State of Alabama Department of Public Health
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $1,609.34 per claim for 81479 (Unlisted molecular pathology procedure), which is 41.6× the national median of $38.66.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 9 procedure codes: 81479 at 41.6× median, 81220 at 6.1× 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:
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.
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.
Advanced Detection Signals
Additional statistical tests from advanced fraud detection methods
These signals use advanced statistical methods including digit distribution analysis, change-point detection, and market concentration metrics. Learn more.
Risk Assessment
Bills $1,609.34 per claim for 81479 (Unlisted molecular pathology procedure) — 41.6× the national median of $38.66.
Bills $1,113.98 per claim for 81220 (CFTR gene analysis, common variants) — 6.1× the national median of $183.31.
Bills $21.55 per claim for 82379 — 3.2× the national median of $6.76.
Billing in the top 1% nationally for 3 procedure codes: 81479, 81220, 82775.
This is a statistical summary, not an accusation. See our methodology.
Compared to Clinical Medical Laboratory Peers
Total spending distribution among 88 providers in this specialty
This provider's total spending of $373.6M is at the 75th percentile among 88 Clinical Medical Laboratory providers.
Total Paid
$373.6M
$373,629,555
Total Claims
4.7M
Beneficiaries
4.0M
1.2 claims/patient
Avg Cost/Claim
$79
#176 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
State of Alabama Department of Public Health is a Clinical Medical Laboratory provider based in Prattville, AL. From the 2018–2024 period, this provider received $373.6M in Medicaid payments across 4.7M claims.
Important Context
- ℹ️This is a government entity that may serve as a fiscal agent for large populations. Government providers often bill at high volumes due to the scale of public programs they administer.
Why This Matters
This provider received $373.6M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 46,703 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 (81479 (Unlisted molecular pathology procedure)) accounts for 72% of total spending.
$267.7M
166K claims
$1,609.34
$38.66
Unlisted molecular pathology procedure
$267.7M
166K claims · 71.7%
$11.3M
10K claims
$1,113.98
$183.31
CFTR gene analysis, common variants
$11.3M
10K claims · 3.0%
$11.2M
323K claims · 3.0%
$9.9M
250K claims
$39.65
$38.79
Infectious agent detection, amplified probe, multiple organisms
$9.9M
250K claims · 2.6%
$8.7M
323K claims · 2.3%
$7.0M
323K claims · 1.9%
$7.0M
323K claims · 1.9%
$7.0M
323K claims · 1.9%
$7.0M
323K claims · 1.9%
Thyroid stimulating hormone (TSH)
$6.9M
324K claims · 1.9%
$5.5M
66K claims · 1.5%
$5.3M
323K claims · 1.4%
$4.3M
190K claims · 1.2%
$3.1M
323K claims · 0.8%
$2.7M
323K claims · 0.7%
$2.5M
156K claims
$15.81
$18.03
HIV-1 antigen with HIV-1 and HIV-2 antibodies
$2.5M
156K claims · 0.7%
$1.9M
163K claims · 0.5%
$1.5M
249K claims
$5.85
$21.08
Trichomonas vaginalis detection, nucleic acid, amplified probe
$1.5M
249K claims · 0.4%
$1.3M
77K claims · 0.3%
$1.2M
72K claims · 0.3%
$432K
31K claims · 0.1%
$74K
3K claims · 0.0%
$65K
3K claims
$22.30
$51.73
HIV-1 detection by nucleic acid, quantitative
$65K
3K claims · 0.0%
$30K
8K claims · 0.0%
$27K
1K claims · 0.0%
$25K
7K claims · 0.0%
$13K
3K claims
$4.63
$4.71
Complete blood count (CBC) with differential, automated
$13K
3K claims · 0.0%
$11K
3K claims · 0.0%
$8K
5K claims · 0.0%
$8K
2K claims
$3.54
$5.31
Urine culture, colony count, with identification
$8K
2K claims · 0.0%
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