Single-test outliers in Wyoming 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
17
warning
23
info
588
Total
628
FRONTIER WYOMING, L.L.C. (1053503565): 29.9 claims/beneficiary (avg 2.1). 357,222 claims, 11,943 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.
LOVE CARE & DIGNITY, INC. (1235279498): 24.5 claims/beneficiary (avg 2.1). 12,848 claims, 524 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.
CHELSEA OLSON (1003181686) bills $543.32/claim for H2019 (Ther behav svc, per 15 min) vs avg $86.98 (+9.4Ο). $13,583 across 25 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.
ASCENSION HEALTH NETWORK, LLC (1255792883): 19.0 claims/beneficiary (avg 2.1). 532 claims, 28 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.
BRIDGES OF WYOMING, INC (1710330782): 18.8 claims/beneficiary (avg 2.1). 13,419 claims, 713 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.
MAGIC CITY ENTERPRISES, INC (1194895359): 17.2 claims/beneficiary (avg 2.1). 191,477 claims, 11,152 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.
MOUNTAIN REGIONAL SERVICES, INC (1962573782): 17.1 claims/beneficiary (avg 2.1). 101,906 claims, 5,955 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.
LINCOLN SELF RELIANCE, INC. (1528112620): 16.0 claims/beneficiary (avg 2.1). 167,582 claims, 10,506 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.
STACEY HOUK FAMILY ENRICHMENT CENTER LLC (1679088132): 15.0 claims/beneficiary (avg 2.1). 8,548 claims, 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.
REHABILITATION ENTERPRISES OF NORTHEASTERN WYOMING (1689716227): 14.3 claims/beneficiary (avg 2.1). 29,014 claims, 2,022 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.
1326447939 (1326447939) bills $426.50/claim for 87635 (Sars-cov-2 covid-19 amp prb) vs avg $36.33 (+5.2Ο). $24,737 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.
1326447939 (1326447939) bills $522.51/claim for 99283 (Emergency dept visit low mdm) vs avg $99.86 (+5.1Ο). $245,580 across 470 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.
SINKS CANYON THERAPIES INC (1891828752) bills $193.84/claim for 97110 (Therapeutic exercises) vs avg $31.94 (+5.0Ο). $277,197 across 1,430 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.
JENNIFER BRADOF (1275971442) bills $322.50/claim for H2019 (Ther behav svc, per 15 min) vs avg $86.98 (+4.9Ο). $135,772 across 421 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.
2ND STREET DENTAL, LLC (1881194280) bills $40.54/claim for D0220 (Intraoral - periapical first image) vs avg $14.64 (+4.6Ο). $244,036 across 6,019 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.
RENEWED HOPE FOUNDATION, INC. (1083802292): 13.5 claims/beneficiary (avg 2.1). 15,241 claims, 1,126 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.
WYOMING HOME HEALTH INC. (1386103737): 13.2 claims/beneficiary (avg 2.1). 10,623 claims, 807 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.
GOODWILL INDUSTRIES OF WY, INC. (1639303167): 11.3 claims/beneficiary (avg 2.1). 44,127 claims, 3,892 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.
QUALITY HOME HEALTH CARE INC (1386740496): 11.0 claims/beneficiary (avg 2.1). 51,870 claims, 4,714 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.
NORTHWEST COMMUNITY ACTION PROGRAMS OF WYOMING, INC. (1881714210) bills $1,182.81/claim for T1002 (Rn services up to 15 minutes) vs avg $178.97 (+3.8Ο). $106,453 across 90 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.
SWEETWATER PEDIATRICS P.C. (1215135025) bills $101.26/claim for 90651 (9vhpv vaccine 2/3 dose im) vs avg $7.13 (+3.7Ο). $11,037 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.
SENIOR CITIZENS COUNCIL (1265793624): 10.8 claims/beneficiary (avg 2.1). 44,591 claims, 4,137 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.
ARK REGIONAL SERVICES, INC (1407939218): 10.6 claims/beneficiary (avg 2.1). 169,172 claims, 15,967 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.
