Statistical Outliers

Single-test outliers in Utah 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

279

warning

187

info

1,397

Total

1,863

Outliers by Type

Severity Distribution

critical

279 (15.0%)

warning

187 (10.0%)

info

1,397 (75.0%)

1,082 results

criticalCost OutlierScore: 26.3

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

CARL GRAY (1598873382) bills $2,220.83/claim for 99214 (Office o/p est mod 30 min) vs avg $76.47 (+26.3σ). $1,390,242 across 626 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.

CARL GRAYOGDENProvider total: $1.7M

criticalCost OutlierScore: 24.9

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

RICHARD COREY (1568529105) bills $1,777.69/claim for 99213 (Office o/p est low 20 min) vs avg $58.85 (+24.9σ). $24,888 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.

RICHARD COREYPROVOProvider total: $50.1K

criticalCost OutlierScore: 12.1

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

UTAH NAVAJO HEALTH SYSTEM, INCORPORATED (1811991151) bills $271.76/claim for 90686 (Iiv4 vacc no prsv 0.5 ml im) vs avg $6.61 (+12.1σ). $765,556 across 2,817 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.

UTAH NAVAJO HEALTH SYSTEM, INCORPORATEDMONTEZUMA CREEKProvider total: $55.1M

criticalCost OutlierScore: 12.0

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

DHHS IHS PHOENIX AREA (1518244086) bills $660.40/claim for 36415 (Coll venous bld venipuncture) vs avg $17.21 (+12.0σ). $26,416 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.

DHHS IHS PHOENIX AREAFORT DUCHESNEProvider total: $122.2K

criticalCost OutlierScore: 11.8

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

UTAH HEMATOLOGY ONCOLOGY PC (1427273705) bills $1,039.94/claim for 99214 (Office o/p est mod 30 min) vs avg $76.47 (+11.8σ). $3,210,308 across 3,087 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.

UTAH HEMATOLOGY ONCOLOGY PCOGDENProvider total: $4.6M

criticalOverutilizationScore: 11.7

Unusually high claims-per-beneficiary ratio

VALLEY MENTAL HEALTH INCORPORATED (1316009228): 29.7 claims/beneficiary (avg 1.9). 47,079 claims, 1,585 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.

VALLEY MENTAL HEALTH INCORPORATEDSALT LAKE CITYProvider total: $5.0M

criticalCost OutlierScore: 11.7

Cost-per-claim above average for D0220 (Dental X-ray (Periapical, First Film))

UTAH NAVAJO HEALTH SYSTEM, INCORPORATED (1811991151) bills $428.50/claim for D0220 (Intraoral - periapical first image) vs avg $19.95 (+11.7σ). $4,386,965 across 10,238 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.

UTAH NAVAJO HEALTH SYSTEM, INCORPORATEDMONTEZUMA CREEKProvider total: $55.1M

criticalCost OutlierScore: 11.5

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

1326447939 (1326447939) bills $479.34/claim for 99283 (Emergency dept visit low mdm) vs avg $46.64 (+11.5σ). $24,926 across 52 claims.

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

GUAM HEALTHCARE DEVELOPMENT INCORPORATEDDEDEDOProvider total: $60.4K

criticalCost OutlierScore: 11.4

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

UTAH NAVAJO HEALTH SYSTEM, INCORPORATED (1457489486) bills $256.79/claim for 90686 (Iiv4 vacc no prsv 0.5 ml im) vs avg $6.61 (+11.4σ). $10,785 across 42 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.

UTAH NAVAJO HEALTH SYSTEM, INCORPORATEDBLANDINGProvider total: $2.5M

criticalOverutilizationScore: 11.3

Unusually high claims-per-beneficiary ratio

METRO TREATMENT OF UTAH LP (1700092236): 28.7 claims/beneficiary (avg 1.9). 92,868 claims, 3,237 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.

