Fishing Point Health Care LLC

Cost Outlier

Cost Outlier means this provider charges significantly more per claim than other providers billing the same procedure codes. This could indicate upcoding, inflated charges, or specialized services that justify higher costs.

Billing Swing

Billing Swing means this provider's total billing changed dramatically from one year to the next — increasing or decreasing by more than 200% with over $1M in absolute change. This could indicate a change in practice scope, a billing scheme ramping up, or legitimate growth.

New Entrant

New Entrant means this provider began billing Medicaid recently but is already receiving millions of dollars in payments. While some new providers legitimately grow fast (e.g., large group practices), this pattern is also common in fraud schemes that set up shell companies to bill aggressively before shutting down.

Instant Volume

Instant Volume means this provider billed over $1 million in their very first year of Medicaid participation. New providers typically ramp up gradually, so immediate high-volume billing can be a red flag.

High Cost Per Claim

High Cost Per Claim means each individual claim from this provider costs significantly more than what other providers charge for the same services. This could indicate upcoding (billing for more expensive services than provided) or legitimate specialized care.

High Claims Per Patient

High Claims Per Patient means this provider files an unusually high number of claims per individual patient. This could indicate legitimate intensive treatment or a pattern of billing for services not actually rendered.