Statistical Outliers

Single-test outliers in South Carolina 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

426

warning

520

info

4,583

Total

5,529

Outliers by Type

Severity Distribution

critical

426 (7.7%)

warning

520 (9.4%)

info

4,583 (82.9%)

3,793 results

criticalCost OutlierScore: 24.9

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

EAST COOPER COMMUNITY HOSPITAL, INC. (1821026816) bills $2,623.32/claim for 36415 (Coll venous bld venipuncture) vs avg $19.76 (+24.9σ). $107,556 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.

EAST COOPER COMMUNITY HOSPITAL, INC.MT PLEASANTProvider total: $3.0M

criticalCost OutlierScore: 18.8

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

MEDICAL UNIVERSITY HOSPITAL AUTHORITY (1659435840) bills $301.69/claim for D0150 (Comprehensive oral evaluation) vs avg $39.93 (+18.8σ). $284,794 across 944 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.

MEDICAL UNIVERSITY HOSPITAL AUTHORITYCHARLESTONProvider total: $241.4M

criticalCost OutlierScore: 18.5

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

EAST COOPER MEDICAL CENTER LLC (1841069044) bills $952.37/claim for 85025 (Complete cbc w/auto diff wbc) vs avg $7.86 (+18.5σ). $71,428 across 75 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.

EAST COOPER MEDICAL CENTER LLCMOUNT PLEASANTProvider total: $73.2K

criticalCost OutlierScore: 17.3

Cost-per-claim above average for 96372

PRISMA HEALTH-UPSTATE (1851846661) bills $2,088.18/claim for 96372 (Ther/proph/diag inj sc/im) vs avg $25.75 (+17.3σ). $758,008 across 363 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.

PRISMA HEALTH-UPSTATEGREENVILLEProvider total: $10.7M

criticalCost OutlierScore: 16.5

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

AGAPE HOSPICE OF THE LOWCOUNTRY LLC (1033309877) bills $2,562.36/claim for T1015 (Clinic service) vs avg $72.75 (+16.5σ). $92,245 across 36 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.

AGAPE HOSPICE OF THE LOWCOUNTRY LLCNORTH CHARLESTONProvider total: $23.7M

criticalCost OutlierScore: 13.2

Cost-per-claim above average for D1208

PALMETTO SURGERY CENTER LLC (1073505038) bills $105.09/claim for D1208 (Topical fluoride excluding varnish) vs avg $16.48 (+13.2σ). $35,205 across 335 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.

PALMETTO SURGERY CENTER LLCCOLUMBIAProvider total: $4.6M

criticalCost OutlierScore: 12.9

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

MCLEOD REGIONAL MEDICAL CENTER OF THE PEE DEE, INC. (1699756221) bills $320.89/claim for 99211 (Off/op est may x req phy/qhp) vs avg $19.37 (+12.9σ). $377,049 across 1,175 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.

MCLEOD REGIONAL MEDICAL CENTER OF THE PEE DEE, INC.FLORENCEProvider total: $90.9M

criticalCost OutlierScore: 12.5

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

ALYSON MCGREGOR (1437290764) bills $266.28/claim for 99283 (Emergency dept visit low mdm) vs avg $43.59 (+12.5σ). $19,705 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.

ALYSON MCGREGORGREENVILLEProvider total: $240.9K

criticalCost OutlierScore: 11.9

Cost-per-claim above average for D1351 (Dental Sealant (per Tooth))

MCLEOD REGIONAL MEDICAL CENTER OF THE PEE DEE, INC. (1699756221) bills $884.49/claim for D1351 (Sealant per tooth) vs avg $39.64 (+11.9σ). $245,887 across 278 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.

MCLEOD REGIONAL MEDICAL CENTER OF THE PEE DEE, INC.FLORENCEProvider total: $90.9M

criticalCost OutlierScore: 11.7

Cost-per-claim above average for 87880 (Rapid Strep A Test (Optical/Immunoassay))

QHG OF SOUTH CAROLINA INC (1235183328) bills $106.11/claim for 87880 (Strep a assay w/optic) vs avg $12.50 (+11.7σ). $231,531 across 2,182 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.