METRO TREATMENT OF UTAH LPST GEORGEProvider total: $495.5K

criticalCost OutlierScore: 11.3

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

CONFEDERATED TRIBES OF THE GOSHUTE RESERVATION (1265892012) bills $289.56/claim for 87880 (Strep a assay w/optic) vs avg $12.35 (+11.3σ). $15,636 across 54 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.

CONFEDERATED TRIBES OF THE GOSHUTE RESERVATIONSALT LAKE CITYProvider total: $15.1M

criticalCost OutlierScore: 10.0

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

PAIUTE INDIAN TRIBE OF UTAH (1942693213) bills $126.85/claim for D1206 (Topical fluoride varnish) vs avg $8.76 (+10.0σ). $15,222 across 120 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.

PAIUTE INDIAN TRIBE OF UTAHCEDAR CITYProvider total: $1.4M

criticalOverutilizationScore: 9.7

Unusually high claims-per-beneficiary ratio

SUNCREST HOSPICE UTAH LLC (1023572971): 24.9 claims/beneficiary (avg 1.9). 4,114 claims, 165 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.

SUNCREST HOSPICE UTAH LLCSANDYProvider total: $705.0K

criticalCost OutlierScore: 9.6

Cost-per-claim above average for D2392 (Dental Filling, Composite/Resin (Two Surfaces, Posterior))

CONFEDERATED TRIBES OF THE GOSHUTE RESERVATION (1174969125) bills $487.84/claim for D2392 (Resin composite - two surfaces posterior) vs avg $82.97 (+9.6σ). $267,337 across 548 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.

CONFEDERATED TRIBES OF THE GOSHUTE RESERVATIONSALT LAKE CITYProvider total: $4.5M

criticalCost OutlierScore: 9.6

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

CONFEDERATED TRIBES OF THE GOSHUTE RESERVATION (1174969125) bills $395.91/claim for D1110 (Prophylaxis - adult) vs avg $28.96 (+9.6σ). $570,107 across 1,440 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.

CONFEDERATED TRIBES OF THE GOSHUTE RESERVATIONSALT LAKE CITYProvider total: $4.5M

criticalCost OutlierScore: 9.5

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

NAT-SU HEALTH CARE LLC (1508549049) bills $716.44/claim for 99213 (Office o/p est low 20 min) vs avg $58.85 (+9.5σ). $604,679 across 844 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.

NAT-SU HEALTH CARE LLCTOOELEProvider total: $1.1M

criticalCost OutlierScore: 9.5

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

NORTHWESTERN BAND OF THE SHOSHONE (1841856986) bills $320.03/claim for D1120 (Prophylaxis - child) vs avg $19.86 (+9.5σ). $76,486 across 239 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.

NORTHWESTERN BAND OF THE SHOSHONEBRIGHAM CITYProvider total: $8.5M

criticalCost OutlierScore: 9.4

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

CONFEDERATED TRIBES OF THE GOSHUTE INDIAN RESERVATION (1023730413) bills $705.17/claim for 99213 (Office o/p est low 20 min) vs avg $58.85 (+9.4σ). $36,669 across 52 claims.

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

CONFEDERATED TRIBES OF THE GOSHUTE INDIAN RESERVATIONSLCProvider total: $537.9K

criticalCost OutlierScore: 9.3

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

CONFEDERATED TRIBES OF THE GOSHUTE RESERVATION (1174969125) bills $312.57/claim for D1120 (Prophylaxis - child) vs avg $19.86 (+9.3σ). $327,573 across 1,048 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.

CONFEDERATED TRIBES OF THE GOSHUTE RESERVATIONSALT LAKE CITYProvider total: $4.5M

criticalOverutilizationScore: 9.2

Unusually high claims-per-beneficiary ratio

METRO TREATMENT OF UTAH LP (1124234448): 23.8 claims/beneficiary (avg 1.9). 81,085 claims, 3,414 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.

METRO TREATMENT OF UTAH LPWOODS CROSSProvider total: $496.4K

criticalCost OutlierScore: 9.1

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

NAT-SU HEALTH CARE LLC (1508549049) bills $719.00/claim for 99203 (Office o/p new low 30 min) vs avg $74.13 (+9.1σ). $41,702 across 58 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.

