Concourse Sentinel

Medicaid Integrity Analytics

πŸ“ŠOverviewπŸ₯ProvidersπŸ’ŠProceduresπŸ“Rate Benchmarks🚨WatchlistπŸ”Statistical OutliersπŸ—‚οΈReportsπŸ‘₯Population Healthβš–οΈCompareπŸ“ˆTrendsπŸ—ΊοΈGeography

Cross-Dataset

πŸ•ΈοΈEntity Networks🏠Home Healthβ›”Exclusions (LEIE)πŸ“‹Context & Disclaimers
πŸ‡ΊπŸ‡ΈAll States

Federal Compliance (WI)

πŸ›οΈOverviewπŸ“ŠOIG QSRπŸ”„Monthly Screening⏸️§455.23 Suspensionsβ›”OIG Exclusion Refs🧾RAC Coordination🎯PERM Sample
by Concourse

Data: CMS T-MSIS 2018-2024

Source: opendata.hhs.gov

Statistical Outliers

Single-test outliers in Wisconsin 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

275

warning

435

info

4,230

Total

4,940

Outliers by Type
Severity Distribution
critical
275 (5.6%)
warning
435 (8.8%)
info
4,230 (85.6%)
3,139 results
criticalCost OutlierScore: 21.1

Cost-per-claim above average for 98941

LAKE SUPERIOR COMMUNITY HEALTH CENTER (1063789022) bills $210.92/claim for 98941 (Chiropract manj 3-4 regions) vs avg $18.47 (+21.1Οƒ). $18,139 across 86 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.

LAKE SUPERIOR COMMUNITY HEALTH CENTERSUPERIORProvider total: $4.2M
criticalCost OutlierScore: 15.7

Cost-per-claim above average for 99000

MILE BLUFF MEDICAL CENTER INC (1568487411) bills $123.99/claim for 99000 (Specimen handling office-lab) vs avg $3.73 (+15.7Οƒ). $49,348 across 398 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.

MILE BLUFF MEDICAL CENTER INCMAUSTONProvider total: $6.6M
criticalCost OutlierScore: 15.5

Cost-per-claim above average for S5125

CENTER FOR INDEPENDENT LIVING FOR WESTERN WISCONSIN (1710139159) bills $1,102.77/claim for S5125 (Attendant care service /15m) vs avg $21.47 (+15.5Οƒ). $49,625 across 45 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.

CENTER FOR INDEPENDENT LIVING FOR WESTERN WISCONSINMENOMONIEProvider total: $682.4K
criticalCost OutlierScore: 13.7

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

OCONTO HOSPITAL & MEDICAL CENTER, INC. (1144725409) bills $6.05/claim for 36415 (Coll venous bld venipuncture) vs avg $0.19 (+13.7Οƒ). $11,537 across 1,906 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.

OCONTO HOSPITAL & MEDICAL CENTER, INC.MARINETTEProvider total: $292.3K
criticalCost OutlierScore: 13.1

Cost-per-claim above average for 91300

FROEDTERT SOUTH, INC. (1003831132) bills $6.21/claim for 91300 (Code 91300) vs avg $0.06 (+13.0Οƒ). $13,095 across 2,109 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.

FROEDTERT SOUTH, INC.PLEASANT PRAIRIEProvider total: $33.1M
criticalCost OutlierScore: 12.2

Cost-per-claim above average for A0429 (BLS Emergency Ambulance Transport)

ABLELIGHT INC. (1417010604) bills $3,298.31/claim for A0429 (Bls-emergency) vs avg $125.35 (+12.2Οƒ). $3,456,626 across 1,048 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.

ABLELIGHT INC.WATERTOWNProvider total: $125.1M
criticalCost OutlierScore: 12.2

Cost-per-claim above average for 81025

ALLINA HEALTH SYSTEM (1285691725) bills $87.37/claim for 81025 (Urine pregnancy test) vs avg $8.72 (+12.2Οƒ). $10,398 across 119 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.

ALLINA HEALTH SYSTEMRIVER FALLSProvider total: $4.6M
criticalCost OutlierScore: 12.0

Cost-per-claim above average for T2003

KISMET ADVOCACY LLC (1043718497) bills $1,320.13/claim for T2003 (N-et; encounter/trip) vs avg $47.37 (+12.0Οƒ). $30,363 across 23 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.