QHG OF SOUTH CAROLINA INCFLORENCEProvider total: $5.4M

criticalCost OutlierScore: 11.3

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

PRISMA HEALTH-UPSTATE (1437605532) bills $100.19/claim for 96127 (Brief emotional/behav assmt) vs avg $6.43 (+11.3σ). $139,761 across 1,395 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.

PRISMA HEALTH-UPSTATEGREENVILLEProvider total: $25.0M

criticalCost OutlierScore: 10.8

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

PRISMA HEALTH-UPSTATE (1851846661) bills $96.56/claim for 96127 (Brief emotional/behav assmt) vs avg $6.43 (+10.8σ). $43,549 across 451 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.

PRISMA HEALTH-UPSTATEGREENVILLEProvider total: $10.7M

criticalCost OutlierScore: 10.7

Cost-per-claim above average for 3008F

B-L FAMILY PRACTICE P A (1558356196) bills $22.09/claim for 3008F vs avg $0.20 (+10.7σ). $26,398 across 1,195 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.

B-L FAMILY PRACTICE P ALEESVILLEProvider total: $1.7M

criticalCost OutlierScore: 10.1

Cost-per-claim above average for J2405 (Ondansetron (Zofran) Injection (1 mg))

CHESTER HMA LLC (1366481632) bills $293.01/claim for J2405 (Ondansetron hcl injection) vs avg $4.03 (+10.1σ). $177,273 across 605 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.

CHESTER HMA LLCCHESTERProvider total: $1.4M

criticalCost OutlierScore: 10.0

Cost-per-claim above average for J3490

BON SECOURS ST. FRANCIS XAVIER HOSPITAL INC. (1851361778) bills $1,287.08/claim for J3490 (Drugs unclassified injection) vs avg $44.50 (+10.0σ). $2,660,396 across 2,067 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.

BON SECOURS ST. FRANCIS XAVIER HOSPITAL INC.CHARLESTONProvider total: $35.9M

criticalCost OutlierScore: 10.0

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

ALYSON MCGREGOR (1437290764) bills $842.62/claim for 99285 (Emergency dept visit hi mdm) vs avg $65.58 (+10.0σ). $123,023 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.

ALYSON MCGREGORGREENVILLEProvider total: $240.9K

criticalCost OutlierScore: 9.7

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

OUTPATIENT SURGERY CENTER OF HILTON HEAD (1619935483) bills $175.57/claim for D0150 (Comprehensive oral evaluation) vs avg $39.93 (+9.7σ). $15,626 across 89 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.

OUTPATIENT SURGERY CENTER OF HILTON HEADHILTON HEAD ISLANDProvider total: $896.0K

criticalCost OutlierScore: 9.6

Cost-per-claim above average for 90680

SPARTANBURG MEDICAL CENTER (1609807122) bills $17.17/claim for 90680 (Rv5 vacc 3 dose live oral) vs avg $0.30 (+9.6σ). $91,209 across 5,313 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.

SPARTANBURG MEDICAL CENTERSPARTANBURGProvider total: $187.8M

criticalOverutilizationScore: 9.6

Unusually high claims-per-beneficiary ratio

GENERAL COUNCIL ON FINANCE & ADMINS (1568114957): 32.2 claims/beneficiary (avg 2.1). 13,572 claims, 422 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.

GENERAL COUNCIL ON FINANCE & ADMINSIRMOProvider total: $3.3M

criticalCost OutlierScore: 9.5

Cost-per-claim above average for 96110

PRISMA HEALTH-UPSTATE (1851846661) bills $94.74/claim for 96110 (Developmental screen w/score) vs avg $7.79 (+9.5σ). $261,392 across 2,759 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.

