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

DHHS PHS Naihs Shiprock Hospital

General Acute Care Hospital·Shiprock, NM·NPI: 1780639971SharePrint 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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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.

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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 $491.01 per claim for 99211 (Office/outpatient visit, minimal complexity) — 38.0× the national median of $12.93.

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Bills $409.26 per claim for 99212 (Office/outpatient visit, low complexity) — 16.3× the national median of $25.06.

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Bills $527.68 per claim for 99213 (Office/outpatient visit, est. patient, low-mod complexity) — 14.0× the national median of $37.81.

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Billing in the top 1% nationally for 25 procedure codes: 99211, 99212, 99213.

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

Compared to General Acute Care Hospital Peers

Total spending distribution among 156 providers in this specialty

P25MedianP75P90

This provider's total spending of $190.6M is at the 50th percentile among 156 General Acute Care Hospital providers.

Active Billing Period:2018-01→2024-12(84 months)
Sharp billing drop in final month

Total Paid

$190.6M

$190,581,941

Total Claims

431K

Beneficiaries

329K

1.3 claims/patient

Avg Cost/Claim

$442

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

🔍 Analysis

Provider Overview

DHHS PHS Naihs Shiprock Hospital is a General Acute Care Hospital provider based in Shiprock, NM. From the 2018–2024 period, this provider received $190.6M in Medicaid payments across 431K claims.

Why This Matters

This provider received $190.6M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 23,822 Medicaid beneficiaries for a full year at average per-enrollee costs.

↑ 17% growthsince first billing year

Monthly Spending Trend

Yearly Spending

2018
$18.5M
+15%
2019
$21.4M
-8%
2020
$19.6M
+95%
2021
$38.3M
-1%
2022
$38.0M
-13%
2023
$33.1M
-34%
2024
$21.7M

Procedure Breakdown

Cost per claim compared to national benchmarks

This provider bills for 30 distinct procedure codes. The top code (99211 (Office/outpatient visit, minimal complexity)) accounts for 37% of total spending.

99211Top 1%

Office/outpatient visit, minimal complexity

$71.2M

145K claims · 37.3%

Your Cost: $491.01/claim|Median: $12.93
38.0× median
99212Top 1%

Office/outpatient visit, low complexity

$49.7M

121K claims · 26.1%

Your Cost: $409.26/claim|Median: $25.06
16.3× median
99213Top 1%

Office/outpatient visit, est. patient, low-mod complexity

$39.2M

74K claims · 20.6%

Your Cost: $527.68/claim|Median: $37.81
14.0× median
Q3014Top 1%

Telehealth originating site facility fee

$5.5M

11K claims · 2.9%

Your Cost: $519.43/claim|Median: $15.37
33.8× median
G0463Top 1%

Hospital outpatient clinic visit

$5.0M

22K claims · 2.6%

Your Cost: $221.32/claim|Median: $26.41
8.4× median
87635Top 1%

COVID-19 SARS-CoV-2 amplified probe detection

$3.6M

7K claims · 1.9%

Your Cost: $514.53/claim|Median: $39.70
13.0× median
0002ATop 1%

COVID-19 vaccine admin, Pfizer, 2nd dose

$2.1M

4K claims · 1.1%

Your Cost: $500.54/claim|Median: $36.70
13.6× median
0001ATop 1%

COVID-19 vaccine admin, Pfizer, 1st dose

$2.0M

4K claims · 1.1%

Your Cost: $490.97/claim|Median: $33.72
14.6× median
0124ATop 1%

$1.5M

3K claims · 0.8%

Your Cost: $534.19/claim|Median: $34.32
15.6× median
90480Top 1%

$1.5M

3K claims · 0.8%

Your Cost: $552.90/claim|Median: $25.29
21.9× median
0064ATop 1%

$1.4M

3K claims · 0.7%

Your Cost: $514.23/claim|Median: $34.17
15.1× median
0012ATop 1%

COVID-19 vaccine admin, Moderna, 2nd dose

$1.0M

2K claims · 0.5%

Your Cost: $485.58/claim|Median: $33.85
14.3× median
0011ATop 1%

COVID-19 vaccine admin, Moderna, 1st dose

$1.0M

2K claims · 0.5%

Your Cost: $486.10/claim|Median: $25.93
18.8× median
0054ATop 5%

$921K

2K claims · 0.5%

Your Cost: $532.88/claim|Median: $35.83
14.9× median
0004ATop 1%

$893K

2K claims · 0.5%

Your Cost: $509.52/claim|Median: $35.62
14.3× median
0071ATop 1%

$741K

1K claims · 0.4%

Your Cost: $525.31/claim|Median: $38.71
13.6× median
0134ATop 1%

$699K

1K claims · 0.4%

Your Cost: $505.66/claim|Median: $33.54
15.1× median
0072ATop 1%

$643K

1K claims · 0.3%

Your Cost: $547.97/claim|Median: $39.57
13.8× median
0003ATop 1%

COVID-19 vaccine admin, Pfizer, 3rd dose

$546K

1K claims · 0.3%

Your Cost: $466.86/claim|Median: $36.49
12.8× median
99214Normal range

Office/outpatient visit, est. patient, mod-high complexity

$163K

4K claims · 0.1%

Your Cost: $43.40/claim|Median: $53.41
0.8× median
0052ATop 5%

$127K

211 claims · 0.1%

Your Cost: $601.08/claim|Median: $37.79
15.9× median
0154ATop 1%

$124K

196 claims · 0.1%

Your Cost: $631.36/claim|Median: $39.23
16.1× median
90471Top 1%

Immunization administration, 1 vaccine, percutaneous/ID/SC/IM

$111K

502 claims · 0.1%

Your Cost: $221.59/claim|Median: $9.80
22.6× median
0031ATop 1%

COVID-19 vaccine admin, J&J, single dose

$109K

224 claims · 0.1%

Your Cost: $488.77/claim|Median: $32.49
15.0× median
51900Normal range

$109K

266 claims · 0.1%

Your Cost: $411.18/claim|Median: $277.53
1.5× median
0074ATop 1%

$108K

171 claims · 0.1%

Your Cost: $633.29/claim|Median: $39.19
16.2× median
0051ATop 5%

$88K

158 claims · 0.0%

Your Cost: $558.09/claim|Median: $36.92
15.1× median
0081ATop 1%

$76K

119 claims · 0.0%

Your Cost: $636.04/claim|Median: $38.21
16.6× median
91320Top 1%

$73K

114 claims · 0.0%

Your Cost: $642.53/claim|Median: $72.65
8.8× median
0111ATop 1%

$62K

98 claims · 0.0%

Your Cost: $630.37/claim|Median: $38.84
16.2× median

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