Optum Medical Care of New Jersey PC
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 22 procedure codes: 92552 at 2.3× median, 90792 at 2.3× median.
Statistical flags are not proof of wrongdoing. Some entities (government agencies, home care programs) may legitimately bill at high rates. Hospitals, government entities, and large care organizations may legitimately bill at higher rates due to patient acuity, overhead costs, or specialized services. Read our methodology.
Red Flags Explained
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Each flag represents a statistical test that identified unusual billing patterns. Here's what each flag on this provider means in plain English:
Rate Outlier
Rate Outlier means this provider charges above the 90th percentile for multiple different procedure codes simultaneously. While one high-cost code could reflect specialization, consistently high rates across many codes may indicate systematic overbilling.
These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.
Risk Assessment
Bills $147.71 per claim for 93970 (Duplex scan of extremity veins, complete, bilateral) — 3.4× the national median of $43.07.
Bills $22.22 per claim for 90461 (Immunization admin, additional vaccine, counseling) — 3.2× the national median of $6.93.
Billing above the 90th percentile for 2 procedure codes simultaneously.
This is a statistical summary, not an accusation. See our methodology.
Compared to Durable Medical Equipment & Medical Supplies Peers
Total spending distribution among 35 providers in this specialty
This provider's total spending of $218.8M is at the 50th percentile among 35 Durable Medical Equipment & Medical Supplies providers.
Total Paid
$218.8M
$218,818,427
Total Claims
4.3M
Beneficiaries
3.9M
1.1 claims/patient
Avg Cost/Claim
$51
#392 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Optum Medical Care of New Jersey PC is a Durable Medical Equipment & Medical Supplies provider based in Secaucus, NJ. From the 2018–2024 period, this provider received $218.8M in Medicaid payments across 4.3M claims.
Why This Matters
This provider received $218.8M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 27,352 Medicaid beneficiaries for a full year at average per-enrollee costs.
Monthly Spending Trend
Yearly Spending
Procedure Breakdown
Cost per claim compared to national benchmarks
This provider bills for 30 distinct procedure codes. The top code (99214 (Office/outpatient visit, est. patient, mod-high complexity)) accounts for 30% of total spending.
$65.2M
810K claims
$80.51
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$65.2M
810K claims · 29.8%
$54.1M
919K claims
$58.87
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$54.1M
919K claims · 24.7%
$6.1M
48K claims
$128.12
$84.03
Office/outpatient visit, new patient, mod-high complexity
$6.1M
48K claims · 2.8%
$5.8M
216K claims
$26.67
$17.85
Immunization administration, first vaccine/toxoid, with counseling
$5.8M
216K claims · 2.6%
$4.9M
51K claims
$96.79
$74.82
Preventive medicine, established patient, age 5-11
$4.9M
51K claims · 2.3%
$4.7M
110K claims
$42.97
$39.70
COVID-19 SARS-CoV-2 amplified probe detection
$4.7M
110K claims · 2.2%
$4.5M
46K claims
$96.66
$75.18
Preventive medicine, established patient, age 1-4
$4.5M
46K claims · 2.0%
$4.1M
26K claims
$158.31
$54.68
Echocardiography, transthoracic, complete, with Doppler
$4.1M
26K claims · 1.9%
$3.7M
43K claims
$86.28
$57.85
Office/outpatient visit, new patient, low-mod complexity
$3.7M
43K claims · 1.7%
$3.6M
35K claims
$104.98
$80.15
Preventive medicine, established patient, age 12-17
$3.6M
35K claims · 1.7%
$2.8M
32K claims
$88.08
$69.35
Preventive medicine, established patient, infant (under 1)
$2.8M
32K claims · 1.3%
$2.6M
12K claims
$208.25
$205.41
Foot insert, removable, molded to patient model
$2.6M
12K claims · 1.2%
$2.5M
24K claims
$102.07
$72.71
Preventive medicine, established patient, age 18-39
$2.5M
24K claims · 1.1%
$2.4M
23K claims
$107.12
$76.06
Preventive medicine, established patient, age 40-64
$2.4M
23K claims · 1.1%
$2.4M
224K claims
$10.71
$11.48
Streptococcus, Group A, rapid antigen detection
$2.4M
224K claims · 1.1%
$2.4M
65K claims
$36.68
$25.06
Office/outpatient visit, low complexity
$2.4M
65K claims · 1.1%
Upper GI endoscopy with biopsy
$2.4M
9K claims · 1.1%
$2.1M
4K claims
$557.96
$233.73
Polysomnography, sleep study, 6+ hours
$2.1M
4K claims · 1.0%
$2.1M
13K claims
$165.25
$121.58
Office or other outpatient consultation, moderate complexity
$2.1M
13K claims · 1.0%
$2.0M
7K claims
$304.10
$106.14
Myocardial perfusion imaging, SPECT, multiple studies
$2.0M
7K claims · 0.9%
$1.7M
60K claims
$28.82
$12.63
Pure tone audiometry, air only, each ear
$1.7M
60K claims · 0.8%
$1.7M
123K claims
$13.43
$12.59
Influenza virus detection, rapid test
$1.7M
123K claims · 0.8%
$1.6M
6K claims
$254.54
$108.91
Psychiatric diagnostic evaluation with medical services
$1.6M
6K claims · 0.7%
Colonoscopy with biopsy
$1.5M
5K claims · 0.7%
$1.3M
9K claims
$147.71
$43.07
Duplex scan of extremity veins, complete, bilateral
$1.3M
9K claims · 0.6%
$1.2M
55K claims
$22.22
$6.93
Immunization admin, additional vaccine, counseling
$1.2M
55K claims · 0.6%
$1.0M
36K claims
$28.99
$23.99
Subsequent hospital care, per day, moderate complexity
$1.0M
36K claims · 0.5%
Psychotherapy, 30 minutes
$953K
16K claims · 0.4%
$905K
8K claims
$109.87
$82.43
Office or other outpatient consultation, low complexity
$905K
8K claims · 0.4%
$872K
9K claims
$94.03
$74.09
Office/outpatient visit, high complexity
$872K
9K claims · 0.4%
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