New York Network Ipa INC
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 131 procedure codes: 99213 at 2.2× median, 99214 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.
Risk Assessment
Bills $129.26 per claim for 77067 (Screening mammography, bilateral, including CAD) — 3.3× the national median of $39.33.
Bills $169.64 per claim for 93306 (Echocardiography, transthoracic, complete, with Doppler) — 3.1× the national median of $54.68.
Bills $161.37 per claim for 93880 — 3.3× the national median of $49.03.
Billing above the 90th percentile for 12 procedure codes simultaneously.
This is a statistical summary, not an accusation. See our methodology.
Total Paid
$530.0M
$529,965,639
Total Claims
11.2M
Beneficiaries
5.3M
2.1 claims/patient
Avg Cost/Claim
$47
#112 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
New York Network Ipa INC is a Exclusive Provider Organization provider based in Brooklyn, NY. From the 2018–2024 period, this provider received $530.0M in Medicaid payments across 11.2M claims.
Why This Matters
This provider received $530.0M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 66,245 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 19% of total spending.
$99.1M
1.4M claims
$70.49
$63.08
Infectious disease detection (COVID-19)
$99.1M
1.4M claims · 18.7%
$46.1M
553K claims
$83.33
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$46.1M
553K claims · 8.7%
Therapeutic activities, each 15 min
$35.4M
531K claims · 6.7%
$34.7M
1.4M claims
$24.32
$12.93
Office/outpatient visit, minimal complexity
$34.7M
1.4M claims · 6.6%
$33.0M
1.4M claims
$23.51
$15.76
Infectious disease detection, COVID-19, antigen
$33.0M
1.4M claims · 6.2%
$20.4M
671K claims
$30.38
$24.49
Therapeutic exercises, each 15 min
$20.4M
671K claims · 3.8%
$18.8M
162K claims
$116.04
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$18.8M
162K claims · 3.5%
$15.8M
122K claims
$129.26
$39.33
Screening mammography, bilateral, including CAD
$15.8M
122K claims · 3.0%
Psychotherapy, 60 minutes
$14.9M
114K claims · 2.8%
$13.6M
482K claims
$28.13
$20.04
Therapeutic procedure, neuromuscular reeducation, per 15 minutes
$13.6M
482K claims · 2.6%
Speech/hearing/language treatment
$13.1M
179K claims · 2.5%
$12.7M
218K claims
$58.38
$25.06
Office/outpatient visit, low complexity
$12.7M
218K claims · 2.4%
$12.1M
575K claims
$21.12
$16.79
Manual therapy techniques, per 15 minutes
$12.1M
575K claims · 2.3%
Ultrasound, abdominal, complete
$9.1M
87K claims · 1.7%
$8.5M
78K claims · 1.6%
$8.2M
81K claims
$101.28
$57.85
Office/outpatient visit, new patient, low-mod complexity
$8.2M
81K claims · 1.6%
Psychotherapy, 45 minutes
$5.7M
65K claims · 1.1%
$5.2M
102K claims
$50.67
$21.41
Screening digital breast tomosynthesis, bilateral
$5.2M
102K claims · 1.0%
Ultrasound, transvaginal
$4.0M
35K claims · 0.8%
$3.8M
120K claims
$31.60
$39.70
COVID-19 SARS-CoV-2 amplified probe detection
$3.8M
120K claims · 0.7%
$3.6M
34K claims · 0.7%
$3.5M
24K claims
$147.80
$84.03
Office/outpatient visit, new patient, mod-high complexity
$3.5M
24K claims · 0.7%
$3.4M
17K claims
$195.49
$79.28
Duplex scan of arterial inflow and venous outflow, complete
$3.4M
17K claims · 0.6%
Ultrasound, pelvic, complete
$2.6M
29K claims · 0.5%
$2.5M
15K claims
$169.64
$54.68
Echocardiography, transthoracic, complete, with Doppler
$2.5M
15K claims · 0.5%
$2.3M
43K claims · 0.4%
$2.3M
54K claims
$41.60
$30.04
SARS-CoV-2 COVID-19 antigen detection, immunoassay
$2.3M
54K claims · 0.4%
$2.1M
29K claims
$73.74
$40.11
Office/outpatient visit, new patient, low complexity
$2.1M
29K claims · 0.4%
$2.1M
13K claims · 0.4%
$2.0M
17K claims
$119.99
$47.08
Ophthalmological exam, comprehensive, established patient
$2.0M
17K claims · 0.4%