PRISMA HEALTH-UPSTATEGREENVILLEProvider total: $10.7M

criticalCost OutlierScore: 9.3

Cost-per-claim above average for 81025

PRISMA HEALTH-UPSTATE (1407301211) bills $332.01/claim for 81025 (Urine pregnancy test) vs avg $15.62 (+9.3σ). $2,577,696 across 7,764 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.

PRISMA HEALTH-UPSTATEGREENVILLEProvider total: $22.0M

criticalCost OutlierScore: 9.2

Cost-per-claim above average for 92014

HEALTH CARE PARTNERS OF SOUTH CAROLINA, INC. (1528771086) bills $230.43/claim for 92014 (Compre oph exam est pt 1/>) vs avg $63.88 (+9.2σ). $29,725 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.

HEALTH CARE PARTNERS OF SOUTH CAROLINA, INC.CONWAYProvider total: $34.3K

criticalCost OutlierScore: 9.2

Cost-per-claim above average for D1206 (Topical Fluoride Varnish Application)

ANMED HEALTH MEDICUS SURGERY CENTER LLC (1265435614) bills $111.52/claim for D1206 (Topical fluoride varnish) vs avg $16.72 (+9.2σ). $21,636 across 194 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.

ANMED HEALTH MEDICUS SURGERY CENTER LLCANDERSONProvider total: $2.7M

criticalCost OutlierScore: 9.1

Cost-per-claim above average for 96110

PRISMA HEALTH-UPSTATE (1437605532) bills $90.75/claim for 96110 (Developmental screen w/score) vs avg $7.79 (+9.1σ). $528,089 across 5,819 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.

PRISMA HEALTH-UPSTATEGREENVILLEProvider total: $25.0M

criticalCost OutlierScore: 9.0

Cost-per-claim above average for 83036 (Hemoglobin A1c (Diabetes Monitoring))

PRISMA HEALTH-UPSTATE (1174079271) bills $45.86/claim for 83036 (Hemoglobin glycosylated a1c) vs avg $4.62 (+9.0σ). $180,376 across 3,933 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.

PRISMA HEALTH-UPSTATEGREENVILLEProvider total: $4.7M

criticalOverutilizationScore: 9.0

Unusually high claims-per-beneficiary ratio

PRESBYTERIAN AGENCY FOR THE DEVELOPMENTALLY DISABLED INC (1447904040): 30.5 claims/beneficiary (avg 2.1). 2,954 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.

PRESBYTERIAN AGENCY FOR THE DEVELOPMENTALLY DISABLED INCFLORENCEProvider total: $726.7K

criticalCost OutlierScore: 8.9

Cost-per-claim above average for D1208

OUTPATIENT SURGERY CENTER OF HILTON HEAD (1619935483) bills $76.58/claim for D1208 (Topical fluoride excluding varnish) vs avg $16.48 (+8.9σ). $20,830 across 272 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.

OUTPATIENT SURGERY CENTER OF HILTON HEADHILTON HEAD ISLANDProvider total: $896.0K

criticalOverutilizationScore: 8.9

Unusually high claims-per-beneficiary ratio

PURPOSE-SC (1124260427): 30.1 claims/beneficiary (avg 2.1). 33,997 claims, 1,129 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.

PURPOSE-SCGREENVILLEProvider total: $11.1M

criticalCost OutlierScore: 8.9

Cost-per-claim above average for 87880 (Rapid Strep A Test (Optical/Immunoassay))

ANMED HEALTH (1417919531) bills $83.83/claim for 87880 (Strep a assay w/optic) vs avg $12.50 (+8.9σ). $3,243,275 across 38,689 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.

ANMED HEALTHANDERSONProvider total: $75.8M

criticalCost OutlierScore: 8.9

Cost-per-claim above average for J2250

CHESTER HMA LLC (1366481632) bills $69.50/claim for J2250 (Inj midazolam hydrochloride) vs avg $1.53 (+8.9σ). $12,648 across 182 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.

