Statistical Outliers

Single-test outliers in Indiana Medicaid data. These are individual statistical flags — 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 — 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

207

warning

469

info

6,903

Total

7,579

Outliers by Type

Severity Distribution

critical

207 (2.7%)

warning

469 (6.2%)

info

6,903 (91.1%)

5,688 results

criticalCost OutlierScore: 13.4

Cost-per-claim above average for 99232 (Subsequent Hospital Care (Moderate Complexity))

MUNSTER MEDICAL RESEARCH FOUNDATION INC (1003918210) bills $391.29/claim for 99232 (Sbsq hosp ip/obs moderate 35) vs avg $27.97 (+13.4σ). $143,212 across 366 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.

MUNSTER MEDICAL RESEARCH FOUNDATION INCMUNSTERProvider total: $23.7M

criticalCost OutlierScore: 12.8

Cost-per-claim above average for 99222 (Hospital Admission (Moderate Complexity))

REID HOSPITAL & HEALTH CARE SERVICES, INC (1063457380) bills $582.33/claim for 99222 (1st hosp ip/obs moderate 55) vs avg $53.58 (+12.8σ). $62,892 across 108 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.

REID HOSPITAL & HEALTH CARE SERVICES, INCRICHMONDProvider total: $66.8M

criticalCost OutlierScore: 11.3

Cost-per-claim above average for J1100 (Dexamethasone Injection (1 mg))

DEACONESS HOSPITAL, INC. (1053361642) bills $11.80/claim for J1100 (Dexamethasone sodium phos) vs avg $0.39 (+11.3σ). $36,108 across 3,059 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.

DEACONESS HOSPITAL, INC.EVANSVILLEProvider total: $77.4M

criticalCost OutlierScore: 10.8

Cost-per-claim above average for 90471 (Immunization Administration (Injection))

INDIANA UNIVERSITY HEALTH JAY, INC. (1801315692) bills $61.51/claim for 90471 (Immunization admin) vs avg $8.86 (+10.8σ). $133,178 across 2,165 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.

INDIANA UNIVERSITY HEALTH JAY, INC.PORTLANDProvider total: $6.1M

criticalCost OutlierScore: 10.8

Cost-per-claim above average for 99232 (Subsequent Hospital Care (Moderate Complexity))

ST MARY MEDICAL CENTER INC (1558463745) bills $321.46/claim for 99232 (Sbsq hosp ip/obs moderate 35) vs avg $27.97 (+10.8σ). $10,608 across 33 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 MARY MEDICAL CENTER INCHOBARTProvider total: $23.4M

criticalCost OutlierScore: 10.5

Cost-per-claim above average for 96110

PARKVIEW HOSPITAL, INC. (1366407603) bills $88.16/claim for 96110 (Developmental screen w/score) vs avg $6.97 (+10.5σ). $11,019 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.

PARKVIEW HOSPITAL, INC.FORT WAYNEProvider total: $93.0M

criticalCost OutlierScore: 10.5

Cost-per-claim above average for T2003

HERITAGE ADULT DAY INC (1003122334) bills $382.78/claim for T2003 (N-et; encounter/trip) vs avg $19.06 (+10.5σ). $546,233 across 1,427 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.

HERITAGE ADULT DAY INCGARYProvider total: $2.8M

criticalCost OutlierScore: 10.4

Cost-per-claim above average for 99173

ST. VINCENT HOSPITAL & HEALTH CARE CENTER, INC. (1306898960) bills $26.33/claim for 99173 (Visual acuity screen) vs avg $1.45 (+10.4σ). $358,967 across 13,631 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. VINCENT HOSPITAL & HEALTH CARE CENTER, INC.INDIANAPOLISProvider total: $58.9M

criticalCost OutlierScore: 10.4

Cost-per-claim above average for 99211 (Office Visit, Established Patient (May not require physician)

PARKVIEW HOSPITAL, INC. (1366407603) bills $389.62/claim for 99211 (Off/op est may x req phy/qhp) vs avg $21.77 (+10.4σ). $1,968,374 across 5,052 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.