KISMET ADVOCACY LLCGREEN BAYProvider total: $3.8M
criticalCost OutlierScore: 11.5

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

1922775956 (1922775956) bills $265.85/claim for 99213 (Office o/p est low 20 min) vs avg $29.81 (+11.5Οƒ). $41,739 across 157 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.

1922775956Provider total: $68.9K
criticalCost OutlierScore: 11.5

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

CHILDREN'S HOSPITAL OF WISCONSIN, INC. (1881780302) bills $65.29/claim for 83036 (Hemoglobin glycosylated a1c) vs avg $7.31 (+11.5Οƒ). $124,776 across 1,911 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.

CHILDREN'S HOSPITAL OF WISCONSIN, INC.NEENAHProvider total: $3.4M
criticalCost OutlierScore: 10.4

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

EDGERTON HOSPITAL AND HEALTH SERVICES INC. (1154350049) bills $243.01/claim for 99213 (Office o/p est low 20 min) vs avg $29.81 (+10.4Οƒ). $322,966 across 1,329 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.

EDGERTON HOSPITAL AND HEALTH SERVICES INC.EDGERTONProvider total: $3.9M
criticalCost OutlierScore: 9.8

Cost-per-claim above average for J3490

HEALING CORNER, LLC (1598086928) bills $729.13/claim for J3490 (Drugs unclassified injection) vs avg $9.62 (+9.8Οƒ). $229,674 across 315 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.

HEALING CORNER, LLCBROOKFIELDProvider total: $2.9M
criticalCost OutlierScore: 9.5

Cost-per-claim above average for 86900

CHILDREN'S HOSPITAL OF WISCONSIN, INC. (1750482022) bills $94.93/claim for 86900 (Blood typing serologic abo) vs avg $4.35 (+9.5Οƒ). $866,073 across 9,123 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.

CHILDREN'S HOSPITAL OF WISCONSIN, INC.MILWAUKEEProvider total: $262.2M
criticalCost OutlierScore: 8.9

Cost-per-claim above average for 92015

THE MONROE CLINIC, INC. (1740291491) bills $43.92/claim for 92015 (Determine refractive state) vs avg $6.76 (+8.9Οƒ). $222,914 across 5,075 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 MONROE CLINIC, INC.MONROEProvider total: $6.3M
criticalCost OutlierScore: 8.8

Cost-per-claim above average for A0120

BETHESDA LUTHERAN COMMUNITIES (1033429683) bills $300.58/claim for A0120 (Noner transport mini-bus) vs avg $23.52 (+8.8Οƒ). $49,597 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.

BETHESDA LUTHERAN COMMUNITIESWATERTOWNProvider total: $14.2M
criticalCost OutlierScore: 8.5

Cost-per-claim above average for A9150

UNIVERSITY OF WISCONSIN HOSPITALS AND CLINICS AUTHORITY (1750804514) bills $674.62/claim for A9150 (Misc/exper non-prescript dru) vs avg $36.71 (+8.5Οƒ). $376,440 across 558 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.

UNIVERSITY OF WISCONSIN HOSPITALS AND CLINICS AUTHORITYMIDDLETONProvider total: $378.7K
criticalCost OutlierScore: 8.5

Cost-per-claim above average for 90670

RICHLAND HOSPITAL (1659301273) bills $153.54/claim for 90670 (Pcv13 vaccine im) vs avg $9.09 (+8.5Οƒ). $21,189 across 138 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.

RICHLAND HOSPITALRICHLAND CENTERProvider total: $9.2M
criticalCost OutlierScore: 8.1

Cost-per-claim above average for H0020 (Alcohol/Drug Services (Methadone Maintenance))

ANGELA LONG (1689864761) bills $73.81/claim for H0020 (Alcohol and/or drug services; methadone administration and/or service) vs avg $11.68 (+8.1Οƒ). $320,708 across 4,345 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

ANGELA LONGKENOSHAProvider total: $320.7K
criticalCost OutlierScore: 8.1

Cost-per-claim above average for 86901

COLUMBIA ST. MARY'S HOSPITAL MILWAUKEE, INC. (1871656082) bills $12.09/claim for 86901 (Blood typing serologic rh(d)) vs avg $2.22 (+8.1Οƒ). $133,689 across 11,058 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.

