Single-test outliers in West Virginia 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
167
warning
258
info
2,266
Total
2,691
CHARLESTON AREA MEDICAL CENTER INC (1952390239) bills $764.81/claim for D1208 (Topical fluoride excluding varnish) vs avg $21.38 (+15.4Ο). $52,007 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.
ST. JOHN'S/ST.VINCENT'S HOME FOR CHILDREN, INC. (1386720167): 35.5 claims/beneficiary (avg 2.0). 2,127 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.
MED SURG PHYSICIAN GROUP, INC. (1083373997): 33.8 claims/beneficiary (avg 2.0). 1,557 claims, 46 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.
BOARD OF CHILD CARE OF THE UNITED METHODIST CHURCH, INC (1760887459): 32.0 claims/beneficiary (avg 2.0). 25,172 claims, 787 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.
WEST VIRGINIA UNIVERSITY HOSPITALS, INC (1790820835): 31.5 claims/beneficiary (avg 2.0). 40,052 claims, 1,273 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.
FAMILY CONNECTIONS, INC. (1366846016): 31.5 claims/beneficiary (avg 2.0). 18,575 claims, 590 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.
VELTEX MEDICAL, INC. (1902582802): 28.9 claims/beneficiary (avg 2.0). 11,112 claims, 385 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.
PRESSLEY RIDGE (1114594751): 28.3 claims/beneficiary (avg 2.0). 13,562 claims, 479 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.
BECKLEY ONCOLOGY ASSOCIATES INC (1295747277) bills $204.01/claim for 96372 (Ther/proph/diag inj sc/im) vs avg $18.09 (+9.2Ο). $401,078 across 1,966 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.
PATEL & PATEL MD INC (1467535450) bills $407.18/claim for 99231 (Sbsq hosp ip/obs sf/low 25) vs avg $32.45 (+8.7Ο). $14,251 across 35 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. (1487758710): 24.5 claims/beneficiary (avg 2.0). 57,578 claims, 2,348 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.
STEPPING STONE, INC. (1447425459): 24.3 claims/beneficiary (avg 2.0). 5,137 claims, 211 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.
EMS, INC (1942482542): 24.1 claims/beneficiary (avg 2.0). 44,036 claims, 1,825 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.
JACOB'S LADDER AT BROOKSIDE FARM, LLC (1205344355): 24.1 claims/beneficiary (avg 2.0). 4,647 claims, 193 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 CHILDREN'S HOME OF WHEELING, INC. (1821265257): 24.0 claims/beneficiary (avg 2.0). 5,399 claims, 225 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.
BOARD OF CHILD CARE, WV (1366602039): 23.9 claims/beneficiary (avg 2.0). 62,999 claims, 2,641 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.
PRESSLEY RIDGE (1447384573): 22.9 claims/beneficiary (avg 2.0). 57,643 claims, 2,513 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.
POCAHONTAS MEMORIAL HOSPITAL (1609842251) bills $202.58/claim for 80305 (Drug test prsmv dir opt obs) vs avg $16.38 (+7.7Ο). $25,323 across 125 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.
CHARLESTON HOSPITAL INC. (1891732889) bills $386.86/claim for 20610 (Drain/inj joint/bursa w/o us) vs avg $41.73 (+7.6Ο). $15,861 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.
RENAL CONSULTANTS, PLLC (1295720449) bills $1,229.85/claim for 96374 (Ther/proph/diag inj iv push) vs avg $69.07 (+7.6Ο). $424,299 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.
BURLINGTON UNITED METHODIST FAMILY SERVICES, INC. (1841323201): 22.2 claims/beneficiary (avg 2.0). 101,862 claims, 4,592 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.
INTERIM HEALTHCARE OF PITTSBURGH, INC. (1659777076): 21.8 claims/beneficiary (avg 2.0). 57,630 claims, 2,639 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.
OPEN DOORS FOR THE DEVELOPMENTALLY CHALLENGED, INC. (1508907338) bills $615.69/claim for T1002 (Rn services up to 15 minutes) vs avg $45.01 (+7.4Ο). $972,176 across 1,579 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.
PRESSLEY RIDGE (1942333976): 21.7 claims/beneficiary (avg 2.0). 40,254 claims, 1,858 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.
EMS, INC. (1487687109): 21.4 claims/beneficiary (avg 2.0). 152,297 claims, 7,113 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.
CHARLES W. CAMMACK CHILDREN'S CENTER, INC. (1104086503): 21.1 claims/beneficiary (avg 2.0). 82,152 claims, 3,893 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.
