Statistical Outliers

Single-test outliers in Michigan 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

633

warning

800

info

5,775

Total

7,208

Outliers by Type

Severity Distribution

critical

633 (8.8%)

warning

800 (11.1%)

info

5,775 (80.1%)

3,640 results

criticalCost OutlierScore: 31.7

Cost-per-claim above average for 36415 (Blood Draw (Venipuncture))

DOUGLAS CROSBY (1548207707) bills $107.32/claim for 36415 (Coll venous bld venipuncture) vs avg $2.43 (+31.7σ). $12,234 across 114 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.

DOUGLAS CROSBYJACKSONProvider total: $695.3K

criticalCost OutlierScore: 19.7

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

GRAND TRAVERSE BAND OF OTTAWA AND CHIPPEWA INDIANS (1134281132) bills $218.25/claim for D0120 (Periodic oral evaluation) vs avg $26.27 (+19.7σ). $36,011 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.

GRAND TRAVERSE BAND OF OTTAWA AND CHIPPEWA INDIANSSUTTONS BAYProvider total: $1.1M

criticalCost OutlierScore: 19.4

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

NORTH COUNTRY COMMUNITY MENTAL HEALTH (1053474015) bills $447.80/claim for 96127 (Brief emotional/behav assmt) vs avg $4.09 (+19.4σ). $28,659 across 64 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.

NORTH COUNTRY COMMUNITY MENTAL HEALTHPETOSKEYProvider total: $69.3M

criticalCost OutlierScore: 19.3

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

VHS HURON VALLEY-SINAI HOSPITAL INC (1922310200) bills $42.36/claim for J1100 (Dexamethasone sodium phos) vs avg $0.60 (+19.3σ). $164,789 across 3,890 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.

VHS HURON VALLEY-SINAI HOSPITAL INCCOMMERCE TOWNSHIPProvider total: $9.3M

criticalCost OutlierScore: 18.8

Cost-per-claim above average for 90633

SYED JAFRI (1982801791) bills $12.21/claim for 90633 (Hepa vacc ped/adol 2 dose im) vs avg $0.04 (+18.8σ). $12,566 across 1,029 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.

SYED JAFRIALLEGANProvider total: $1.6M

criticalCost OutlierScore: 18.3

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

COUNTY OF WAYNE (1114144847) bills $512.39/claim for 99213 (Office o/p est low 20 min) vs avg $45.07 (+18.3σ). $66,098 across 129 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 WAYNEDETROITProvider total: $7.3M

criticalCost OutlierScore: 17.8

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

SAGINAW COUNTY COMMUNITY MENTAL HEALTH AUTHORITY (1689778953) bills $411.96/claim for 96127 (Brief emotional/behav assmt) vs avg $4.09 (+17.8σ). $97,635 across 237 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.

SAGINAW COUNTY COMMUNITY MENTAL HEALTH AUTHORITYSAGINAWProvider total: $172.2M

criticalCost OutlierScore: 17.7

Cost-per-claim above average for D1110 (Adult Dental Prophylaxis (Teeth Cleaning))

LITTLE TRAVERSE BAY BANDS OF ODAWA INDIANS (1124052816) bills $402.69/claim for D1110 (Prophylaxis - adult) vs avg $48.41 (+17.7σ). $127,654 across 317 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.

LITTLE TRAVERSE BAY BANDS OF ODAWA INDIANSPETOSKEYProvider total: $8.8M

criticalCost OutlierScore: 17.7

Cost-per-claim above average for 87635

1326447939 (1326447939) bills $418.78/claim for 87635 (Sars-cov-2 covid-19 amp prb) vs avg $32.66 (+17.7σ). $74,543 across 178 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: $1.9M

criticalCost OutlierScore: 17.6

Cost-per-claim above average for 90698

SYED JAFRI (1982801791) bills $11.54/claim for 90698 (Dtap-ipv/hib vaccine im) vs avg $0.04 (+17.6σ). $19,496 across 1,689 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.

