Orsini Pharmaceutical Services LLC
Billing Swing
Experienced over 200% change in year-over-year billing with >$1M absolute change.
Billing changed from $4.6M (2020) to $22.5M (2021) — a 388% swing with $17.9M absolute change.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 3 procedure codes: J1428 at 1.0× median, J3490 at 6213.9× median.
Statistical flags are not proof of wrongdoing. Some entities (government agencies, home care programs) may legitimately bill at high rates. Hospitals, government entities, and large care organizations may legitimately bill at higher rates due to patient acuity, overhead costs, or specialized services. Read our methodology.
Red Flags Explained
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Each flag represents a statistical test that identified unusual billing patterns. Here's what each flag on this provider means in plain English:
Billing Swing
Billing Swing means this provider's total billing changed dramatically from one year to the next — increasing or decreasing by more than 200% with over $1M in absolute change. This could indicate a change in practice scope, a billing scheme ramping up, or legitimate growth.
Rate Outlier
Rate Outlier means this provider charges above the 90th percentile for multiple different procedure codes simultaneously. While one high-cost code could reflect specialization, consistently high rates across many codes may indicate systematic overbilling.
These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.
Advanced Detection Signals
Additional statistical tests from advanced fraud detection methods
These signals use advanced statistical methods including digit distribution analysis, change-point detection, and market concentration metrics. Learn more.
Risk Assessment
Bills $35,419.05 per claim for J3490 (Unclassified drugs) — 6213.9× the national median of $5.70.
Billing in the top 1% nationally for 2 procedure codes: J1428, J3490.
This is a statistical summary, not an accusation. See our methodology.
Total Paid
$187.5M
$187,472,847
Total Claims
30K
Beneficiaries
16K
1.8 claims/patient
Avg Cost/Claim
$6K
#500 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Orsini Pharmaceutical Services LLC is a Pharmacy Specialty Pharmacy provider based in Elk Grove Village, IL. From the 2018–2024 period, this provider received $187.5M in Medicaid payments across 30K claims.
Why This Matters
This provider received $187.5M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 23,434 Medicaid beneficiaries for a full year at average per-enrollee costs.
Monthly Spending Trend
Yearly Spending
Procedure Breakdown
Cost per claim compared to national benchmarks
This provider bills for 12 distinct procedure codes. The top code (J1428 (Eteplirsen (Exondys 51) injection, 10 mg)) accounts for 49% of total spending.
$92.3M
4K claims
$20,923.17
$20,923.17
Eteplirsen (Exondys 51) injection, 10 mg
$92.3M
4K claims · 49.2%
$65.6M
2K claims
$31,833.01
$31,833.01
Casimersen (Amondys 45) injection, 10 mg
$65.6M
2K claims · 35.0%
$9.9M
510 claims
$19,316.97
$15,993.89
Burosumab-twza (Crysvita) injection, 1 mg
$9.9M
510 claims · 5.3%
$9.2M
8K claims · 4.9%
$4.7M
3K claims · 2.5%
$3.7M
3K claims · 2.0%
Unclassified drugs
$921K
26 claims · 0.5%
$428K
2K claims · 0.2%
$413K
4K claims · 0.2%
$186K
2K claims · 0.1%
$123K
57 claims
$2,163.12
$2,231.12
Voretigene neparvovec (Luxturna) injection
$123K
57 claims · 0.1%
$7K
313 claims · 0.0%
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