PARKVIEW HOSPITAL, INC.FORT WAYNEProvider total: $93.0M

criticalCost OutlierScore: 10.1

Cost-per-claim above average for 99203 (Office Visit, New Patient (30 min, Low Complexity))

VPA PC (1720605884) bills $295.55/claim for 99203 (Office o/p new low 30 min) vs avg $53.15 (+10.1σ). $618,583 across 2,093 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 PCSOUTH BENDProvider total: $745.6K

criticalCost OutlierScore: 10.0

Cost-per-claim above average for 99232 (Subsequent Hospital Care (Moderate Complexity))

ST CATHERINE HOSPITAL INC (1689776882) bills $300.44/claim for 99232 (Sbsq hosp ip/obs moderate 35) vs avg $27.97 (+10.0σ). $514,059 across 1,711 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 CATHERINE HOSPITAL INCEAST CHICAGOProvider total: $32.2M

criticalCost OutlierScore: 9.7

Cost-per-claim above average for 94640

DEACONESS HOSPITAL, INC. (1053361642) bills $122.92/claim for 94640 (Airway inhalation treatment) vs avg $11.46 (+9.7σ). $276,453 across 2,249 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.

DEACONESS HOSPITAL, INC.EVANSVILLEProvider total: $77.4M

criticalCost OutlierScore: 9.7

Cost-per-claim above average for 99213 (Office Visit, Established Patient (20 min, Low Complexity))

VPA PC (1720605884) bills $260.28/claim for 99213 (Office o/p est low 20 min) vs avg $40.62 (+9.6σ). $88,757 across 341 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 PCSOUTH BENDProvider total: $745.6K

criticalCost OutlierScore: 9.3

Cost-per-claim above average for 99202 (Office Visit, New Patient (15 min, Straightforward))

JOHN JACOBS (1568454163) bills $312.75/claim for 99202 (Office o/p new sf 15 min) vs avg $38.72 (+9.4σ). $45,661 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.

JOHN JACOBSRICHMONDProvider total: $205.8K

criticalCost OutlierScore: 9.3

Cost-per-claim above average for G0299

BRIAN HERR (1700888575) bills $103.89/claim for G0299 (Hhs/hospice of rn ea 15 min) vs avg $1.57 (+9.3σ). $255,160 across 2,456 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.

BRIAN HERRFORT WAYNEProvider total: $1.3M

criticalCost OutlierScore: 8.9

Cost-per-claim above average for 96127 (Brief Emotional/Behavioral Assessment)

MEMORIAL HOSPITAL (1356320469) bills $106.08/claim for 96127 (Brief emotional/behav assmt) vs avg $4.53 (+8.9σ). $28,960 across 273 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.

MEMORIAL HOSPITALLOGANSPORTProvider total: $15.4M

criticalCost OutlierScore: 8.8

Cost-per-claim above average for 99202 (Office Visit, New Patient (15 min, Straightforward))

VPA PC (1255958310) bills $297.82/claim for 99202 (Office o/p new sf 15 min) vs avg $38.72 (+8.8σ). $192,692 across 647 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 PCINDIANAPOLISProvider total: $712.6K

criticalCost OutlierScore: 8.8

Cost-per-claim above average for 92551

ST. VINCENT HOSPITAL & HEALTH CARE CENTER, INC. (1306898960) bills $109.00/claim for 92551 (Pure tone hearing test air) vs avg $6.53 (+8.8σ). $428,807 across 3,934 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. VINCENT HOSPITAL & HEALTH CARE CENTER, INC.INDIANAPOLISProvider total: $58.9M

criticalCost OutlierScore: 8.8

Cost-per-claim above average for 92507 (Speech-Language Therapy (Individual))

DAMAR CHARTER SCHOOL INC (1194098525) bills $326.85/claim for 92507 (Tx sp lang voice comm indiv) vs avg $54.51 (+8.8σ). $11,113 across 34 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.

DAMAR CHARTER SCHOOL INCINDIANAPOLISProvider total: $11.1K

criticalCost OutlierScore: 8.6

Cost-per-claim above average for G0439 (Annual Wellness Visit (Subsequent))

INDIANA EXCEPTIONAL MEDICAL CARE (1669708756) bills $49.20/claim for G0439 (Ppps, subseq visit) vs avg $0.82 (+8.6σ). $45,458 across 924 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.

