Multi-Method Detection: Providers Flagged by Multiple Independent Systems
These providers were flagged by multiple independent detection systems — statistical tests, Benford's Law, billing velocity analysis, and change point detection. When different approaches all point to the same provider, the probability of a false positive drops dramatically. This is our highest-confidence list.
246
Multi-method flags
43.7
Top composite score
30
Flagged by 3+ methods
$23.87B
Top 50 spending
Why Multi-Method Detection Matters
Any single fraud detection method has limitations. Statistical tests can flag legitimate outliers. Benford's Law can misfire on providers with standardized fee schedules. Velocity checks may catch providers who genuinely expanded services. But when two or three independent methods all flag the same provider, something unusual is almost certainly happening.
If one test has a 10% false positive rate and another independent test also has a 10% false positive rate, the chance both would flag the same innocent provider is just 1%. Add a third independent method and the probability of a triple false positive drops to 0.1%. This is the power of multi-method detection.
Detection Methods in This Dataset
Top 20 Highest Composite Scores
NPI: 1275197055 · Transportation Broker · Lombard, IL
43.7
composite
NPI: 1396049987 · Case Management · New York, NY
40.0
composite
NPI: 1366780850 · Case Management · New York, NY
40.0
composite
NPI: 1194832477 · General Acute Care Hospital · New York, NY
40.0
composite
NPI: 1477643690 · General Acute Care Hospital Children · Houston, TX
40.0
composite
NPI: 1952476988 · General Acute Care Hospital · Bronx, NY
40.0
composite
NPI: 1437156635 · Psychologist Intellectual & Developmental Disabilities · New Castle, DE
38.8
composite
NPI: 1730369760 · Community Based Residential Treatment Facility Intellectual and/or Developmental Disabilities · Brooklyn, NY
38.5
composite
NPI: 1376554592 · Ambulance · Chicago, IL
36.1
composite
NPI: 1780621904 · Obstetrics & Gynecology · St Louis Park, MN
36.0
composite
NPI: 1730451071 · Case Management · New York, NY
35.5
composite
NPI: 1811062763 · Health Maintenance Organization · Rockville, MD
35.4
composite
NPI: 1417349622 · Case Manager/Care Coordinator · New York, NY
34.0
composite
NPI: 1700120888 · Case Management · Brooklyn, NY
34.0
composite
NPI: 1891765178 · General Acute Care Hospital Children · Fort Worth, TX
33.8
composite
NPI: 1639138480 · Pediatrics · Hollywood, FL
33.5
composite
NPI: 1457601965 · Non-emergency Medical Transport (VAN) · Pasadena, CA
33.4
composite
NPI: 1679525919 · General Acute Care Hospital · Cleveland, OH
33.3
composite
NPI: 1770795536 · Case Management · Jackson, MS
32.7
composite
NPI: 1851726731 · Clinical Medical Laboratory · Teterboro, NJ
30.0
composite
Most Common Method Combinations
The provider with the highest composite score of 43.7 was flagged by 3 independent methods simultaneously. Of the 246 multi-method providers, 30 were flagged by 3 or more independent systems — these are the cases where the probability of a coincidental false positive is lowest.
The Independence Principle
The key to this approach is that each detection method operates independently. Statistical tests look at cost-per-claim ratios. Change point detection analyzes billing trends over time. Benford's Law examines leading digit distributions. Velocity checks count daily claim volume. Because these methods use different features and mathematical frameworks, their errors are uncorrelated — agreement between them is highly meaningful.
The most common combination is Statistical + Velocity, appearing in 96 providers. This makes sense: a provider who bills at unusually high rates (caught by statistical tests) and whose billing behavior suddenly shifted (caught by change point detection) presents a consistent pattern of anomalous behavior across two different dimensions.
Important Caveat
Even multi-method flags are not proof of fraud. A provider that legitimately expanded into a new service area might trigger both velocity and change point flags. A new clinic growing rapidly could trigger statistical outlier and billing swing flags simultaneously. These flags identify the cases most worth investigating — not cases where guilt is established. All providers are presumed innocent until proven otherwise through proper investigation.
