467442418) bills $877.89/claim for 94640 (Airway inhalation treatment) vs avg $23.28 (+12.9σ). $115,881 across 132 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.

NORTHWEST TEXAS HEALTHCARE SYSTEM INCAMARILLOProvider total: $44.8M

criticalCost OutlierScore: 12.8

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

COMMUNITY HEALTH CENTERS OF SOUTH CENTRAL TEXAS INC (1558611475) bills $259.10/claim for 99212 (Office o/p est sf 10 min) vs avg $23.57 (+12.8σ). $337,870 across 1,304 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 CENTERS OF SOUTH CENTRAL TEXAS INCVICTORIAProvider total: $1.7M

criticalCost OutlierScore: 12.7

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

RACHEL MARIE JELKS (1326284415) bills $1,083.25/claim for D0120 (Periodic oral evaluation) vs avg $38.74 (+12.6σ). $25,998 across 24 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.

RACHEL MARIE JELKSHOUSTONProvider total: $11.2M

criticalCost OutlierScore: 12.4

Cost-per-claim above average for 82108

TOTAL RENAL CARE INC (1649549643) bills $73.01/claim for 82108 (Assay of aluminum) vs avg $0.48 (+12.4σ). $18,324 across 251 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.

TOTAL RENAL CARE INCTEXARKANAProvider total: $691.7K

criticalCost OutlierScore: 12.3

Cost-per-claim above average for A4335

RITA MUNIZ TUTTLE (1124121207) bills $21.35/claim for A4335 (Incontinence supply) vs avg $5.21 (+12.3σ). $22,695 across 1,063 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.

RITA MUNIZ TUTTLEMCALLENProvider total: $235.4K

criticalCost OutlierScore: 12.2

Cost-per-claim above average for G0299

SOLEO HEALTH INC (1275065260) bills $737.34/claim for G0299 (Hhs/hospice of rn ea 15 min) vs avg $23.43 (+12.2σ). $182,123 across 247 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.

SOLEO HEALTH INCFORT WORTHProvider total: $1.9M

criticalCost OutlierScore: 12.0

Cost-per-claim above average for G0151

TEXAS VISITING NURSE SERVICE, LTD. (1790735827) bills $561.94/claim for G0151 (Hhcp-serv of pt,ea 15 min) vs avg $5.67 (+12.0σ). $132,057 across 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.

TEXAS VISITING NURSE SERVICE, LTD.HARLINGENProvider total: $137.7M

criticalCost OutlierScore: 12.0

Cost-per-claim above average for J0696

NAVARRO HOSPITAL LP (1144274226) bills $145.79/claim for J0696 (Ceftriaxone sodium injection) vs avg $3.86 (+12.0σ). $36,738 across 252 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.

NAVARRO HOSPITAL LPCORSICANAProvider total: $7.3M

criticalCost OutlierScore: 12.0

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

MAOFU HOME HEALTH CARE SERVICES INC. (1891971297) bills $1,029.27/claim for D0120 (Periodic oral evaluation) vs avg $38.74 (+12.0σ). $13,380 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.

MAOFU HOME HEALTH CARE SERVICES INC.HOUSTONProvider total: $24.6M

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