INDIANA EXCEPTIONAL MEDICAL CAREEVANSVILLEProvider total: $20.6M

criticalCost OutlierScore: 8.4

Cost-per-claim above average for 99231 (Subsequent Hospital Care (Low Complexity))

INDIANA UNIVERSITY HEALTH INC (1114958584) bills $578.68/claim for 99231 (Sbsq hosp ip/obs sf/low 25) vs avg $25.33 (+8.4σ). $372,090 across 643 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.

INDIANA UNIVERSITY HEALTH INCINDIANAPOLISProvider total: $75.6M

criticalCost OutlierScore: 8.4

Cost-per-claim above average for 99231 (Subsequent Hospital Care (Low Complexity))

INDIANA UNIVERSITY HEALTH NORTH HOSPITAL INC (1568492916) bills $575.87/claim for 99231 (Sbsq hosp ip/obs sf/low 25) vs avg $25.33 (+8.4σ). $14,397 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.

INDIANA UNIVERSITY HEALTH NORTH HOSPITAL INCCARMELProvider total: $6.9M

criticalCost OutlierScore: 8.0

Cost-per-claim above average for 83690

HARRISON COUNTY HOSPITAL (1851378137) bills $17.00/claim for 83690 (Assay of lipase) vs avg $3.41 (+7.9σ). $31,802 across 1,871 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.

HARRISON COUNTY HOSPITALCORYDONProvider total: $12.8M

criticalCost OutlierScore: 7.7

Cost-per-claim above average for S5125

TODD'S COMPANIONPLUS OF IN LLC (1447464177) bills $4,566.15/claim for S5125 (Attendant care service /15m) vs avg $272.44 (+7.7σ). $529,673 across 116 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.

TODD'S COMPANIONPLUS OF IN LLCNASHVILLEProvider total: $529.7K

criticalCost OutlierScore: 7.6

Cost-per-claim above average for T1015 (Clinic Service)

MERIDIAN HEALTH SERVICES CORP (1346748654) bills $289.43/claim for T1015 (Clinic service) vs avg $21.52 (+7.6σ). $3,022,484 across 10,443 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.

MERIDIAN HEALTH SERVICES CORPINDIANAPOLISProvider total: $4.0M

criticalCost OutlierScore: 7.5

Cost-per-claim above average for 99204 (Office Visit, New Patient (45 min, Moderate Complexity))

VPA PC (1255958310) bills $324.06/claim for 99204 (Office o/p new mod 45 min) vs avg $78.79 (+7.5σ). $103,374 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.

VPA PCINDIANAPOLISProvider total: $712.6K

criticalCost OutlierScore: 7.4

Cost-per-claim above average for D0140 (Limited Oral Evaluation (Problem-Focused))

1891799763 (1891799763) bills $99.54/claim for D0140 (Limited oral evaluation - problem focused) vs avg $30.26 (+7.4σ). $44,294 across 445 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 ST THOMAS EAST END MEDICAL CENTER CORPORATIONST THOMASProvider total: $558.2K

criticalCost OutlierScore: 7.3

Cost-per-claim above average for 99231 (Subsequent Hospital Care (Low Complexity))

GIBSON GENERAL HOSPITAL INC. (1558346007) bills $506.75/claim for 99231 (Sbsq hosp ip/obs sf/low 25) vs avg $25.33 (+7.3σ). $10,642 across 21 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.

GIBSON GENERAL HOSPITAL INC.PRINCETONProvider total: $4.4M

criticalCost OutlierScore: 7.2

Cost-per-claim above average for 99283 (Emergency Dept Visit (Moderate Complexity))

1326447939 (1326447939) bills $482.90/claim for 99283 (Emergency dept visit low mdm) vs avg $70.42 (+7.2σ). $15,453 across 32 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.

GUAM HEALTHCARE DEVELOPMENT INCORPORATEDDEDEDOProvider total: $54.2K

criticalCost OutlierScore: 7.1

Cost-per-claim above average for A7046

AERATECH MEDICAL INC (1538668843) bills $30.25/claim for A7046 (Repl water chamber, pap dev) vs avg $6.94 (+7.1σ). $202,526 across 6,695 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.

