Department of Health and Senior Services
Specialist
Trenton, New Jersey
NPI: 1326168840
Risk Tier
Critical
Total Paid
$1.07B
$1,073,667,311
Total Claims
3.3M
Beneficiaries
622K
Avg Cost/Claim
$324.14
Active billing period: 84 months (2018-01 to 2024-12)
Statistical Fraud Flags (4)
Cost Outlier
Billing over 3× the national median for specific procedure codes.
Bills $299.43 per claim for T1018 (School-based IEP services, per encounter), which is 7.6× the national median of $39.53.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 1 procedure codes: T1018 at 7.6× median.
Unusually High Spending
This provider's total payments are significantly above the median for their specialty.
High Cost Per Claim
Average payment per claim is much higher than peers billing the same procedures.
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