COLUMBIA ST. MARY'S HOSPITAL MILWAUKEE, INC.MILWAUKEEProvider total: $64.5M
criticalCost OutlierScore: 8.1

Cost-per-claim above average for 81003 (Urinalysis by Dipstick (Automated))

BEAVER DAM COMMUNITY HOSPITALS INC (1023187416) bills $38.78/claim for 81003 (Urinalysis auto w/o scope) vs avg $3.43 (+8.1Οƒ). $81,595 across 2,104 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.

BEAVER DAM COMMUNITY HOSPITALS INCBEAVER DAMProvider total: $10.6M
criticalCost OutlierScore: 8.1

Cost-per-claim above average for H0022

GOODMAN'S BEHAVIORAL HEALTH CLINIC, LLC (1740458363) bills $284.48/claim for H0022 (Alcohol and/or drug interven) vs avg $36.48 (+8.1Οƒ). $90,750 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.

GOODMAN'S BEHAVIORAL HEALTH CLINIC, LLCREEDSBURGProvider total: $256.0K
criticalCost OutlierScore: 8.0

Cost-per-claim above average for H0039

COUNTY OF SHAWANO (1750549432) bills $2,276.14/claim for H0039 (Asser com tx face-face/15min) vs avg $71.58 (+8.0Οƒ). $122,912 across 54 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

COUNTY OF SHAWANOSHAWANOProvider total: $336.4K
criticalCost OutlierScore: 7.9

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

MELISSA LOPEZ (1497397707) bills $324.53/claim for 99204 (Office o/p new mod 45 min) vs avg $63.81 (+7.9Οƒ). $142,146 across 438 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.

MELISSA LOPEZJANESVILLEProvider total: $414.5K
criticalCost OutlierScore: 7.8

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

MOUNDVIEW MEMORIAL HOSPITAL & CLINICS, INC (1710939533) bills $190.49/claim for 99213 (Office o/p est low 20 min) vs avg $29.81 (+7.8Οƒ). $643,079 across 3,376 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.

MOUNDVIEW MEMORIAL HOSPITAL & CLINICS, INCFRIENDSHIPProvider total: $8.8M
criticalCost OutlierScore: 7.8

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

PRAIRIE RIDGE HEALTH, INC. (1841376183) bills $189.81/claim for 99213 (Office o/p est low 20 min) vs avg $29.81 (+7.8Οƒ). $1,919,916 across 10,115 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.

PRAIRIE RIDGE HEALTH, INC.COLUMBUSProvider total: $6.8M
criticalCost OutlierScore: 7.8

Cost-per-claim above average for 92341

MCHS HOSPITALS INC (1952809816) bills $129.03/claim for 92341 (Fit spectacles bifocal) vs avg $25.77 (+7.8Οƒ). $14,064 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.

MCHS HOSPITALS INCEAU CLAIREProvider total: $12.4M
criticalCost OutlierScore: 7.8

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

WESTFIELDS HOSPITAL, INC. (1881640183) bills $63.88/claim for 87880 (Strep a assay w/optic) vs avg $15.18 (+7.8Οƒ). $20,889 across 327 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.

WESTFIELDS HOSPITAL, INC.NEW RICHMONDProvider total: $8.5M
criticalCost OutlierScore: 7.6

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

VPA PC (1255958344) bills $286.72/claim for 99212 (Office o/p est sf 10 min) vs avg $27.95 (+7.6Οƒ). $176,906 across 617 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 PCWEST ALLISProvider total: $1.2M
criticalCost OutlierScore: 7.6

Cost-per-claim above average for T1999

PETER JOHN JACQUES (1952597486) bills $1,990.12/claim for T1999 (Noc retail items andsupplies) vs avg $139.26 (+7.6Οƒ). $23,881 across 12 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.

