DHHS PHS Naihs Shiprock Hospital
General Acute Care Hospital
Shiprock, New Mexico
NPI: 1780639971
Risk Tier
High
Total Paid
$190.6M
$190,581,941
Total Claims
431K
Beneficiaries
329K
Avg Cost/Claim
$442.47
Active billing period: 84 months (2018-01 to 2024-12)
Statistical Fraud Flags (2)
Cost Outlier
Billing over 3× the national median for specific procedure codes.
Bills $491.01 per claim for 99211 (Office/outpatient visit, minimal complexity), which is 38.0× the national median of $12.93.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 45 procedure codes: 99211 at 38.0× median, 99212 at 16.3× median.
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