AERATECH MEDICAL INCINDIANAPOLISProvider total: $13.1M

criticalCost OutlierScore: 7.0

Cost-per-claim above average for 99214 (Office Visit, Established Patient (30 min, Moderate Complexi)

YOLANDA HEATH (1972847085) bills $230.59/claim for 99214 (Office o/p est mod 30 min) vs avg $55.45 (+7.0σ). $205,918 across 893 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.

YOLANDA HEATHHIGHLANDProvider total: $1.1M

criticalCost OutlierScore: 7.0

Cost-per-claim above average for E0260 (Hospital Bed, Semi-Electric)

GEORGE'S FAMILY PHARMACY INC (1053314021) bills $342.01/claim for E0260 (Hospital bed, semi-electric (head and foot adjustment), with any type side) vs avg $26.67 (+7.0σ). $1,805,832 across 5,280 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.

GEORGE'S FAMILY PHARMACY INCBROOKVILLEProvider total: $24.3M

criticalCost OutlierScore: 7.0

Cost-per-claim above average for J3490

OPTUM PHARMACY 702, LLC (1083045140) bills $960.64/claim for J3490 (Drugs unclassified injection) vs avg $29.68 (+7.0σ). $58,599 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.

OPTUM PHARMACY 702, LLCJEFFERSONVILLEProvider total: $55.1M

criticalCost OutlierScore: 7.0

Cost-per-claim above average for 99285 (Emergency Dept Visit (High Complexity))

JOHN LEE (1093246001) bills $363.67/claim for 99285 (Emergency dept visit hi mdm) vs avg $90.65 (+7.0σ). $22,184 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.

JOHN LEEBLOOMINGTONProvider total: $104.8K

criticalCost OutlierScore: 6.9

Cost-per-claim above average for 99212 (Office Visit, Established Patient (10 min, Straightforward))

FRANCISCAN HEALTH MICHIGAN CITY (1710051941) bills $163.09/claim for 99212 (Office o/p est sf 10 min) vs avg $28.59 (+6.9σ). $435,952 across 2,673 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.

FRANCISCAN HEALTH MICHIGAN CITYMICHIGAN CITYProvider total: $21.2M

criticalCost OutlierScore: 6.9

Cost-per-claim above average for 81001 (Urinalysis with Microscopy)

HARRISON COUNTY HOSPITAL (1851378137) bills $7.35/claim for 81001 (Urinalysis auto w/scope) vs avg $1.65 (+6.9σ). $87,935 across 11,960 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.

HARRISON COUNTY HOSPITALCORYDONProvider total: $12.8M

criticalCost OutlierScore: 6.9

Cost-per-claim above average for 59425

MEMORIAL HOSPITAL (1356320469) bills $225.80/claim for 59425 (Antepartum care only) vs avg $62.54 (+6.9σ). $395,607 across 1,752 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.

MEMORIAL HOSPITALLOGANSPORTProvider total: $15.4M

criticalCost OutlierScore: 6.7

Cost-per-claim above average for D0120 (Periodic Oral Evaluation (Established Patient))

NAGA ANUMOLU-ALAPATI (1508128745) bills $67.23/claim for D0120 (Periodic oral evaluation) vs avg $18.78 (+6.7σ). $16,405 across 244 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.

NAGA ANUMOLU-ALAPATIFORT BRANCHProvider total: $44.9K

criticalCost OutlierScore: 6.7

Cost-per-claim above average for 99239 (Hospital Discharge Day (more than 30 min))

REID HOSPITAL & HEALTH CARE SERVICES, INC (1063457380) bills $509.51/claim for 99239 (Hosp ip/obs dschrg mgmt >30) vs avg $58.87 (+6.7σ). $29,551 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.

REID HOSPITAL & HEALTH CARE SERVICES, INCRICHMONDProvider total: $66.8M

criticalCost OutlierScore: 6.7

Cost-per-claim above average for A4604

AERATECH MEDICAL INC (1538668843) bills $100.11/claim for A4604 (Tubing with heating element) vs avg $23.25 (+6.7σ). $638,317 across 6,376 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.