PETER JOHN JACQUESAPPLETONProvider total: $1.3M
criticalCost OutlierScore: 7.5

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

OCONTO HOSPITAL & MEDICAL CENTER INC (1356373302) bills $183.44/claim for 99213 (Office o/p est low 20 min) vs avg $29.81 (+7.5Οƒ). $1,137,488 across 6,201 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.

OCONTO HOSPITAL & MEDICAL CENTER INCOCONTOProvider total: $4.8M
criticalCost OutlierScore: 7.5

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

EDGERTON HOSPITAL AND HEALTH SERVICES INC. (1154350049) bills $281.38/claim for 99212 (Office o/p est sf 10 min) vs avg $27.95 (+7.5Οƒ). $1,121,869 across 3,987 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.

EDGERTON HOSPITAL AND HEALTH SERVICES INC.EDGERTONProvider total: $3.9M
criticalCost OutlierScore: 7.4

Cost-per-claim above average for 96374

AURORA MEDICAL CENTER BAY AREA, INC (1043397177) bills $24.00/claim for 96374 (Ther/proph/diag inj iv push) vs avg $2.13 (+7.4Οƒ). $196,743 across 8,197 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.

AURORA MEDICAL CENTER BAY AREA, INCMARINETTEProvider total: $9.7M
criticalCost OutlierScore: 7.3

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

FLAMBEAU HOSPITAL INC (1700963048) bills $180.41/claim for 99213 (Office o/p est low 20 min) vs avg $29.81 (+7.3Οƒ). $189,254 across 1,049 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.

FLAMBEAU HOSPITAL INCPARK FALLSProvider total: $7.0M
criticalCost OutlierScore: 7.3

Cost-per-claim above average for 81002 (Urinalysis without Microscopy)

CHILDREN'S HOSPITAL OF WISCONSIN, INC. (1881780302) bills $61.75/claim for 81002 (Urinalysis nonauto w/o scope) vs avg $4.73 (+7.3Οƒ). $35,627 across 577 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.

CHILDREN'S HOSPITAL OF WISCONSIN, INC.NEENAHProvider total: $3.4M
criticalCost OutlierScore: 7.2

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

ASPIRUS STANLEY HOSPITAL & CLINICS, INC (1053391730) bills $272.72/claim for 99212 (Office o/p est sf 10 min) vs avg $27.95 (+7.2Οƒ). $522,523 across 1,916 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.

ASPIRUS STANLEY HOSPITAL & CLINICS, INCSTANLEYProvider total: $4.8M
criticalCost OutlierScore: 7.1

Cost-per-claim above average for H0005

AMERY REGIONAL MEDICAL CENTER, INC (1093763518) bills $183.80/claim for H0005 (Alcohol and/or drug services; group counseling by a clinician) vs avg $18.80 (+7.1Οƒ). $34,923 across 190 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.

AMERY REGIONAL MEDICAL CENTER, INCAMERYProvider total: $8.6M
criticalCost OutlierScore: 7.0

Cost-per-claim above average for 99392 (Preventive Visit, Established Patient (Ages 1-4))

RICHLAND HOSPITAL (1659301273) bills $161.67/claim for 99392 (Prev visit est age 1-4) vs avg $56.15 (+7.0Οƒ). $25,221 across 156 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.

RICHLAND HOSPITALRICHLAND CENTERProvider total: $9.2M
criticalCost OutlierScore: 6.9

Cost-per-claim above average for 99391 (Preventive Visit, Established Patient (Infant, <1 year))

RICHLAND HOSPITAL (1659301273) bills $132.57/claim for 99391 (Per pm reeval est pat infant) vs avg $55.59 (+6.9Οƒ). $41,361 across 312 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.