NAT-SU HEALTH CARE LLCTOOELEProvider total: $1.1M

criticalOverutilizationScore: 9.0

Unusually high claims-per-beneficiary ratio

ONAWANDA CHEE (1578882734): 23.3 claims/beneficiary (avg 1.9). 628 claims, 27 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.

ONAWANDA CHEESLCProvider total: $78.5K

criticalCost OutlierScore: 9.0

Cost-per-claim above average for 99391 (Preventive Visit, Established Patient (Infant, <1 year))

UTAH NAVAJO HEALTH SYSTEM, INCORPORATED (1457489486) bills $696.17/claim for 99391 (Per pm reeval est pat infant) vs avg $79.13 (+9.0σ). $43,859 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.

UTAH NAVAJO HEALTH SYSTEM, INCORPORATEDBLANDINGProvider total: $2.5M

criticalCost OutlierScore: 9.0

Cost-per-claim above average for 99392 (Preventive Visit, Established Patient (Ages 1-4))

CONFEDERATED TRIBES OF THE GOSHUTE RESERVATION (1750510277) bills $601.72/claim for 99392 (Prev visit est age 1-4) vs avg $76.68 (+9.0σ). $485,584 across 807 claims.

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

CONFEDERATED TRIBES OF THE GOSHUTE RESERVATIONIBAPAHProvider total: $41.3M

criticalCost OutlierScore: 8.9

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

UTAH HEMATOLOGY ONCOLOGY PC (1427273705) bills $413.26/claim for 80053 (Comprehen metabolic panel) vs avg $14.57 (+8.9σ). $132,656 across 321 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.

UTAH HEMATOLOGY ONCOLOGY PCOGDENProvider total: $4.6M

criticalOverutilizationScore: 8.7

Unusually high claims-per-beneficiary ratio

COMMUNITY NURSING SERVICE (1316996457): 22.5 claims/beneficiary (avg 1.9). 28,026 claims, 1,245 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.

COMMUNITY NURSING SERVICEWEST VALLEY CITYProvider total: $4.1M

criticalCost OutlierScore: 8.6

Cost-per-claim above average for 99204 (Office Visit, New Patient (45 min, Moderate Complexity))

CONFEDERATED TRIBES OF THE GOSHUTE RESERVATION (1750510277) bills $579.95/claim for 99204 (Office o/p new mod 45 min) vs avg $96.15 (+8.6σ). $407,125 across 702 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.

CONFEDERATED TRIBES OF THE GOSHUTE RESERVATIONIBAPAHProvider total: $41.3M

criticalCost OutlierScore: 8.5

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

CONFEDERATED TRIBES OF THE GOSHUTE RESERVATION (1265892012) bills $186.66/claim for 81003 (Urinalysis auto w/o scope) vs avg $6.73 (+8.5σ). $321,991 across 1,725 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.

CONFEDERATED TRIBES OF THE GOSHUTE RESERVATIONSALT LAKE CITYProvider total: $15.1M

criticalCost OutlierScore: 8.5

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

UTAH NAVAJO HEALTH SYSTEM, INCORPORATED (1699803635) bills $326.96/claim for 97140 (Manual therapy 1/> regions) vs avg $17.85 (+8.5σ). $302,769 across 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.

UTAH NAVAJO HEALTH SYSTEM, INCORPORATEDMONUMENT VALLEYProvider total: $1.8M

criticalCost OutlierScore: 8.4

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

GOSHUTE HEALTH CARE LLC (1669058285) bills $674.61/claim for 99203 (Office o/p new low 30 min) vs avg $74.13 (+8.5σ). $27,659 across 41 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.

GOSHUTE HEALTH CARE LLCTOOELEProvider total: $2.9M

criticalCost OutlierScore: 8.3

Cost-per-claim above average for 90688

UTAH NAVAJO HEALTH SYSTEM, INCORPORATED (1811991151) bills $385.68/claim for 90688 (Iiv4 vaccine splt 0.5 ml im) vs avg $11.15 (+8.3σ). $122,646 across 318 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.