SYED JAFRIALLEGANProvider total: $1.6M

criticalCost OutlierScore: 17.3

Cost-per-claim above average for 85025 (Complete Blood Count (CBC) with Differential)

DOUGLAS CROSBY (1548207707) bills $108.44/claim for 85025 (Complete cbc w/auto diff wbc) vs avg $3.48 (+17.3σ). $25,484 across 235 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.

DOUGLAS CROSBYJACKSONProvider total: $695.3K

criticalCost OutlierScore: 17.2

Cost-per-claim above average for 96372

MONROE COUNTY COMMUNITY MENTAL HEALTH AUTHORITY (1245303890) bills $493.46/claim for 96372 (Ther/proph/diag inj sc/im) vs avg $11.92 (+17.2σ). $3,623,943 across 7,344 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.

MONROE COUNTY COMMUNITY MENTAL HEALTH AUTHORITYMONROEProvider total: $55.3M

criticalCost OutlierScore: 17.0

Cost-per-claim above average for 97112

SAGINAW COUNTY COMMUNITY MENTAL HEALTH AUTHORITY (1689778953) bills $362.35/claim for 97112 (Neuromuscular reeducation) vs avg $23.20 (+17.0σ). $73,557 across 203 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.

SAGINAW COUNTY COMMUNITY MENTAL HEALTH AUTHORITYSAGINAWProvider total: $172.2M

criticalCost OutlierScore: 15.5

Cost-per-claim above average for 90680

SYED JAFRI (1982801791) bills $10.53/claim for 90680 (Rv5 vacc 3 dose live oral) vs avg $0.05 (+15.5σ). $18,631 across 1,770 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.

SYED JAFRIALLEGANProvider total: $1.6M

criticalCost OutlierScore: 15.4

Cost-per-claim above average for 97110 (Therapeutic Exercise (per 15 min))

COMMUNITY MENTAL HEALTH FOR CENTRAL MICHIGAN (1881622892) bills $808.60/claim for 97110 (Therapeutic exercises) vs avg $30.43 (+15.4σ). $11,320 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.

COMMUNITY MENTAL HEALTH FOR CENTRAL MICHIGANMT PLEASANTProvider total: $255.7M

criticalCost OutlierScore: 15.3

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

HURON COUNTY COMMUNITY MENTAL HEALTH AUTHORITY (1659485514) bills $592.84/claim for 99214 (Office o/p est mod 30 min) vs avg $64.49 (+15.3σ). $607,659 across 1,025 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.

HURON COUNTY COMMUNITY MENTAL HEALTH AUTHORITYBAD AXEProvider total: $42.8M

criticalCost OutlierScore: 14.2

Cost-per-claim above average for 71046 (Chest X-ray (2 views, Frontal and Lateral))

1326447939 (1326447939) bills $244.70/claim for 71046 (X-ray exam chest 2 views) vs avg $18.65 (+14.2σ). $27,651 across 113 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: $1.9M

criticalCost OutlierScore: 14.2

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

SAGINAW COUNTY COMMUNITY MENTAL HEALTH AUTHORITY (1689778953) bills $424.86/claim for 99203 (Office o/p new low 30 min) vs avg $54.71 (+14.2σ). $64,578 across 152 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.

SAGINAW COUNTY COMMUNITY MENTAL HEALTH AUTHORITYSAGINAWProvider total: $172.2M

criticalCost OutlierScore: 14.0

Cost-per-claim above average for 80053 (Comprehensive Metabolic Panel (14 tests))

1326447939 (1326447939) bills $186.42/claim for 80053 (Comprehen metabolic panel) vs avg $5.12 (+14.0σ). $89,294 across 479 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: $1.9M

criticalCost OutlierScore: 13.6

Cost-per-claim above average for D1110 (Adult Dental Prophylaxis (Teeth Cleaning))

NIMKEE DENTAL SAGINAW CHIPPEWA INDIAN TRIBE (1417039843) bills $320.94/claim for D1110 (Prophylaxis - adult) vs avg $48.41 (+13.6σ). $124,525 across 388 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.

NIMKEE DENTAL SAGINAW CHIPPEWA INDIAN TRIBEMT PLEASANTProvider total: $219.2K

criticalCost OutlierScore: 13.1

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

LITTLE TRAVERSE BAY BANDS OF ODAWA INDIANS (1124052816) bills $424.60/claim for D0140 (Limited oral evaluation - problem focused) vs avg $44.74 (+13.1σ). $67,512 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.

