State of Oklahoma Dept of Human Services
Case Management
Oklahoma City, Oklahoma
NPI: 1265529168
Risk Tier
Critical
Total Paid
$224.5M
$224,454,102
Total Claims
493K
Beneficiaries
455K
Avg Cost/Claim
$454.93
Active billing period: 82 months (2018-01 to 2024-10)
Statistical Fraud Flags (4)
Cost Outlier
Billing over 3× the national median for specific procedure codes.
Bills $454.93 per claim for G9012 (Other specified case management service, per 15 minutes), which is 3.3× the national median of $137.85.
Single-Code
Billing almost exclusively for 1-2 procedure codes despite high total volume.
Bills primarily for code G9012 (1 unique codes).
High Cost Per Claim
Average payment per claim is much higher than peers billing the same procedures.
Spending Spike
Experienced a dramatic increase in billing over a short period.
Advanced Detection Signals
CUSUM Change Point
Billing shifted 0.2x in 2024-03 — a statistically significant structural change in billing behavior was detected.
Suspicious Concentration
Herfindahl-Hirschman Index of 1 across 1 procedure codes — billing is highly concentrated in very few services.
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