AERATECH MEDICAL INCINDIANAPOLISProvider total: $13.1M

criticalCost OutlierScore: 6.6

Cost-per-claim above average for 11721

INDIANA UNIVERSITY HEALTH PAOLI INC (1912984451) bills $50.69/claim for 11721 (Debride nail 6 or more) vs avg $8.47 (+6.6σ). $11,761 across 232 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.

INDIANA UNIVERSITY HEALTH PAOLI INCPAOLIProvider total: $4.4M

criticalCost OutlierScore: 6.6

Cost-per-claim above average for D0150 (Comprehensive Oral Evaluation (New or Established Patient))

LAKSHMI SAJJA (1669062402) bills $101.79/claim for D0150 (Comprehensive oral evaluation) vs avg $29.33 (+6.6σ). $12,011 across 118 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.

LAKSHMI SAJJATERRE HAUTEProvider total: $57.9K

criticalCost OutlierScore: 6.5

Cost-per-claim above average for 90670

BEACON MEDICAL GROUP, INC. (1447203674) bills $164.59/claim for 90670 (Pcv13 vaccine im) vs avg $5.58 (+6.5σ). $13,497 across 82 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.

BEACON MEDICAL GROUP, INC.SOUTH BENDProvider total: $172.2K

criticalCost OutlierScore: 6.4

Cost-per-claim above average for D0150 (Comprehensive Oral Evaluation (New or Established Patient))

1891799763 (1891799763) bills $99.69/claim for D0150 (Comprehensive oral evaluation) vs avg $29.33 (+6.4σ). $113,353 across 1,137 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 ST THOMAS EAST END MEDICAL CENTER CORPORATIONST THOMASProvider total: $558.2K

criticalCost OutlierScore: 6.4

Cost-per-claim above average for 78452

KENTUCKIANA MEDICAL CENTER LLC (1760659205) bills $1,833.05/claim for 78452 (Ht muscle image spect mult) vs avg $141.79 (+6.4σ). $25,663 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.

KENTUCKIANA MEDICAL CENTER LLCCLARKSVILLEProvider total: $224.1K

criticalCost OutlierScore: 6.4

Cost-per-claim above average for T1015 (Clinic Service)

MERIDIAN HEALTH SERVICES CORP (1528539590) bills $247.55/claim for T1015 (Clinic service) vs avg $21.52 (+6.4σ). $268,343 across 1,084 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.

MERIDIAN HEALTH SERVICES CORPRICHMONDProvider total: $495.2K

criticalCost OutlierScore: 6.4

Cost-per-claim above average for 99396 (Preventive Visit, Established Patient (Ages 40-64))

VPA PC (1366768160) bills $350.00/claim for 99396 (Prev visit est age 40-64) vs avg $60.97 (+6.4σ). $22,050 across 63 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 PCBROWNSBURGProvider total: $2.0M

criticalCost OutlierScore: 6.4

Cost-per-claim above average for A4253 (Blood Glucose Test Strips (per 50))

ALLY MEDICAL SUPPLY INC (1528693611) bills $27.09/claim for A4253 (Blood glucose/reagent strips) vs avg $3.13 (+6.4σ). $17,883 across 660 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.

ALLY MEDICAL SUPPLY INCINDIANAPOLISProvider total: $42.8K

criticalCost OutlierScore: 6.3

Cost-per-claim above average for 96372

MAJOR HOSPITAL (1174555692) bills $108.12/claim for 96372 (Ther/proph/diag inj sc/im) vs avg $12.15 (+6.3σ). $120,011 across 1,110 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.

MAJOR HOSPITALSHELBYVILLEProvider total: $14.2M

criticalCost OutlierScore: 6.2

Cost-per-claim above average for A4253 (Blood Glucose Test Strips (per 50))

ADMIRAL MEDICAL SUPPLY INC. (1801060173) bills $26.45/claim for A4253 (Blood glucose/reagent strips) vs avg $3.13 (+6.2σ). $164,674 across 6,225 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.

ADMIRAL MEDICAL SUPPLY INC.INDIANAPOLISProvider total: $1.1M

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