Single-test outliers in Vermont 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
12
warning
26
info
806
Total
844
COLLABORATIVE SOLUTIONS CORPORATION (1376220178): 32.3 claims/beneficiary (avg 2.2). 11,529 claims, 357 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.
AFFORDABLE DENTURES - BURLINGTON III, P.C. (1659814176): 22.3 claims/beneficiary (avg 2.2). 2,724 claims, 122 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.
ASPIRE LIVING & LEARNING, INC. (1316119910): 21.2 claims/beneficiary (avg 2.2). 66,289 claims, 3,122 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.
HABIT OPCO, LLC (1912155516): 15.1 claims/beneficiary (avg 2.2). 3,590,317 claims, 237,943 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.
JESSICA HENEY (1417395930) bills $180.72/claim for G0467 (Fqhc visit, estab pt) vs avg $23.62 (+6.6Ο). $36,685 across 203 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.
UNITED COUNSELING SERVICE OF BENNINGTON COUNTY, INC. (1366579112): 12.5 claims/beneficiary (avg 2.2). 363,391 claims, 29,138 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.
PRIDE SUPPORT SERVICES INC (1417447723) bills $271.74/claim for T1016 (Case management) vs avg $16.87 (+5.7Ο). $18,478 across 68 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 COUNSELING & SUPPORT SERVICES (1780708263): 11.1 claims/beneficiary (avg 2.2). 587,102 claims, 52,696 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.
UNIVERSITY OF VERMONT MEDICAL CENTER INC (1568419976) bills $276.54/claim for 99284 (Emergency dept visit mod mdm) vs avg $56.12 (+4.4Ο). $11,338 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.
PATH INTEGRATED HEALTHCARE (1760948251) bills $52.14/claim for 90853 (Group psychotherapy) vs avg $12.06 (+4.3Ο). $25,968 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.
SOUTHWESTERN VERMONT MEDICAL CENTER INC. (1205865789) bills $19.07/claim for 36415 (Coll venous bld venipuncture) vs avg $3.52 (+4.2Ο). $82,475 across 4,324 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.
VALARIE MCGETTIGAN (1790874550) bills $73.18/claim for 97140 (Manual therapy 1/> regions) vs avg $30.11 (+4.1Ο). $10,684 across 146 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.
GREEN MOUNTAIN SUPPORT SERVICES INC. (1649838533): 10.6 claims/beneficiary (avg 2.2). 106,200 claims, 10,033 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.
NO DIET DIETITIAN, LLC (1689141988): 9.4 claims/beneficiary (avg 2.2). 3,315 claims, 352 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.
SOUTHWESTERN VERMONT MEDICAL CENTER INC. (1205865789) bills $44.21/claim for 71045 (X-ray exam chest 1 view) vs avg $6.10 (+4.0Ο). $15,740 across 356 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.
RIVER ROCK TREATMENT (1073116208): 9.3 claims/beneficiary (avg 2.2). 2,203 claims, 238 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.
SOUTHWESTERN VERMONT MEDICAL CENTER INC. (1205865789) bills $32.33/claim for 83036 (Hemoglobin glycosylated a1c) vs avg $5.55 (+4.0Ο). $16,584 across 513 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.
NORTHEAST KINGDOM HUMAN SERVICES INC DS WAIVER (1538292768): 9.1 claims/beneficiary (avg 2.2). 672,713 claims, 73,752 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.
ROBERT VAILLANCOURT (1205864527): 9.0 claims/beneficiary (avg 2.2). 5,223 claims, 580 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.
KINGDOM AUTISM AND BEHAVIORAL HEALTH, LLC (1447797873): 8.9 claims/beneficiary (avg 2.2). 2,271 claims, 256 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.
FAIRFAX EMS INC (1588691778) bills $380.93/claim for A0427 (Als1-emergency) vs avg $234.30 (+3.7Ο). $18,285 across 48 claims.
This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.
ASPIRE LIVING & LEARNING, INC. (1316119910) bills $261.56/claim for T2021 (Day habil waiver per 15 min) vs avg $18.78 (+3.6Ο). $5,784,237 across 22,114 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.
TRANSITION II (1942638077): 8.4 claims/beneficiary (avg 2.2). 60,291 claims, 7,172 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.
NORTHEAST KINGDOM HUMAN SERVICES INC MH CHILDREN (1043343700) bills $2.21/claim for 90837 (Psytx w pt 60 minutes) vs avg $71.39 (-3.2Ο). $26,713 across 12,077 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.
AFFORDABLE DENTURES - BURLINGTON III, P.C. (1659814176) bills $26.74/claim for D7140 (Extraction erupted tooth or exposed root) vs avg $84.90 (-3.2Ο). $72,835 across 2,724 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.
STATE OF VERMONT (1164542361) bills $2,522.34/claim for T1027 (Family training & counseling) vs avg $231.61 (+3.2Ο). $2,292,805 across 909 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 THE RUTLAND REGION (1912502212) bills $21.39/claim for D0230 (Intraoral - periapical each addl image) vs avg $8.96 (+3.1Ο). $26,541 across 1,241 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.
MAPLE LEAF FAMILY DENTISTRY (1912100256) bills $63.51/claim for D2392 (Resin composite - two surfaces posterior) vs avg $122.92 (-3.1Ο). $51,186 across 806 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.
WASHINGTON COUNTY MENTAL HEALTH SERVICES, INC. (1710901939): 7.7 claims/beneficiary (avg 2.2). 418,286 claims, 53,992 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.
REGIONAL HOME CARE INC (1730683566) bills $117.98/claim for E1390 (Oxygen concentrator, single delivery port, capable of delivering 85 percent or) vs avg $49.15 (+3.1Ο). $76,099 across 645 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.