LITTLE TRAVERSE BAY BANDS OF ODAWA INDIANSPETOSKEYProvider total: $8.8M

criticalCost OutlierScore: 12.8

Cost-per-claim above average for 17110 (Destruction of Warts (up to 14))

VHS CHILDRENS HOSPITAL OF MICHIGAN INC (1538471800) bills $911.05/claim for 17110 (Destruct b9 lesion 1-14) vs avg $59.30 (+12.8σ). $67,418 across 74 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.

VHS CHILDRENS HOSPITAL OF MICHIGAN INCDETROITProvider total: $180.2M

criticalCost OutlierScore: 12.1

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

SAULT TRIBE OF CHIPPEWA INDIANS (1285802868) bills $144.65/claim for D0120 (Periodic oral evaluation) vs avg $26.27 (+12.1σ). $259,788 across 1,796 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.

SAULT TRIBE OF CHIPPEWA INDIANSSAULT SAINTE MARIEProvider total: $1.7M

criticalCost OutlierScore: 12.0

Cost-per-claim above average for J1200

VHS CHILDRENS HOSPITAL OF MICHIGAN INC (1538471800) bills $113.28/claim for J1200 (Diphenhydramine hcl injectio) vs avg $1.00 (+12.0σ). $408,590 across 3,607 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.

VHS CHILDRENS HOSPITAL OF MICHIGAN INCDETROITProvider total: $180.2M

criticalCost OutlierScore: 11.8

Cost-per-claim above average for 97110 (Therapeutic Exercise (per 15 min))

ST CLAIR COUNTY COMMUNITY MENTAL HEALTH AUTHORITY (1689783672) bills $629.02/claim for 97110 (Therapeutic exercises) vs avg $30.43 (+11.8σ). $15,096 across 24 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 CLAIR COUNTY COMMUNITY MENTAL HEALTH AUTHORITYPORT HURONProvider total: $157.2M

criticalCost OutlierScore: 11.8

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

GREAT LAKES BAY HEALTH CENTERS (1902136385) bills $141.62/claim for D0120 (Periodic oral evaluation) vs avg $26.27 (+11.8σ). $28,042 across 198 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.

GREAT LAKES BAY HEALTH CENTERSVASSARProvider total: $231.5K

criticalCost OutlierScore: 11.7

Cost-per-claim above average for H2000

PATHWAYS (1487683546) bills $3,081.88/claim for H2000 (Comp multidisipln evaluation) vs avg $152.42 (+11.7σ). $2,527,145 across 820 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.

PATHWAYSMARQUETTEProvider total: $89.1M

criticalCost OutlierScore: 11.7

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

COPPER COUNTRY COMMUNITY MENTAL HEALTH SERVICES (1881607497) bills $342.75/claim for 99213 (Office o/p est low 20 min) vs avg $45.07 (+11.7σ). $2,133,638 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.

COPPER COUNTRY COMMUNITY MENTAL HEALTH SERVICESHOUGHTONProvider total: $79.2M

criticalCost OutlierScore: 11.4

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

HURON COUNTY COMMUNITY MENTAL HEALTH AUTHORITY (1659485514) bills $336.90/claim for 99213 (Office o/p est low 20 min) vs avg $45.07 (+11.4σ). $5,123,518 across 15,208 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.

HURON COUNTY COMMUNITY MENTAL HEALTH AUTHORITYBAD AXEProvider total: $42.8M

criticalCost OutlierScore: 11.1

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

GREAT LAKES BAY HEALTH CENTERS (1023348406) bills $134.67/claim for D0120 (Periodic oral evaluation) vs avg $26.27 (+11.1σ). $21,816 across 162 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.

GREAT LAKES BAY HEALTH CENTERSSAGINAWProvider total: $66.5K

criticalCost OutlierScore: 11.1

Cost-per-claim above average for D1110 (Adult Dental Prophylaxis (Teeth Cleaning))

NOTTAWASEPPI HURON BAND OF THE POTAWATOMI (1770500548) bills $269.15/claim for D1110 (Prophylaxis - adult) vs avg $48.41 (+11.0σ). $57,060 across 212 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.

