Texas Department of State Health
Clinical Medical Laboratory
Austin, Texas
NPI: 1114931391
Risk Tier
Critical
Total Paid
$381.9M
$381,851,367
Total Claims
2.7M
Beneficiaries
2.3M
Avg Cost/Claim
$140.90
Active billing period: 84 months (2018-01 to 2024-12)
Statistical Fraud Flags (5)
Cost Outlier
Billing over 3× the national median for specific procedure codes.
Bills $279.70 per claim for S3620 (Newborn metabolic screening panel), which is 23.7× the national median of $11.82.
Billing Swing
Experienced over 200% change in year-over-year billing with >$1M absolute change.
Billing changed from $10.1M (2019) to $73.8M (2020) — a 632% swing with $63.8M absolute change.
Explosive Growth
Billing increased over 500% year-over-year — far beyond normal growth patterns.
Billing grew 632% from 2019 to 2020.
High Cost Per Claim
Average payment per claim is much higher than peers billing the same procedures.
Spending Spike
Experienced a dramatic increase in billing over a short period.
Advanced Detection Signals
CUSUM Change Point
Billing shifted 35.6x in 2019-11 — a statistically significant structural change in billing behavior was detected.
Disclaimer: Statistical flags indicate unusual billing patterns — they are not proof of fraud or wrongdoing. Some entities (government agencies, home care programs, hospitals) may legitimately bill at higher rates due to patient acuity, overhead costs, or specialized services. This report is generated from public HHS data and statistical analysis only. No clinical or investigative review has been performed.
Generated by OpenMedicaid | openmedicaid.org | Data: HHS 2018-2024