CHESTER HMA LLCCHESTERProvider total: $1.4M

criticalOverutilizationScore: 8.8

Unusually high claims-per-beneficiary ratio

ADVANTAGE HEALTH SYSTEMS (1710906771): 29.8 claims/beneficiary (avg 2.1). 37,934 claims, 1,271 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.

ADVANTAGE HEALTH SYSTEMSCOLUMBIAProvider total: $2.5M

criticalCost OutlierScore: 8.8

Cost-per-claim above average for D1120 (Child Dental Prophylaxis (Teeth Cleaning))

OUTPATIENT SURGERY CENTER OF HILTON HEAD (1619935483) bills $108.91/claim for D1120 (Prophylaxis - child) vs avg $34.97 (+8.8σ). $35,504 across 326 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.

OUTPATIENT SURGERY CENTER OF HILTON HEADHILTON HEAD ISLANDProvider total: $896.0K

criticalOverutilizationScore: 8.8

Unusually high claims-per-beneficiary ratio

SOLOMON INTERNATIONAL INC. (1659770881): 29.8 claims/beneficiary (avg 2.1). 8,164 claims, 274 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.

SOLOMON INTERNATIONAL INC.MURRELLS INLETProvider total: $666.5K

criticalOverutilizationScore: 8.8

Unusually high claims-per-beneficiary ratio

D&S COMMUNITY SERVICES SC, LLC (1265045629): 29.7 claims/beneficiary (avg 2.1). 29,589 claims, 996 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.

D&S COMMUNITY SERVICES SC, LLCGREENVILLEProvider total: $8.3M

criticalOverutilizationScore: 8.8

Unusually high claims-per-beneficiary ratio

LUTHERAN FAMILY SERVICES IN THE CAROLINAS (1538876537): 29.7 claims/beneficiary (avg 2.1). 15,879 claims, 535 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.

LUTHERAN FAMILY SERVICES IN THE CAROLINASCOLUMBIAProvider total: $2.1M

criticalOverutilizationScore: 8.8

Unusually high claims-per-beneficiary ratio

EXCALIBUR YOUTH SERVICES, LLC. (1083852511): 29.6 claims/beneficiary (avg 2.1). 8,565 claims, 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.

EXCALIBUR YOUTH SERVICES, LLC.SIMPSONVILLEProvider total: $4.6M

criticalCost OutlierScore: 8.7

Cost-per-claim above average for 85018

SPARTANBURG MEDICAL CENTER (1609807122) bills $51.50/claim for 85018 (Hemoglobin) vs avg $2.53 (+8.7σ). $1,048,619 across 20,363 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.

SPARTANBURG MEDICAL CENTERSPARTANBURGProvider total: $187.8M

criticalCost OutlierScore: 8.7

Cost-per-claim above average for 93005

PRISMA HEALTH-UPSTATE (1508312604) bills $39.33/claim for 93005 (Electrocardiogram tracing) vs avg $3.12 (+8.6σ). $19,116 across 486 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.

PRISMA HEALTH-UPSTATEGREENVILLEProvider total: $82.9K

criticalCost OutlierScore: 8.6

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

GEORGETOWN MEMORIAL HOSPITAL (1982604021) bills $7.07/claim for J1100 (Dexamethasone sodium phos) vs avg $0.52 (+8.6σ). $66,858 across 9,457 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.

GEORGETOWN MEMORIAL HOSPITALGEORGETOWNProvider total: $27.6M

criticalCost OutlierScore: 8.6

Cost-per-claim above average for D7140 (Tooth Extraction (Erupted Tooth, Simple))

CAROLINA REGIONAL SURGERY CENTER. LTD (1275596264) bills $453.04/claim for D7140 (Extraction erupted tooth or exposed root) vs avg $91.96 (+8.6σ). $350,655 across 774 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.

