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

Pediatric Home Respiratory Services LLC

Home Health·Roseville, MN·NPI: 1629141213SharePrint Report
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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:

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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

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Bills $1,451.79 per claim for B4153 — 3.5× the national median of $410.73.

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Bills $1,351.84 per claim for E0466 (Home ventilator, any type, used with non-invasive interface) — 4.3× the national median of $317.50.

•

Bills $141.43 per claim for A4217 (Sterile water or saline for nebulizer, per unit) — 10.8× the national median of $13.14.

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Billing in the top 1% nationally for 2 procedure codes: E0466, E0482.

This is a statistical summary, not an accusation. See our methodology.

Compared to Home Health Peers

Total spending distribution among 322 providers in this specialty

P25MedianP75P90

This provider's total spending of $197.5M is at the 50th percentile among 322 Home Health providers.

Active Billing Period:2018-01→2024-12(84 months)

Total Paid

$197.5M

$197,481,599

Total Claims

1.1M

Beneficiaries

929K

1.2 claims/patient

Avg Cost/Claim

$173

#468 of 618K providers by total spending(top <0.1%)

🔍 Analysis

Provider Overview

Pediatric Home Respiratory Services LLC is a Home Health provider based in Roseville, MN. From the 2018–2024 period, this provider received $197.5M in Medicaid payments across 1.1M claims.

Why This Matters

This provider received $197.5M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 24,685 Medicaid beneficiaries for a full year at average per-enrollee costs.

↑ 84% growthsince first billing year

Monthly Spending Trend

Yearly Spending

2018
$19.1M
+20%
2019
$23.0M
+14%
2020
$26.2M
+1%
2021
$26.4M
+14%
2022
$30.1M
+25%
2023
$37.6M
-6%
2024
$35.2M

Procedure Breakdown

Cost per claim compared to national benchmarks

This provider bills for 30 distinct procedure codes. The top code (E0465 (Home ventilator, any type, used with invasive interface)) accounts for 15% of total spending.

E0465Top 5%

Home ventilator, any type, used with invasive interface

$30.2M

24K claims · 15.3%

Your Cost: $1,263.90/claim|Median: $583.21
2.2× median
B4149Top 5%

Enteral formula, manufactured blenderized, per 100 calories

$24.5M

47K claims · 12.4%

Your Cost: $525.62/claim|Median: $300.16
1.8× median
B4035Top 5%

Enteral feeding supply kit, pump fed, per day

$19.5M

66K claims · 9.9%

Your Cost: $295.43/claim|Median: $117.24
2.5× median
B4161Normal range

Enteral formula, semisolid, 100 calories = 1 unit

$16.9M

30K claims · 8.6%

Your Cost: $555.39/claim|Median: $465.86
1.2× median
B4160Top 25%

Enteral formula, per 100 calories

$11.0M

44K claims · 5.6%

Your Cost: $247.41/claim|Median: $157.30
1.6× median
B9998Top 25%

Enteral/parenteral nutritional supplies, NOS

$10.2M

97K claims · 5.2%

Your Cost: $104.77/claim|Median: $55.51
1.9× median
B4153Top 5%

$7.7M

5K claims · 3.9%

Your Cost: $1,451.79/claim|Median: $410.73
3.5× median
B4088Top 25%

$6.6M

49K claims · 3.3%

Your Cost: $135.18/claim|Median: $73.20
1.9× median
E0466Top 1%

Home ventilator, any type, used with non-invasive interface

$6.3M

5K claims · 3.2%

Your Cost: $1,351.84/claim|Median: $317.50
4.3× median
A4606Top 10%

$4.8M

35K claims · 2.4%

Your Cost: $137.42/claim|Median: $50.63
2.7× median
A4217Top 5%

Sterile water or saline for nebulizer, per unit

$3.9M

28K claims · 2.0%

Your Cost: $141.43/claim|Median: $13.14
10.8× median
E0445Top 25%

$3.8M

18K claims · 1.9%

Your Cost: $212.74/claim|Median: $118.11
1.8× median
B9002Top 10%

$2.8M

23K claims · 1.4%

Your Cost: $122.95/claim|Median: $54.41
2.3× median
B4155Top 10%

$2.7M

11K claims · 1.4%

Your Cost: $246.51/claim|Median: $46.72
5.3× median
A7521Top 5%

$2.4M

7K claims · 1.2%

Your Cost: $350.51/claim|Median: $39.24
8.9× median
B4150Top 5%

Enteral formula, nutritionally complete with fiber, per 100 calories

$2.3M

8K claims · 1.2%

Your Cost: $278.16/claim|Median: $89.79
3.1× median
T4530Top 5%

$2.2M

14K claims · 1.1%

Your Cost: $162.66/claim|Median: $83.90
1.9× median
A4624Top 25%

$2.1M

11K claims · 1.0%

Your Cost: $181.92/claim|Median: $107.53
1.7× median
A4351Top 10%

Intermittent urinary catheter, straight tip, each

$1.8M

8K claims · 0.9%

Your Cost: $216.20/claim|Median: $116.15
1.9× median
A4605Top 5%

$1.7M

4K claims · 0.8%

Your Cost: $411.69/claim|Median: $121.51
3.4× median
T4521Top 5%

$1.6M

12K claims · 0.8%

Your Cost: $140.04/claim|Median: $81.60
1.7× median
A7520Top 10%

$1.4M

9K claims · 0.7%

Your Cost: $159.84/claim|Median: $49.59
3.2× median
A7507Top 5%

$1.3M

9K claims · 0.7%

Your Cost: $142.21/claim|Median: $59.66
2.4× median
T4534Normal range

Adult-sized disposable underpads/pads, small

$1.2M

9K claims · 0.6%

Your Cost: $128.03/claim|Median: $110.54
1.2× median
B4152Top 5%

Enteral formula, calorically dense, per 100 calories

$1.2M

5K claims · 0.6%

Your Cost: $262.17/claim|Median: $92.20
2.8× median
E0482Top 1%

$1.2M

2K claims · 0.6%

Your Cost: $598.07/claim|Median: $246.17
2.4× median
T4522Top 10%

Adult-sized disposable incontinence product, brief/diaper, above XL

$1.1M

9K claims · 0.6%

Your Cost: $128.63/claim|Median: $84.50
1.5× median
A7526Top 5%

$1.1M

13K claims · 0.6%

Your Cost: $88.79/claim|Median: $33.61
2.6× median
B4154Top 5%

$1.1M

2K claims · 0.5%

Your Cost: $538.04/claim|Median: $132.96
4.0× median
A4927Top 25%

Gloves, non-sterile, per 100

$1.0M

39K claims · 0.5%

Your Cost: $26.64/claim|Median: $12.90
2.1× median

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