Top 50 Multi-Method Providers
| # | Provider | Score | Methods | Detection Flags |
|---|---|---|---|---|
| 1 | Intelliride LLC$297.9M | 43.7 | 3 | StatisticalVelocityChange Point |
| 2 | Community Assistance Resources & Extended Services INC$1.04B | 40.0 | 2 | StatisticalChange Point |
| 3 | Community Care Management Partners LLC (ccmp)$247.2M | 40.0 | 2 | StatisticalChange Point |
| 4 | The New York and Presbyterian Hospital$454.9M | 40.0 | 2 | StatisticalVelocity |
| 5 | Texas Children's Hospital$277.3M | 40.0 | 2 | StatisticalChange Point |
| 6 | Montefiore Medical Center$961.1M | 40.0 | 2 | StatisticalVelocity |
| 7 | Easter Seals Delaware & Marylands Eastern Shore INC$315.9M | 38.8 | 2 | StatisticalChange Point |
| 8 | Human Care Services for Families and Children INC$203.8M | 38.5 | 2 | StatisticalChange Point |
| 9 | City of Chicago$1.23B | 36.1 | 2 | StatisticalChange Point |
| 10 | Park Nicollet Clinic$209.7M | 36.0 | 3 | StatisticalVelocityChange Point |
| 11 | Coordinated Behavioral Care INC$407.2M | 35.5 | 2 | StatisticalChange Point |
| 12 | Mid Atlantic Pemanente Medical Group$317.6M | 35.4 | 3 | StatisticalVelocityChange Point |
| 13 | The Collaborative for Children and Families$347.3M | 34.0 | 2 | StatisticalChange Point |
| 14 | Hamaspik of Kings County Inc.$295.4M | 34.0 | 2 | StatisticalChange Point |
| 15 | Cook Children's Medical Center$286.7M | 33.8 | 2 | StatisticalChange Point |
| 16 | Saltzman Tanis Pittell Levin and Jacobson$201.3M | 33.5 | 3 | StatisticalVelocityChange Point |
| 17 | Call the Car$723.9M | 33.4 | 3 | StatisticalVelocityChange Point |
| 18 | The Cleveland Clinic Foundation$863.5M | 33.3 | 3 | StatisticalVelocityChange Point |
| 19 | Mississippi Department of Rehabilitaion Svs$317.2M | 32.7 | 2 | StatisticalBenford's Law |
| 20 | Infinity Diagnostics Laboratory INC$138.0M | 30.0 | 3 | StatisticalVelocityChange Point |
| 21 | Texas Department of State Health$381.9M | 30.0 | 2 | StatisticalChange Point |
| 22 | University of Kentucky$716.4M | 30.0 | 2 | StatisticalVelocity |
| 23 | Rector & Visitors of the University of Virginia$500.5M | 30.0 | 2 | StatisticalVelocity |
| 24 | Medical Transportation Management Inc.$38.4M | 30.0 | 2 | StatisticalVelocity |
| 25 | Children's Health System of Texas$263.8M | 30.0 | 2 | StatisticalChange Point |
| 26 | Children's Hospital Medical Center of Akron$556.6M | 30.0 | 2 | StatisticalVelocity |
| 27 | New York Psychotherapy and Counseling Center$304.0M | 30.0 | 2 | StatisticalChange Point |
| 28 | Topcare Medical Group INC$160.4M | 30.0 | 3 | StatisticalVelocityChange Point |
| 29 | County of San Bernardino$1.05B | 30.0 | 2 | StatisticalVelocity |
| 30 | New England Emergency Response Systems INC$264.1M | 30.0 | 2 | StatisticalVelocity |
| 31 | Yale New Haven Hospital$1.08B | 30.0 | 2 | StatisticalVelocity |
| 32 | Boston Medical Center Corporation$768.5M | 30.0 | 2 | StatisticalVelocity |
| 33 | City & County of San Francisco$1.34B | 30.0 | 2 | StatisticalVelocity |
| 34 | Beth Israel Medical Center$278.7M | 30.0 | 2 | StatisticalChange Point |
| 35 | Baystate Medical Center INC$374.5M | 30.0 | 2 | StatisticalVelocity |
| 36 | Quest Diagnostics Clinical Laboratories INC$197.6M | 30.0 | 2 | StatisticalVelocity |
| 37 | County of Riverside$1.40B | 30.0 | 2 | StatisticalVelocity |
| 38 | Virginia Commonwealth University Health System Authority$658.5M | 30.0 | 2 | StatisticalVelocity |
| 39 | Norton Hospitals, INC$299.0M | 30.0 | 2 | StatisticalChange Point |
| 40 | Brightview LLC$501.1M | 30.0 | 2 | StatisticalVelocity |
| 41 | Advance Hi-tech Nursing Inc.$399.8M | 30.0 | 3 | StatisticalVelocityChange Point |
| 42 | New England Home Care Inc.$400.1M | 30.0 | 2 | StatisticalVelocity |
| 43 | Daybreak Community Services Texas LLC$243.2M | 30.0 | 2 | StatisticalChange Point |
| 44 | New York City Health and Hospitals Corporation$217.7M | 30.0 | 2 | StatisticalChange Point |
| 45 | The Metrohealth System$574.1M | 30.0 | 2 | StatisticalVelocity |
| 46 | Legacy Community Health Services, INC$406.5M | 30.0 | 2 | StatisticalChange Point |
| 47 | Hennepin Healthcare System INC$708.9M | 30.0 | 2 | StatisticalVelocity |
| 48 | Group Health Plan, Inc.$204.3M | 30.0 | 2 | StatisticalVelocity |
| 49 | St Lukes Roosevelt Hospital Center$190.5M | 30.0 | 2 | StatisticalChange Point |
| 50 | Chartwell Community Services Inc.$253.4M | 30.0 | 3 | StatisticalVelocityChange Point |
Key Takeaways
- ▸246 providers were flagged by 2 or more independent detection systems, making them the highest-confidence anomalies in our dataset.
- ▸30 providers were flagged by 3+ methods — the probability of a triple false positive in independent tests is extremely low.
- ▸The most common combination is Statistical + Velocity, found in 96 providers.
- ▸The top 50 multi-method providers account for $23.87B in total Medicaid spending.
- ▸Multi-method flags are the strongest signal available, but they are still screening results — not verdicts. Each case requires individual review.
Source: HHS T-MSIS Other Services File (2018–2024) · 227M records