Single-test outliers in Wisconsin 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
318
warning
392
info
4,230
Total
4,940
LAKE SUPERIOR COMMUNITY HEALTH CENTER (1063789022) bills $210.92/claim for 98941 (Chiropract manj 3-4 regions) vs avg $18.47 (+21.1Ο). $18,139 across 86 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.
WAUKESHA COUNTY (1265753305): 70.8 claims/beneficiary (avg 2.7). 30,171 claims, 426 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.
ODYSSEY HEALTHCARE HOLDING COMPANY (1558061242): 60.6 claims/beneficiary (avg 2.7). 5,877 claims, 97 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.
MILE BLUFF MEDICAL CENTER INC (1568487411) bills $123.99/claim for 99000 (Specimen handling office-lab) vs avg $3.73 (+15.7Ο). $49,348 across 398 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.
CENTER FOR INDEPENDENT LIVING FOR WESTERN WISCONSIN (1710139159) bills $1,102.77/claim for S5125 (Attendant care service /15m) vs avg $21.47 (+15.5Ο). $49,625 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.
ODYSSEY HEALTHCARE HOLDING COMPANY (1366143810): 54.6 claims/beneficiary (avg 2.7). 10,155 claims, 186 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.
OCONTO HOSPITAL & MEDICAL CENTER, INC. (1144725409) bills $6.05/claim for 36415 (Coll venous bld venipuncture) vs avg $0.19 (+13.7Ο). $11,537 across 1,906 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.
FROEDTERT SOUTH, INC. (1003831132) bills $6.21/claim for 91300 (Code 91300) vs avg $0.06 (+13.0Ο). $13,095 across 2,109 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.
ODYSSEY HEALTHCARE HOLDING COMPANY (1265132963): 49.4 claims/beneficiary (avg 2.7). 26,599 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.
ABLELIGHT INC. (1417010604) bills $3,298.31/claim for A0429 (Bls-emergency) vs avg $125.35 (+12.2Ο). $3,456,626 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.
ALLINA HEALTH SYSTEM (1285691725) bills $87.37/claim for 81025 (Urine pregnancy test) vs avg $8.72 (+12.2Ο). $10,398 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.
PROFESSIONAL HOME CARE SERVICES INC (1821014218): 47.5 claims/beneficiary (avg 2.7). 85,508 claims, 1,800 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.
KISMET ADVOCACY LLC (1043718497) bills $1,320.13/claim for T2003 (N-et; encounter/trip) vs avg $47.37 (+12.0Ο). $30,363 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.
1922775956 (1922775956) bills $265.85/claim for 99213 (Office o/p est low 20 min) vs avg $29.81 (+11.5Ο). $41,739 across 157 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 HOSPITAL OF WISCONSIN, INC. (1881780302) bills $65.29/claim for 83036 (Hemoglobin glycosylated a1c) vs avg $7.31 (+11.5Ο). $124,776 across 1,911 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.
ST JOSEPHS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST F (1366440521): 44.5 claims/beneficiary (avg 2.7). 7,260 claims, 163 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.
MINISTRY HOME CARE, LLC. (1811930407): 43.8 claims/beneficiary (avg 2.7). 4,121 claims, 94 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.
VITAS HEALTHCARE CORPORATION MIDWEST (1538201108): 41.7 claims/beneficiary (avg 2.7). 52,501 claims, 1,259 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.
EDGERTON HOSPITAL AND HEALTH SERVICES INC. (1154350049) bills $243.01/claim for 99213 (Office o/p est low 20 min) vs avg $29.81 (+10.4Ο). $322,966 across 1,329 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.
HEALING CORNER, LLC (1598086928) bills $729.13/claim for J3490 (Drugs unclassified injection) vs avg $9.62 (+9.8Ο). $229,674 across 315 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 HOSPITAL OF WISCONSIN, INC. (1750482022) bills $94.93/claim for 86900 (Blood typing serologic abo) vs avg $4.35 (+9.5Ο). $866,073 across 9,123 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.
TAYLOR HOILAND (1245722412): 37.2 claims/beneficiary (avg 2.7). 8,478 claims, 228 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 MONROE CLINIC, INC. (1740291491) bills $43.92/claim for 92015 (Determine refractive state) vs avg $6.76 (+8.9Ο). $222,914 across 5,075 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.
BETHESDA LUTHERAN COMMUNITIES (1033429683) bills $300.58/claim for A0120 (Noner transport mini-bus) vs avg $23.52 (+8.8Ο). $49,597 across 165 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.
MINISTRY HOME CARE, LLC. (1730122342): 35.3 claims/beneficiary (avg 2.7). 17,703 claims, 501 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.
LS PROFESSIONAL COMFORT HOMES INC (1437228244): 34.9 claims/beneficiary (avg 2.7). 2,370 claims, 68 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.