NOTTAWASEPPI HURON BAND OF THE POTAWATOMIWYOMINGProvider total: $2.8M

criticalCost OutlierScore: 11.0

Cost-per-claim above average for 99441 (Telephone E&M (5-10 min))

MACOMB COUNTY COMMUNITY MENTAL HEALTH (1255385399) bills $221.06/claim for 99441 (Code 99441) vs avg $18.08 (+11.0σ). $62,780 across 284 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.

MACOMB COUNTY COMMUNITY MENTAL HEALTHCLINTON TWPProvider total: $300.0M

criticalCost OutlierScore: 11.0

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

NIMKEE DENTAL SAGINAW CHIPPEWA INDIAN TRIBE (1417039843) bills $258.05/claim for D0150 (Comprehensive oral evaluation) vs avg $42.64 (+11.0σ). $18,063 across 70 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.

NIMKEE DENTAL SAGINAW CHIPPEWA INDIAN TRIBEMT PLEASANTProvider total: $219.2K

criticalCost OutlierScore: 10.9

Cost-per-claim above average for J2250

VHS HARPER-HUTZEL HOSPITAL INC (1427360700) bills $6.39/claim for J2250 (Inj midazolam hydrochloride) vs avg $0.07 (+10.9σ). $89,276 across 13,980 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.

VHS HARPER-HUTZEL HOSPITAL INCDETROITProvider total: $76.7M

criticalCost OutlierScore: 10.9

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

THE WELLNESS PLAN MEDICAL CENTERS (1043373244) bills $132.36/claim for D0120 (Periodic oral evaluation) vs avg $26.27 (+10.9σ). $633,208 across 4,784 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.

THE WELLNESS PLAN MEDICAL CENTERSDETROITProvider total: $17.5M

criticalCost OutlierScore: 10.8

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

GOGEBIC COUNTY COMMUNITY MENTAL HEALTH AUTHORITY (1912957143) bills $439.58/claim for 99214 (Office o/p est mod 30 min) vs avg $64.49 (+10.8σ). $1,727,104 across 3,929 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.

GOGEBIC COUNTY COMMUNITY MENTAL HEALTH AUTHORITYWAKEFIELDProvider total: $35.3M

criticalCost OutlierScore: 10.8

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

SANILAC COUNTY COMMUNITY MENTAL HEALTH AUTHORITY (1306854880) bills $438.59/claim for 99214 (Office o/p est mod 30 min) vs avg $64.49 (+10.8σ). $372,364 across 849 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.

SANILAC COUNTY COMMUNITY MENTAL HEALTH AUTHORITYSANDUSKYProvider total: $61.0M

criticalCost OutlierScore: 10.8

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

COPPER COUNTRY COMMUNITY MENTAL HEALTH SERVICES (1881607497) bills $436.48/claim for 99214 (Office o/p est mod 30 min) vs avg $64.49 (+10.8σ). $1,824,478 across 4,180 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.

COPPER COUNTRY COMMUNITY MENTAL HEALTH SERVICESHOUGHTONProvider total: $79.2M

criticalCost OutlierScore: 10.6

Cost-per-claim above average for J2919

VHS CHILDRENS HOSPITAL OF MICHIGAN INC (1538471800) bills $583.42/claim for J2919 (Inj, methylpred sod succ 5mg) vs avg $6.63 (+10.6σ). $21,587 across 37 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.

VHS CHILDRENS HOSPITAL OF MICHIGAN INCDETROITProvider total: $180.2M

criticalCost OutlierScore: 10.6

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

SANILAC COUNTY COMMUNITY MENTAL HEALTH AUTHORITY (1306854880) bills $314.89/claim for 99213 (Office o/p est low 20 min) vs avg $45.07 (+10.6σ). $4,163,835 across 13,223 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.

