New York Network Ipa INC
Exclusive Provider Organization
Brooklyn, New York
NPI: 1275665457
Risk Tier
Elevated
Total Paid
$530.0M
$529,965,639
Total Claims
11.2M
Beneficiaries
5.3M
Avg Cost/Claim
$47.48
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 131 procedure codes: 99213 at 2.2× median, 99214 at 2.2× median.
Advanced Detection Signals
Billing Velocity
6040.3 claims per working day — may exceed physically possible volume for a single provider.
CUSUM Change Point
Billing shifted 3.7x in 2021-09 — a statistically significant structural change in billing behavior was detected.
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