ALEXIS POWELL (1679018022): 34.8 claims/beneficiary (avg 2.7). 51,656 claims, 1,486 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.
KALA MCCLELLAN (1477987832): 34.6 claims/beneficiary (avg 2.7). 44,631 claims, 1,289 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 WISCONSIN HOSPITALS AND CLINICS AUTHORITY (1750804514) bills $674.62/claim for A9150 (Misc/exper non-prescript dru) vs avg $36.71 (+8.5Ο). $376,440 across 558 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.
RICHLAND HOSPITAL (1659301273) bills $153.54/claim for 90670 (Pcv13 vaccine im) vs avg $9.09 (+8.5Ο). $21,189 across 138 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.
ATLAS HEALTHCARE, INC (1356462881): 33.6 claims/beneficiary (avg 2.7). 128,062 claims, 3,811 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.
VISTA CARE COLORADO, LLC (1174211767): 33.0 claims/beneficiary (avg 2.7). 20,583 claims, 624 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.
ANGELA LONG (1689864761) bills $73.81/claim for H0020 (Alcohol and/or drug services; methadone administration and/or service) vs avg $11.68 (+8.1Ο). $320,708 across 4,345 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.
COLUMBIA ST. MARY'S HOSPITAL MILWAUKEE, INC. (1871656082) bills $12.09/claim for 86901 (Blood typing serologic rh(d)) vs avg $2.22 (+8.1Ο). $133,689 across 11,058 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.
BEAVER DAM COMMUNITY HOSPITALS INC (1023187416) bills $38.78/claim for 81003 (Urinalysis auto w/o scope) vs avg $3.43 (+8.1Ο). $81,595 across 2,104 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.
GOODMAN'S BEHAVIORAL HEALTH CLINIC, LLC (1740458363) bills $284.48/claim for H0022 (Alcohol and/or drug interven) vs avg $36.48 (+8.1Ο). $90,750 across 319 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.
COUNTY OF SHAWANO (1750549432) bills $2,276.14/claim for H0039 (Asser com tx face-face/15min) vs avg $71.58 (+8.0Ο). $122,912 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.
MELISSA LOPEZ (1497397707) bills $324.53/claim for 99204 (Office o/p new mod 45 min) vs avg $63.81 (+7.9Ο). $142,146 across 438 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.
MOUNDVIEW MEMORIAL HOSPITAL & CLINICS, INC (1710939533) bills $190.49/claim for 99213 (Office o/p est low 20 min) vs avg $29.81 (+7.8Ο). $643,079 across 3,376 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.
PRAIRIE RIDGE HEALTH, INC. (1841376183) bills $189.81/claim for 99213 (Office o/p est low 20 min) vs avg $29.81 (+7.8Ο). $1,919,916 across 10,115 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.
MCHS HOSPITALS INC (1952809816) bills $129.03/claim for 92341 (Fit spectacles bifocal) vs avg $25.77 (+7.8Ο). $14,064 across 109 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.
WESTFIELDS HOSPITAL, INC. (1881640183) bills $63.88/claim for 87880 (Strep a assay w/optic) vs avg $15.18 (+7.8Ο). $20,889 across 327 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 (1255958344) bills $286.72/claim for 99212 (Office o/p est sf 10 min) vs avg $27.95 (+7.6Ο). $176,906 across 617 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.
PETER JOHN JACQUES (1952597486) bills $1,990.12/claim for T1999 (Noc retail items andsupplies) vs avg $139.26 (+7.6Ο). $23,881 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.
MOMENTS HOSPICE OF APPLETON LLC (1982215307): 30.4 claims/beneficiary (avg 2.7). 4,776 claims, 157 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.
OCONTO HOSPITAL & MEDICAL CENTER INC (1356373302) bills $183.44/claim for 99213 (Office o/p est low 20 min) vs avg $29.81 (+7.5Ο). $1,137,488 across 6,201 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.
EDGERTON HOSPITAL AND HEALTH SERVICES INC. (1154350049) bills $281.38/claim for 99212 (Office o/p est sf 10 min) vs avg $27.95 (+7.5Ο). $1,121,869 across 3,987 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.
MID AMERICA HEALTHCARE CORP OF WISCONSIN (1477660132): 30.0 claims/beneficiary (avg 2.7). 414,379 claims, 13,803 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 MEDICAL CENTER BAY AREA, INC (1043397177) bills $24.00/claim for 96374 (Ther/proph/diag inj iv push) vs avg $2.13 (+7.4Ο). $196,743 across 8,197 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.
MINISTRY HOME CARE, LLC. (1861435471): 29.8 claims/beneficiary (avg 2.7). 23,279 claims, 780 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.