JOSEPH KENNEDY (1649664913) bills $212.79/claim for 99285 (Emergency dept visit hi mdm) vs avg $64.37 (+3.1Ο). $80,220 across 377 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.
LAMOILLE COUNTY HEALTH MENTAL HEALTH SERVICES (1144347824): 7.7 claims/beneficiary (avg 2.2). 191,193 claims, 24,722 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.
AMY SIEGEL LICSW LLC (1821515685): 7.7 claims/beneficiary (avg 2.2). 3,743 claims, 486 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.
LAMOILLE COUNTY MENTAL HEALTH SERVICES (1396891842) jumped 14.3x from $18,033 (2020-08) to $258,767 (2020-09).
Monthly billing jumped significantly in a single month compared to the prior month. This can indicate new contracts, seasonal variation, or coding changes β not necessarily problematic.
VERMONT DEPARTMENT OF MENTAL HEALTH (1659406296) jumped 14.3x from $231,544 (2019-04) to $3,309,460 (2019-05).
Monthly billing jumped significantly in a single month compared to the prior month. This can indicate new contracts, seasonal variation, or coding changes β not necessarily problematic.
HEALTH CARE & REHABILITATION SERVICES (1841417292) jumped 13.7x from $30,492 (2019-08) to $416,255 (2019-09).
Monthly billing jumped significantly in a single month compared to the prior month. This can indicate new contracts, seasonal variation, or coding changes β not necessarily problematic.
WASHINGTON COUNTY MENTAL HEALTH SERVICES, INC. (1922026996) jumped 12.7x from $82,481 (2020-08) to $1,044,096 (2020-09).
Monthly billing jumped significantly in a single month compared to the prior month. This can indicate new contracts, seasonal variation, or coding changes β not necessarily problematic.
WASHINGTON COUNTY MENTAL HEALTH SERVICES, INC. (1922026996) submitted 48,733 claims for 90837 (Psytx w pt 60 minutes) vs avg 2,169 (+11.9Ο).
This provider submits an unusually high number of claims for a specific code compared to peers. This often simply indicates a larger practice or organization.
HEALTH CARE & REHABILITATION SERVICES (1841417292) jumped 11.3x from $46,769 (2023-08) to $529,786 (2023-09).
Monthly billing jumped significantly in a single month compared to the prior month. This can indicate new contracts, seasonal variation, or coding changes β not necessarily problematic.
HEALTH CARE & REHABILITATION SERVICES (1841417292) jumped 11.2x from $36,866 (2022-08) to $412,888 (2022-09).
Monthly billing jumped significantly in a single month compared to the prior month. This can indicate new contracts, seasonal variation, or coding changes β not necessarily problematic.
LAMOILLE COUNTY MENTAL HEALTH SERVICES (1396891842) jumped 10.3x from $27,509 (2019-06) to $284,320 (2019-07).
Monthly billing jumped significantly in a single month compared to the prior month. This can indicate new contracts, seasonal variation, or coding changes β not necessarily problematic.
GIFFORD HEALTH CARE, INC (1013269430): 100% mismatch (594/594). $258,331 via third parties.
The billing NPI differs from the servicing NPI on most claims. This is normal for group practices, hospitals, and billing companies where the organization bills on behalf of individual clinicians. Only concerning when combined with other flags.
SHIPPEE FAMILY EYE CARE PC (1023407467): 100% mismatch (1,059/1,059). $1,037,331 via third parties.
The billing NPI differs from the servicing NPI on most claims. This is normal for group practices, hospitals, and billing companies where the organization bills on behalf of individual clinicians. Only concerning when combined with other flags.
CAIRN COUNSELING CENTER PLC (1023571395): 100% mismatch (68/68). $513,483 via third parties.
The billing NPI differs from the servicing NPI on most claims. This is normal for group practices, hospitals, and billing companies where the organization bills on behalf of individual clinicians. Only concerning when combined with other flags.
LITTLE RIVERS HEALTH CARE, INC. (1033163555): 100% mismatch (161/161). $114,556 via third parties.
The billing NPI differs from the servicing NPI on most claims. This is normal for group practices, hospitals, and billing companies where the organization bills on behalf of individual clinicians. Only concerning when combined with other flags.
VICTORIA HILL PHYSICAL THERAPY, LLC (1013080993): 100% mismatch (139/139). $117,943 via third parties.
The billing NPI differs from the servicing NPI on most claims. This is normal for group practices, hospitals, and billing companies where the organization bills on behalf of individual clinicians. Only concerning when combined with other flags.
VERMONT DENTAL CARE (1033247705): 100% mismatch (1,301/1,301). $1,812,615 via third parties.
The billing NPI differs from the servicing NPI on most claims. This is normal for group practices, hospitals, and billing companies where the organization bills on behalf of individual clinicians. Only concerning when combined with other flags.
BATTENKILL VALLEY HEALTH CENTER, INC (1033530696): 100% mismatch (1,658/1,658). $3,730,807 via third parties.
The billing NPI differs from the servicing NPI on most claims. This is normal for group practices, hospitals, and billing companies where the organization bills on behalf of individual clinicians. Only concerning when combined with other flags.
FREEDOM PHYSICAL THERAPY, P.C (1073717112): 100% mismatch (211/211). $281,890 via third parties.
The billing NPI differs from the servicing NPI on most claims. This is normal for group practices, hospitals, and billing companies where the organization bills on behalf of individual clinicians. Only concerning when combined with other flags.
SPRINGFIELD MEDICAL CARE SYSTEMS INC (1003141474): 100% mismatch (1,501/1,501). $3,563,447 via third parties.
The billing NPI differs from the servicing NPI on most claims. This is normal for group practices, hospitals, and billing companies where the organization bills on behalf of individual clinicians. Only concerning when combined with other flags.