Single-test outliers in Washington 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
395
warning
505
info
5,437
Total
6,337
WILSON, ALLEN AND ASSOCIATES (1417237512) bills $292.11/claim for D1206 (Topical fluoride varnish) vs avg $15.79 (+21.9Ο). $234,568 across 803 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.
VP SURGERY CENTER OF AUBURN LLC (1932530284) bills $161.41/claim for D0272 (Bitewings - two radiographic images) vs avg $9.11 (+19.1Ο). $42,934 across 266 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.
WILSON, ALLEN AND ASSOCIATES (1417237512) bills $300.42/claim for D0120 (Periodic oral evaluation) vs avg $22.57 (+18.7Ο). $563,588 across 1,876 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.
MULTICARE HEALTH SYSTEM (1366556227) bills $1,691.79/claim for D2393 (Resin composite - three surfaces posterior) vs avg $82.25 (+17.1Ο). $20,302 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.
MULTICARE HEALTH SYSTEM (1326564071) bills $1,819.24/claim for D7140 (Extraction erupted tooth or exposed root) vs avg $56.64 (+16.7Ο). $49,120 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.
APEX ANESTHESIA SERVICES PC (1023467958) bills $846.07/claim for D9999 (Adjunctive procedure) vs avg $25.51 (+16.7Ο). $597,326 across 706 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.
WILSON, ALLEN AND ASSOCIATES (1417237512) bills $300.22/claim for D0150 (Comprehensive oral evaluation) vs avg $32.36 (+14.3Ο). $45,934 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.
CLALLAM COUNTY PUBLIC HOSPITAL DISTRICT 2 (1306845557) bills $100.12/claim for 96127 (Brief emotional/behav assmt) vs avg $4.01 (+14.1Ο). $372,642 across 3,722 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.
VPA PC (1699392787) bills $304.95/claim for 99212 (Office o/p est sf 10 min) vs avg $27.91 (+14.0Ο). $278,112 across 912 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.
SEATTLE CHILDREN'S HOSPITAL (1467536276) bills $500.16/claim for D2391 (Resin composite - one surface posterior) vs avg $48.81 (+13.1Ο). $217,068 across 434 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.
MULTICARE HEALTH SYSTEM (1306952726) bills $491.99/claim for D2391 (Resin composite - one surface posterior) vs avg $48.81 (+12.8Ο). $30,012 across 61 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.
BICYCLE HEALTH MEDICAL GROUP PA (1194342162) bills $434.10/claim for 99211 (Off/op est may x req phy/qhp) vs avg $17.67 (+12.3Ο). $282,601 across 651 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.
YAKIMA VALLEY COUNCIL ON ALCOHOLISM (1710283619): 27.6 claims/beneficiary (avg 2.0). 1,737 claims, 63 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.
YAKIMA VALLEY COUNCIL ON ALCOHOLISM (1245444223): 26.9 claims/beneficiary (avg 2.0). 3,706 claims, 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.
THUNYA WALKER (1790097731) bills $46.30/claim for 92015 (Determine refractive state) vs avg $9.04 (+11.2Ο). $15,973 across 345 claims.
This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.
ADAMS COUNTY PUBLIC HOSPITAL DISTRICT 3 (1811108822) bills $159.33/claim for D1351 (Sealant per tooth) vs avg $20.64 (+11.0Ο). $124,917 across 784 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.
LINCOLN COUNTY PUBLIC HOSPITAL DISTRICT 1 (1073524690) bills $46.27/claim for 36415 (Coll venous bld venipuncture) vs avg $3.59 (+10.6Ο). $39,237 across 848 claims.
This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.
A-ONE MEDICAL (1568674612): 24.5 claims/beneficiary (avg 2.0). 7,164 claims, 293 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.
RENAL TREATMENT CENTERS WEST INC (1831153980) bills $57.01/claim for G0008 (Admin influenza virus vac) vs avg $1.44 (+10.6Ο). $10,945 across 192 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.
GRANT COUNTY PUBLIC HOSPITAL DISTRICT NO. 3 (1811979610) bills $179.76/claim for 80305 (Drug test prsmv dir opt obs) vs avg $11.16 (+10.5Ο). $385,042 across 2,142 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 COLVILLE RESERVATION (1760056022): 24.3 claims/beneficiary (avg 2.0). 63,391 claims, 2,607 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.
ALLIANCE NURSING (1750457297): 24.0 claims/beneficiary (avg 2.0). 59,292 claims, 2,468 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.
REBECKA HAATS (1174044895) bills $221.01/claim for D0150 (Comprehensive oral evaluation) vs avg $32.36 (+10.1Ο). $68,956 across 312 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.
NEW ERA MENTAL HEALTH PLLC (1073198602) bills $169.63/claim for H0046 (Mental health service, nos) vs avg $8.02 (+10.0Ο). $12,213 across 72 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.
