Statistical flags indicate unusual patterns — not proof of fraud or wrongdoing. Read our methodology

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Non-emergency Medical Transport (VAN)

Pasadena, California

NPI: 1457601965

Risk Tier

Critical

Total Paid

$723.9M

$723,937,837

Total Claims

26.6M

Beneficiaries

3.4M

Avg Cost/Claim

$27.21

Active billing period: 73 months (2018-02 to 2024-12)

Statistical Fraud Flags (5)

Cost Outlier

Billing over 3× the national median for specific procedure codes.

Bills $81.78 per claim for A0380 (BLS mileage, per mile), which is 4.0× the national median of $20.61.

Rate Outlier

Billing above the 90th percentile across multiple procedure codes simultaneously.

Billing above the 90th percentile for 6 procedure codes: A0390 at 4.2× median, A0428 at 3.4× 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.

Spending Spike

Experienced a dramatic increase in billing over a short period.

Advanced Detection Signals

Billing Velocity

16566.7 claims per working day — may exceed physically possible volume for a single provider.

CUSUM Change Point

Billing shifted 3.4x in 2023-02 — 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