SANILAC COUNTY COMMUNITY MENTAL HEALTH AUTHORITYSANDUSKYProvider total: $61.0M

criticalCost OutlierScore: 10.6

Cost-per-claim above average for 99238 (Hospital Discharge Day (30 min or less))

ASHWEENA GONUGUNTLA (1134182009) bills $136.35/claim for 99238 (Hosp ip/obs dschrg mgmt 30/<) vs avg $40.56 (+10.6σ). $15,272 across 112 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.

ASHWEENA GONUGUNTLAEAST LANSINGProvider total: $22.8K

criticalCost OutlierScore: 10.6

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

HIAWATHA COMMUNITY BEHAVIORAL HEALTH AUTHORITY (1629161567) bills $429.60/claim for 99214 (Office o/p est mod 30 min) vs avg $64.49 (+10.6σ). $1,999,339 across 4,654 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.

HIAWATHA COMMUNITY BEHAVIORAL HEALTH AUTHORITYSAULT SAINTE MARIEProvider total: $38.6M

criticalCost OutlierScore: 10.5

Cost-per-claim above average for J0696

OPTION CARE ENTERPRISES, INC. (1942252499) bills $23.07/claim for J0696 (Ceftriaxone sodium injection) vs avg $0.89 (+10.5σ). $10,266 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.

OPTION CARE ENTERPRISES, INC.FARMINGTON HILLSProvider total: $6.1M

criticalCost OutlierScore: 10.5

Cost-per-claim above average for 96372

NORTHERN LAKES COMMUNITY MENTAL HEALTH AUTHORITY (1518068071) bills $307.43/claim for 96372 (Ther/proph/diag inj sc/im) vs avg $11.92 (+10.5σ). $3,172,674 across 10,320 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.

NORTHERN LAKES COMMUNITY MENTAL HEALTH AUTHORITYTRAVERSE CITYProvider total: $148.6M

criticalCost OutlierScore: 10.5

Cost-per-claim above average for 90832 (Psychotherapy (30 min))

MONROE COUNTY COMMUNITY MENTAL HEALTH AUTHORITY (1245303890) bills $415.31/claim for 90832 (Psytx w pt 30 minutes) vs avg $39.27 (+10.5σ). $1,171,177 across 2,820 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.

MONROE COUNTY COMMUNITY MENTAL HEALTH AUTHORITYMONROEProvider total: $55.3M

criticalCost OutlierScore: 10.3

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

HANNAHVILLE INDIAN COMMUNITY (1790869436) bills $345.70/claim for D0140 (Limited oral evaluation - problem focused) vs avg $44.74 (+10.3σ). $86,080 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.

HANNAHVILLE INDIAN COMMUNITYWILSONProvider total: $8.4M

criticalCost OutlierScore: 10.2

Cost-per-claim above average for G0466

SAULT TRIBE OF CHIPPEWA INDIANS (1902074586) bills $599.25/claim for G0466 (Fqhc visit new patient) vs avg $78.54 (+10.2σ). $421,871 across 704 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.

SAULT TRIBE OF CHIPPEWA INDIANSSAULT SAINTE MARIEProvider total: $1.5M

criticalCost OutlierScore: 10.1

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

COPPER COUNTRY COMMUNITY MENTAL HEALTH SERVICES (1881607497) bills $320.74/claim for 99212 (Office o/p est sf 10 min) vs avg $29.27 (+10.1σ). $204,308 across 637 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.

COPPER COUNTRY COMMUNITY MENTAL HEALTH SERVICESHOUGHTONProvider total: $79.2M

criticalCost OutlierScore: 10.1

Cost-per-claim above average for 97530 (Therapeutic Activities (per 15 min))

COUNTY OF MUSKEGON (1003914946) bills $479.31/claim for 97530 (Therapeutic activities) vs avg $37.92 (+10.1σ). $208,020 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.

COUNTY OF MUSKEGONMUSKEGONProvider total: $151.1M

criticalCost OutlierScore: 10.1

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

MONTCALM CARE NETWORK (1710074448) bills $318.64/claim for 99203 (Office o/p new low 30 min) vs avg $54.71 (+10.1σ). $75,200 across 236 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.

MONTCALM CARE NETWORKSTANTONProvider total: $62.1M

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