UTAH NAVAJO HEALTH SYSTEM, INCORPORATEDMONTEZUMA CREEKProvider total: $55.1M

criticalCost OutlierScore: 8.3

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

UTAH NAVAJO HEALTH SYSTEM, INCORPORATED (1740318401) bills $632.46/claim for 99213 (Office o/p est low 20 min) vs avg $58.85 (+8.3σ). $92,972 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.

UTAH NAVAJO HEALTH SYSTEM, INCORPORATEDNAVAJO MOUNTAINProvider total: $93.0K

criticalCost OutlierScore: 8.2

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

GOSHUTE HEALTH CARE LLC (1669058285) bills $623.42/claim for 99213 (Office o/p est low 20 min) vs avg $58.85 (+8.2σ). $1,448,833 across 2,324 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.

GOSHUTE HEALTH CARE LLCTOOELEProvider total: $2.9M

criticalCost OutlierScore: 8.2

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

NAT-SU BEHAVIORAL HEALTH LLC (1669155362) bills $707.02/claim for 90837 (Psytx w pt 60 minutes) vs avg $120.65 (+8.2σ). $42,421 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.

NAT-SU BEHAVIORAL HEALTH LLCTOOELEProvider total: $6.3M

criticalCost OutlierScore: 8.1

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

CONFEDERATED TRIBES OF THE GOSHUTE RESERVATION (1992141964) bills $577.77/claim for 97530 (Therapeutic activities) vs avg $33.30 (+8.1σ). $32,355 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.

CONFEDERATED TRIBES OF THE GOSHUTE RESERVATIONSALT LAKE CITYProvider total: $6.4M

criticalCost OutlierScore: 8.0

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

CONFEDERATED TRIBES OF THE GOSHUTE RESERVATION (1265892012) bills $80.85/claim for 83036 (Hemoglobin glycosylated a1c) vs avg $6.00 (+7.9σ). $502,696 across 6,218 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.

CONFEDERATED TRIBES OF THE GOSHUTE RESERVATIONSALT LAKE CITYProvider total: $15.1M

criticalCost OutlierScore: 8.0

Cost-per-claim above average for 73630 (Foot X-ray (3+ views))

SACRED CIRCLE HEALTHCARE (1891248936) bills $475.73/claim for 73630 (X-ray exam of foot) vs avg $29.65 (+8.0σ). $200,758 across 422 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.

SACRED CIRCLE HEALTHCARESALT LAKE CITYProvider total: $246.9K

criticalCost OutlierScore: 7.9

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

UTAH NAVAJO HEALTH SYSTEM, INCORPORATED (1699803635) bills $533.67/claim for 97110 (Therapeutic exercises) vs avg $39.69 (+7.9σ). $214,535 across 402 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.

UTAH NAVAJO HEALTH SYSTEM, INCORPORATEDMONUMENT VALLEYProvider total: $1.8M

criticalCost OutlierScore: 7.9

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

UTAH NAVAJO HEALTH SYSTEM, INCORPORATED (1457489486) bills $605.80/claim for 99213 (Office o/p est low 20 min) vs avg $58.85 (+7.9σ). $1,343,069 across 2,217 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.

UTAH NAVAJO HEALTH SYSTEM, INCORPORATEDBLANDINGProvider total: $2.5M

criticalCost OutlierScore: 7.9

Cost-per-claim above average for 92004

CONFEDERATED TRIBES OF THE GOSHUTE INDIAN RESERVATION (1023730413) bills $717.43/claim for 92004 (Compre oph exam new pt 1/>) vs avg $93.40 (+7.9σ). $328,583 across 458 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.

CONFEDERATED TRIBES OF THE GOSHUTE INDIAN RESERVATIONSLCProvider total: $537.9K

criticalCost OutlierScore: 7.9

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

GREGORY LITTON (1487603916) bills $1,768.36/claim for 85025 (Complete cbc w/auto diff wbc) vs avg $59.31 (+7.9σ). $222,813 across 126 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.