DAVIS-STUART, INC. (1235354879): 21.1 claims/beneficiary (avg 2.0). 72,035 claims, 3,416 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.
FLORENCE CRITTENTON SERVICES INC. (1336363233): 20.1 claims/beneficiary (avg 2.0). 70,329 claims, 3,495 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.
SERENITY HILLS LIFE CENTER (1043717937): 19.9 claims/beneficiary (avg 2.0). 30,975 claims, 1,559 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.
BURLINGTON UNITED METHODIST FAMILY SERVICES, INC. (1376751958): 19.8 claims/beneficiary (avg 2.0). 85,872 claims, 4,331 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.
WEST VIRGINIA HEALTH CARE COOPERATIVE INC (1043778319) bills $133.43/claim for 87804 (Influenza assay w/optic) vs avg $15.84 (+6.7Ο). $111,416 across 835 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.
POTOMAC VALLEY HOSPITAL OF W VA, INC (1063649606) bills $172.40/claim for 99213 (Office o/p est low 20 min) vs avg $34.12 (+6.6Ο). $29,653 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.
PRESSLEY RIDGE (1649303496): 19.3 claims/beneficiary (avg 2.0). 3,877 claims, 201 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.
CAITLIN CORBITT (1598055782) bills $233.03/claim for 99214 (Office o/p est mod 30 min) vs avg $47.64 (+6.4Ο). $671,122 across 2,880 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 (1154722379) bills $933.98/claim for 90935 (Hemodialysis one evaluation) vs avg $76.61 (+6.2Ο). $43,897 across 47 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.
SUMMERS COUNTY BOARD OF EDUCATION (1841469145) bills $12.46/claim for 92508 (Tx sp lang voice comm group) vs avg $3.06 (+6.0Ο). $14,819 across 1,189 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.
SOUND PHYSICIANS EMERGENCY MEDICINE OF WEST VIRGINIA PLLC (1396109567) bills $162.71/claim for 93010 (Electrocardiogram report) vs avg $13.35 (+6.0Ο). $174,588 across 1,073 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.
CAITLIN CORBITT (1598055782) bills $328.28/claim for 99215 (Office o/p est hi 40 min) vs avg $69.81 (+6.0Ο). $216,996 across 661 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.
HAWC (1235843319): 17.9 claims/beneficiary (avg 2.0). 6,012 claims, 335 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.
ALECTO HEALTHCARE SERVICES FAIRMONT LLC (1649688037) bills $83.31/claim for 81003 (Urinalysis auto w/o scope) vs avg $10.43 (+5.9Ο). $51,983 across 624 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.
YOUTH ACADEMY, LLC (1750508040): 17.8 claims/beneficiary (avg 2.0). 73,318 claims, 4,126 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.
YALE ACADEMY LLC (1649664855): 17.8 claims/beneficiary (avg 2.0). 80,083 claims, 4,502 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.
TRI-STATE EMERGENCY PHYSICIANS LLP (1508313719) bills $480.31/claim for 99291 (Critical care first hour) vs avg $132.57 (+5.8Ο). $14,890 across 31 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.
YORE ACADEMY, INC. (1295972248): 17.1 claims/beneficiary (avg 2.0). 77,938 claims, 4,554 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.
ANISSA ANDERSON (1881792901) bills $1,114.31/claim for D9310 (Consultation diagnostic service by non-treating dentist) vs avg $81.13 (+5.7Ο). $60,173 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.
PRESTON MEMORIAL HOSPITAL CORPORATION (1013950054) bills $152.59/claim for 80305 (Drug test prsmv dir opt obs) vs avg $16.38 (+5.6Ο). $66,989 across 439 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 THERAPEUTIC TREATMENT CENTERS LLC (1720665987): 16.8 claims/beneficiary (avg 2.0). 46,118 claims, 2,750 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.
WEIRTON MEDICAL CENTER, INC (1619921947) bills $104.80/claim for 99212 (Office o/p est sf 10 min) vs avg $20.16 (+5.5Ο). $30,496 across 291 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.
ALECTO HEALTHCARE SERVICES FAIRMONT LLC (1649688037) bills $80.99/claim for 83036 (Hemoglobin glycosylated a1c) vs avg $13.41 (+5.5Ο). $20,166 across 249 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.
NUSKOOL SCHOLARS (1417468745) bills $582.00/claim for T1016 (Case management) vs avg $100.96 (+5.5Ο). $26,772 across 46 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.