Commonwealth of Pennsylvania Department of Education
Local Education Agency (LEA)
West Hazleton, Pennsylvania
NPI: 1245430438
Risk Tier
Critical
Total Paid
$326.0M
$326,016,792
Total Claims
13.0M
Beneficiaries
3.8M
Avg Cost/Claim
$25.14
Active billing period: 82 months (2018-01 to 2024-10)
Statistical Fraud Flags (3)
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 5 procedure codes: 97166 at 3.1× median, 96156 at 10.6× median.
High Claims Per Patient
Filing an unusually high number of claims per beneficiary compared to peers.
Spending Spike
Experienced a dramatic increase in billing over a short period.
Advanced Detection Signals
Billing Velocity
7188.4 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