Presbyterian Healthcare Services
Emergency Medicine
Albuquerque, New Mexico
NPI: 1215913470
Risk Tier
Elevated
Total Paid
$345.5M
$345,535,538
Total Claims
6.8M
Beneficiaries
6.1M
Avg Cost/Claim
$50.85
Active billing period: 84 months (2018-01 to 2024-12)
Statistical Fraud Flags (1)
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 172 procedure codes: 99285 at 2.8× median, 99284 at 2.6× median.
Advanced Detection Signals
Billing Velocity
3676.9 claims per working day — may exceed physically possible volume for a single provider.
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