YAKIMA VALLEY COUNCIL ON ALCOHOLISM (1386858363): 22.8 claims/beneficiary (avg 2.0). 4,660 claims, 204 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.
PUBLIC HOSPITAL DISTRICT NO 4 KING COUNTY WASHINGTON (1902846546) bills $205.27/claim for 97140 (Manual therapy 1/> regions) vs avg $22.75 (+9.8Ο). $513,802 across 2,503 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.
PEDIATRIC HOME CARE, INC. (1134178098): 22.6 claims/beneficiary (avg 2.0). 39,609 claims, 1,750 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.
THE VANCOUVER CLINIC INC PS (1992759427) bills $113.35/claim for 90670 (Pcv13 vaccine im) vs avg $11.20 (+9.7Ο). $336,546 across 2,969 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.
THE HEALING LODGE OF THE SEVEN NATIONS (1437204369): 22.3 claims/beneficiary (avg 2.0). 1,338 claims, 60 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.
PEDIATRIC SERVICES OF AMERICA, LLC (1699707968): 22.2 claims/beneficiary (avg 2.0). 68,169 claims, 3,064 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.
WENATCHEE VALLEY HOSPITAL (1295071520) bills $565.90/claim for 96110 (Developmental screen w/score) vs avg $12.78 (+9.4Ο). $353,685 across 625 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.
CENTRAL WASHINGTON HEALTH SERVICES ASSOCIATION (1306883228) bills $564.39/claim for 96110 (Developmental screen w/score) vs avg $12.78 (+9.3Ο). $531,087 across 941 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.
JESSICA BAUERLE (1043531494) bills $850.00/claim for D9222 (Deep sedation/general anesthesia first 15 min) vs avg $89.86 (+9.1Ο). $11,900 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.
TOTAL RENAL CARE INC (1578202560): 21.1 claims/beneficiary (avg 2.0). 1,014 claims, 48 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.
SEA MAR COMMUNITY HEALTH CENTERS (1992853311): 20.9 claims/beneficiary (avg 2.0). 20,380 claims, 975 beneficiaries.
The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.
CITY OF ILWACO (1609501931) bills $484.12/claim for A0425 (Ground mileage) vs avg $51.49 (+8.8Ο). $13,555 across 28 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.
EVERGREEN RECOVERY CENTERS (1023515400): 20.6 claims/beneficiary (avg 2.0). 68,106 claims, 3,309 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.
MAXIM HEALTHCARE SERVICES, INC. (1932206380): 20.6 claims/beneficiary (avg 2.0). 52,881 claims, 2,569 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.
MULTICARE HEALTH SYSTEM (1306952726) bills $373.10/claim for D2392 (Resin composite - two surfaces posterior) vs avg $62.36 (+8.7Ο). $38,430 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.
NEW CARE CONCEPTS, INC. (1366596587): 20.1 claims/beneficiary (avg 2.0). 5,611 claims, 279 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.
OPTUM INFUSION SERVICES 501 INC (1841832466) bills $698.61/claim for G0299 (Hhs/hospice of rn ea 15 min) vs avg $27.88 (+8.4Ο). $111,078 across 159 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.
VPA PC (1699392787) bills $241.91/claim for 99202 (Office o/p new sf 15 min) vs avg $43.47 (+8.4Ο). $1,182,196 across 4,887 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.
PUBLIC HOSPITAL DISTRICT NO 4 KING COUNTY WASHINGTON (1902846546) bills $1,313.79/claim for 99284 (Emergency dept visit mod mdm) vs avg $128.56 (+8.4Ο). $1,569,983 across 1,195 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.
PUBLIC HOSPITAL DISTRICT NO 4 KING COUNTY WASHINGTON (1902846546) bills $374.50/claim for 71046 (X-ray exam chest 2 views) vs avg $25.66 (+8.2Ο). $44,565 across 119 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.
1447481858 (1447481858): 19.5 claims/beneficiary (avg 2.0). 14,134 claims, 726 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.
PEACEHEALTH (1073510277) bills $98.89/claim for 92551 (Pure tone hearing test air) vs avg $7.28 (+8.2Ο). $17,801 across 180 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.
PEACEHEALTH (1720056187) bills $191.51/claim for A7031 (Replacement facemask interfa) vs avg $30.22 (+7.9Ο). $27,003 across 141 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.
THE VILLA HEALTH PLLC (1508566647) bills $345.07/claim for 90837 (Psytx w pt 60 minutes) vs avg $76.20 (+7.9Ο). $87,648 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.
PEDIATRIC SERVICES OF AMERICA, LLC (1811925308) bills $5,620.83/claim for T1002 (Rn services up to 15 minutes) vs avg $159.49 (+7.8Ο). $14,619,776 across 2,601 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.
MAXIM HEALTHCARE SERVICES, INC, (1447364948): 18.5 claims/beneficiary (avg 2.0). 3,066 claims, 166 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.