Presbyterian Healthcare Services
Surgery
Albuquerque, New Mexico
NPI: 1104802354
Risk Tier
Elevated
Total Paid
$240.2M
$240,239,259
Total Claims
4.0M
Beneficiaries
3.7M
Avg Cost/Claim
$60.13
Active billing period: 84 months (2018-01 to 2024-12)
Statistical Fraud Flags (1)
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 64 procedure codes: 99391 at 1.5× median, 99232 at 2.1× 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