RICHLAND HOSPITALRICHLAND CENTERProvider total: $9.2M
criticalCost OutlierScore: 6.9

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

MEMORIAL HOSPITAL OF BOSCOBEL (1760459846) bills $206.50/claim for 99214 (Office o/p est mod 30 min) vs avg $41.75 (+6.9Οƒ). $234,377 across 1,135 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 HOSPITAL OF BOSCOBELBOSCOBELProvider total: $5.4M
criticalCost OutlierScore: 6.9

Cost-per-claim above average for G0378

COUNTY OF MILWAUKEE (1083728612) bills $349.44/claim for G0378 (Hospital observation per hr) vs avg $34.69 (+6.9Οƒ). $92,602 across 265 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 MILWAUKEEMILWAUKEEProvider total: $3.1M
criticalCost OutlierScore: 6.8

Cost-per-claim above average for 92508 (Speech-Language Therapy (Group))

PENFIELD CHILDREN'S CENTER, INC. (1275692410) bills $19.15/claim for 92508 (Tx sp lang voice comm group) vs avg $6.01 (+6.8Οƒ). $18,439 across 963 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.

PENFIELD CHILDREN'S CENTER, INC.MILWAUKEEProvider total: $2.3M
criticalCost OutlierScore: 6.8

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

FLAMBEAU HOSPITAL INC (1700963048) bills $204.26/claim for 99214 (Office o/p est mod 30 min) vs avg $41.75 (+6.8Οƒ). $97,022 across 475 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.

FLAMBEAU HOSPITAL INCPARK FALLSProvider total: $7.0M
criticalCost OutlierScore: 6.8

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

JEROME LERNER (1710993837) bills $203.36/claim for 99214 (Office o/p est mod 30 min) vs avg $41.75 (+6.8Οƒ). $197,057 across 969 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.

JEROME LERNERGREENFIELDProvider total: $246.4K
criticalCost OutlierScore: 6.8

Cost-per-claim above average for A0425 (Ground Ambulance Mileage (per mile))

ASPIRUS WAUSAU HOSPITAL, INC (1215101076) bills $89.98/claim for A0425 (Ground mileage) vs avg $6.24 (+6.8Οƒ). $828,137 across 9,204 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.

ASPIRUS WAUSAU HOSPITAL, INCWAUSAUProvider total: $6.1M
criticalCost OutlierScore: 6.8

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

MEMORIAL MEDICAL CENTER INC (1437179231) bills $139.10/claim for 90832 (Psytx w pt 30 minutes) vs avg $31.47 (+6.8Οƒ). $322,860 across 2,321 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 MEDICAL CENTER INCASHLANDProvider total: $22.6M
criticalCost OutlierScore: 6.7

Cost-per-claim above average for A0390

FLAMBEAU HOSPITAL INC (1700963048) bills $569.46/claim for A0390 (Advanced life support mileag) vs avg $62.43 (+6.7Οƒ). $94,530 across 166 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.

FLAMBEAU HOSPITAL INCPARK FALLSProvider total: $7.0M
criticalCost OutlierScore: 6.7

Cost-per-claim above average for 87651 (Strep A DNA/RNA Test (Molecular/PCR))

ST JOSEPHS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST F (1164429908) bills $101.99/claim for 87651 (Strep a dna amp probe) vs avg $33.65 (+6.7Οƒ). $15,298 across 150 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 JOSEPHS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST FCHIPPEWA FALLSProvider total: $4.5M
criticalCost OutlierScore: 6.6

Cost-per-claim above average for 97140 (Manual Therapy (per 15 min))

INNOVATIONS REHABILITATION, SC (1891842035) bills $79.94/claim for 97140 (Manual therapy 1/> regions) vs avg $17.27 (+6.6Οƒ). $10,152 across 127 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.

INNOVATIONS REHABILITATION, SCSPARTAProvider total: $10.2K
criticalCost OutlierScore: 6.5

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

TRI-COUNTY MEMORIAL HOSPITAL, INC. (1124063573) bills $195.96/claim for 99214 (Office o/p est mod 30 min) vs avg $41.75 (+6.5Οƒ). $424,652 across 2,167 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.

TRI-COUNTY MEMORIAL HOSPITAL, INC.WHITEHALLProvider total: $4.1M
criticalCost OutlierScore: 6.3

Cost-per-claim above average for 43239

THEDACARE MEDICAL CENTER - BERLIN, INC. (1760413777) bills $848.54/claim for 43239 (Egd biopsy single/multiple) vs avg $182.24 (+6.3Οƒ). $105,219 across 124 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.

THEDACARE MEDICAL CENTER - BERLIN, INC.BERLINProvider total: $9.4M
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