Bioreference Health LLC
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 16 procedure codes: 81539 at 1.3× median, 88307 at 2.2× 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:
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.
Compared to Clinical Medical Laboratory Peers
Total spending distribution among 88 providers in this specialty
This provider's total spending of $620.1M is at the 90th percentile among 88 Clinical Medical Laboratory providers.
Above 90th percentile for this specialty — higher spending than 79 of 88 peers
Total Paid
$620.1M
$620,067,106
Total Claims
60.8M
Beneficiaries
59.0M
1.0 claims/patient
Avg Cost/Claim
$10
#85 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Bioreference Health LLC is a Clinical Medical Laboratory provider based in Elmwood Park, NJ. From the 2018–2024 period, this provider received $620.1M in Medicaid payments across 60.8M claims.
Why This Matters
This provider received $620.1M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 77,508 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 (U0003 (Infectious disease detection (COVID-19))) accounts for 8% of total spending.
$48.0M
675K claims
$71.09
$63.08
Infectious disease detection (COVID-19)
$48.0M
675K claims · 7.7%
$33.5M
1.9M claims
$17.92
$24.95
Chlamydia detection, nucleic acid, amplified probe
$33.5M
1.9M claims · 5.4%
$32.9M
1.9M claims
$17.03
$23.39
Neisseria gonorrhoeae detection, nucleic acid, amplified probe
$32.9M
1.9M claims · 5.3%
Vitamin D, 25 hydroxy
$24.4M
1.5M claims · 3.9%
Comprehensive metabolic panel
$15.7M
2.8M claims · 2.5%
Antibody, SARS-CoV-2 (COVID-19)
$14.8M
415K claims · 2.4%
General health panel
$14.5M
767K claims · 2.3%
$14.3M
407K claims
$35.11
$26.72
Infectious agent detection, nucleic acid, not otherwise specified
$14.3M
407K claims · 2.3%
$13.9M
1.2M claims
$11.96
$18.03
HIV-1 antigen with HIV-1 and HIV-2 antibodies
$13.9M
1.2M claims · 2.2%
$13.5M
400K claims
$33.75
$38.35
Tuberculosis test, cell-mediated immunity
$13.5M
400K claims · 2.2%
$12.1M
726K claims
$16.69
$21.08
Trichomonas vaginalis detection, nucleic acid, amplified probe
$12.1M
726K claims · 2.0%
$11.9M
736K claims
$16.20
$19.06
Cytopathology, cervical or vaginal, ThinPrep
$11.9M
736K claims · 1.9%
Lipid panel
$11.8M
2.7M claims · 1.9%
$11.4M
2.3M claims
$4.93
$5.50
Hemoglobin A1c (glycated hemoglobin)
$11.4M
2.3M claims · 1.8%
$10.5M
597K claims
$17.53
$25.57
HPV detection, high-risk types, nucleic acid
$10.5M
597K claims · 1.7%
$10.0M
1.7M claims
$6.02
$9.87
Thyroid stimulating hormone (TSH)
$10.0M
1.7M claims · 1.6%
$8.6M
228K claims · 1.4%
$8.0M
552K claims
$14.40
$35.43
Drug test, presumptive, by chemistry analyzers
$8.0M
552K claims · 1.3%
$7.9M
224K claims · 1.3%
$7.8M
3.1M claims
$2.53
$4.71
Complete blood count (CBC) with differential, automated
$7.8M
3.1M claims · 1.3%
$7.6M
44K claims
$172.42
$183.31
CFTR gene analysis, common variants
$7.6M
44K claims · 1.2%
Cyanocobalamin (vitamin B-12)
$6.9M
884K claims · 1.1%
$6.7M
142K claims
$47.14
$35.80
Surgical pathology, gross and microscopic examination
$6.7M
142K claims · 1.1%
$6.6M
97K claims · 1.1%
$6.2M
23K claims · 1.0%
Hepatitis C antibody
$6.1M
901K claims · 1.0%
$5.7M
260K claims · 0.9%
$5.7M
958K claims · 0.9%
$5.7M
247K claims · 0.9%
$5.1M
96K claims · 0.8%
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