GREGORY LITTONMURRAYProvider total: $225.7K

criticalCost OutlierScore: 7.9

Cost-per-claim above average for 99204 (Office Visit, New Patient (45 min, Moderate Complexity))

PAIUTE INDIAN TRIBE OF UTAH (1700062296) bills $540.00/claim for 99204 (Office o/p new mod 45 min) vs avg $96.15 (+7.9σ). $46,980 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.

PAIUTE INDIAN TRIBE OF UTAHCEDAR CITYProvider total: $16.4M

criticalCost OutlierScore: 7.8

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

CONFEDERATED TRIBES OF THE GOSHUTE RESERVATION (1194189233) bills $716.95/claim for 99214 (Office o/p est mod 30 min) vs avg $76.47 (+7.8σ). $251,650 across 351 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.

CONFEDERATED TRIBES OF THE GOSHUTE RESERVATIONSALT LAKE CITYProvider total: $13.9M

criticalCost OutlierScore: 7.8

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

UTAH NAVAJO HEALTH SYSTEM, INCORPORATED (1699803635) bills $682.73/claim for 90837 (Psytx w pt 60 minutes) vs avg $120.65 (+7.8σ). $12,972 across 19 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.

UTAH NAVAJO HEALTH SYSTEM, INCORPORATEDMONUMENT VALLEYProvider total: $1.8M

criticalCost OutlierScore: 7.8

Cost-per-claim above average for D0140 (Limited Oral Evaluation (Problem-Focused))

RAYMOND HENDRICKSON (1932116589) bills $592.85/claim for D0140 (Limited oral evaluation - problem focused) vs avg $60.44 (+7.8σ). $441,081 across 744 claims.

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

RAYMOND HENDRICKSONPROVOProvider total: $675.8K

criticalCost OutlierScore: 7.8

Cost-per-claim above average for D0220 (Dental X-ray (Periapical, First Film))

PAIUTE INDIAN TRIBE OF UTAH (1942693213) bills $291.01/claim for D0220 (Intraoral - periapical first image) vs avg $19.95 (+7.8σ). $432,443 across 1,486 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.

PAIUTE INDIAN TRIBE OF UTAHCEDAR CITYProvider total: $1.4M

criticalCost OutlierScore: 7.7

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

IVAN HENDRICKSON (1003079260) bills $552.11/claim for D0150 (Comprehensive oral evaluation) vs avg $91.19 (+7.7σ). $147,414 across 267 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.

IVAN HENDRICKSONST GEORGEProvider total: $1.1M

criticalCost OutlierScore: 7.7

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

MAGNA DENTAL CLINIC (1790077915) bills $99.55/claim for D1206 (Topical fluoride varnish) vs avg $8.76 (+7.7σ). $12,345 across 124 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.

MAGNA DENTAL CLINICMAGNAProvider total: $34.6K

criticalCost OutlierScore: 7.6

Cost-per-claim above average for D0330 (Dental Panoramic X-ray)

CONFEDERATED TRIBES OF THE GOSHUTE RESERVATION (1750510277) bills $377.73/claim for D0330 (Panoramic radiographic image) vs avg $33.79 (+7.6σ). $19,642 across 52 claims.

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

CONFEDERATED TRIBES OF THE GOSHUTE RESERVATIONIBAPAHProvider total: $41.3M

criticalCost OutlierScore: 7.4

Cost-per-claim above average for D2150 (Dental Filling, Amalgam (Two Surfaces))

PAIUTE INDIAN TRIBE OF UTAH (1942693213) bills $324.71/claim for D2150 (Amalgam - two surfaces primary/permanent) vs avg $58.63 (+7.4σ). $75,007 across 231 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.

PAIUTE INDIAN TRIBE OF UTAHCEDAR CITYProvider total: $1.4M

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Statistical Outliers

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