TONYA YELTON (1841355740) bills $162.24/claim for G9012 (Other specified case mgmt) vs avg $55.80 (+3.6Ο). $75,119 across 463 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.
INTEGRITY HOME CARE LLC (1801662465): 10.0 claims/beneficiary (avg 2.1). 3,111 claims, 312 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.
WYOMING RETINA ASSOCIATES, PC (1467734202) bills $19.66/claim for 92014 (Compre oph exam est pt 1/>) vs avg $87.49 (-3.3Ο). $25,067 across 1,275 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.
KING & SAMSON CONSULTING SERVICES LLC (1912552001): 9.8 claims/beneficiary (avg 2.1). 3,991 claims, 407 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.
RACHAEL BICKELS (1437463932) bills $154.27/claim for T1004 (Nsg aide service up to 15min) vs avg $67.49 (+3.3Ο). $151,955 across 985 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.
CATHERINE LOETSCHER (1639317027) bills $317.54/claim for T1016 (Case management) vs avg $114.84 (+3.3Ο). $565,541 across 1,781 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.
JOHNSON COUNTY MEMORIAL HOSPITAL (1992784961): 9.6 claims/beneficiary (avg 2.1). 3,170 claims, 330 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.
HUMBLE HORIZON HOME HEALTH LLC (1255897385): 9.4 claims/beneficiary (avg 2.1). 8,931 claims, 950 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.
LIFESONG COUNSELING LLC (1982031555) bills $237.81/claim for H2019 (Ther behav svc, per 15 min) vs avg $86.98 (+3.1Ο). $11,891 across 50 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.
ROY PAULSON (1104921907) bills $78.79/claim for D0120 (Periodic oral evaluation) vs avg $33.35 (+3.1Ο). $10,243 across 130 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.
WHITE BUFFALO RECOVERY CENTER (1902213093) bills $552.79/claim for T1015 (Clinic service) vs avg $186.90 (+3.1Ο). $234,935 across 425 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.
AMY JONES (1548682651) bills $146.87/claim for G9012 (Other specified case mgmt) vs avg $55.80 (+3.1Ο). $41,123 across 280 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.
ERIN ASAY (1851723860) bills $77.81/claim for D0120 (Periodic oral evaluation) vs avg $33.35 (+3.0Ο). $20,931 across 269 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.
CAMPBELL COUNTY HOSPITAL DISTRICT (1881730141) jumped 16.5x from $15,182 (2019-05) to $250,519 (2019-06).
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.
CAMPBELL COUNTY HOSPITAL DISTRICT (1881730141) jumped 13.3x from $24,317 (2018-05) to $322,979 (2018-06).
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.
NEW HOPE COUNSELING (1033105705): 100% mismatch (183/183). $905,089 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.
ROCK SPRINGS FAMILY PRACTICE INC (1023169778): 100% mismatch (232/232). $241,740 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.
CHEYENNE RADIOLOGY GROUP (1023056082): 100% mismatch (1,464/1,464). $609,714 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.
GILLETTE PEDIATRIC DENTISTRY LLC (1013289966): 100% mismatch (2,415/2,415). $2,852,072 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.
ROCKY MOUNTAIN ONCOLOGY CENTER, LLC (1003862723): 100% mismatch (205/205). $81,031 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.
COWBOY MEDICAL GROUP PC (1154836617): 100% mismatch (108/108). $264,900 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.
VOLUNTEERS OF AMERICA NORTHERN ROCKIES (1144359134): 100% mismatch (162/162). $366,575 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.
PRIORITY DENTAL (1134524986): 100% mismatch (171/171). $109,399 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.
BRITTNEY HYLAND (1104248152) bills 100% ($1,803,991) on H2014.
This provider bills almost all revenue under a single procedure code. While this can indicate a "procedure mill," many legitimate specialists (e.g., dialysis centers, optometrists) naturally concentrate on one code.
PIONEER COUNSELING SERVICES (1093792095): 100% mismatch (397/397). $910,732 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.
WEST PARK HOSPITAL DISTRICT (1043200041): 100% mismatch (60/60). $74,227 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.
OAK HAVEN DENTAL (1033699533): 100% mismatch (185/185). $107,570 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.