CAROLINA REGIONAL SURGERY CENTER. LTDMYRTLE BEACHProvider total: $1.7M

criticalOverutilizationScore: 8.6

Unusually high claims-per-beneficiary ratio

ATTELL DIALYSIS LLC (1467902858): 29.1 claims/beneficiary (avg 2.1). 7,624 claims, 262 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.

ATTELL DIALYSIS LLCSUMMERVILLEProvider total: $120.3K

criticalCost OutlierScore: 8.5

Cost-per-claim above average for J1200

GEORGETOWN MEMORIAL HOSPITAL (1982604021) bills $18.33/claim for J1200 (Diphenhydramine hcl injectio) vs avg $0.59 (+8.5σ). $68,651 across 3,745 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.

GEORGETOWN MEMORIAL HOSPITALGEORGETOWNProvider total: $27.6M

criticalCost OutlierScore: 8.5

Cost-per-claim above average for 85018

PRISMA HEALTH-MIDLANDS (1154373843) bills $50.47/claim for 85018 (Hemoglobin) vs avg $2.53 (+8.5σ). $150,716 across 2,986 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.

PRISMA HEALTH-MIDLANDSCOLUMBIAProvider total: $74.6M

criticalCost OutlierScore: 8.5

Cost-per-claim above average for 82570

PRISMA HEALTH-MIDLANDS (1487868097) bills $118.57/claim for 82570 (Assay of urine creatinine) vs avg $5.06 (+8.5σ). $542,581 across 4,576 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.

PRISMA HEALTH-MIDLANDSCOLUMBIAProvider total: $68.3M

criticalCost OutlierScore: 8.5

Cost-per-claim above average for 85730

MEDICAL UNIVERSITY HOSPITAL AUTHORITY (1770280299) bills $34.92/claim for 85730 (Thromboplastin time partial) vs avg $0.91 (+8.5σ). $74,972 across 2,147 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.

MEDICAL UNIVERSITY HOSPITAL AUTHORITYORANGEBURGProvider total: $8.7M

criticalCost OutlierScore: 8.4

Cost-per-claim above average for 87340

THE REGIONAL MEDICAL CENTER OF ORANGEBURG AND CALHOUN COUNTIES (1457309247) bills $34.53/claim for 87340 (Hepatitis b surface ag ia) vs avg $1.29 (+8.4σ). $12,293 across 356 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 REGIONAL MEDICAL CENTER OF ORANGEBURG AND CALHOUN COUNTIESORANGEBURGProvider total: $25.7M

criticalCost OutlierScore: 8.3

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

CARETEAM PLUS, INC. (1427363209) bills $319.08/claim for 99203 (Office o/p new low 30 min) vs avg $71.16 (+8.3σ). $18,507 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.

CARETEAM PLUS, INC.CONWAYProvider total: $1.6M

criticalCost OutlierScore: 8.2

Cost-per-claim above average for J2550

CHESTER HMA LLC (1366481632) bills $183.17/claim for J2550 (Promethazine hcl injection) vs avg $4.25 (+8.2σ). $158,078 across 863 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.

CHESTER HMA LLCCHESTERProvider total: $1.4M

criticalCost OutlierScore: 8.2

Cost-per-claim above average for J0690

QHG OF SOUTH CAROLINA INC (1235183328) bills $54.01/claim for J0690 (Cefazolin sodium injection) vs avg $1.46 (+8.2σ). $40,992 across 759 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.

QHG OF SOUTH CAROLINA INCFLORENCEProvider total: $5.4M

criticalCost OutlierScore: 8.1

Cost-per-claim above average for 82962

ST. FRANCIS HOSPITAL INC (1023418035) bills $414.66/claim for 82962 (Glucose blood test) vs avg $18.34 (+8.1σ). $163,375 across 394 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. FRANCIS HOSPITAL INCGREENVILLEProvider total: $9.0M

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Statistical Outliers

Single-test outliers in South Carolina Medicaid data. These are individual statistical flags — most are informational.