Statistical flags indicate unusual patterns — not proof of fraud or wrongdoing. Read our methodology

Ideal Option, PLLC

Preventive Medicine, Addiction Medicine·Pasco, WA·NPI: 1457788275SharePrint Report
View on Risk Watchlist →

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:

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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.

Risk Assessment

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Bills $540.63 per claim for H0001 (Alcohol and/or drug assessment) — 5.7× the national median of $94.22.

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Bills $30.75 per claim for 80361 — 4.1× the national median of $7.53.

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Bills $23.56 per claim for 80348 — 3.5× the national median of $6.63.

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Billing in the top 1% nationally for 1 procedure code: H0001.

This is a statistical summary, not an accusation. See our methodology.

Active Billing Period:2018-01→2024-12(84 months)

Total Paid

$259.1M

$259,128,732

Total Claims

3.9M

Beneficiaries

2.7M

1.5 claims/patient

Avg Cost/Claim

$67

#321 of 618K providers by total spending(top <0.1%)

🔍 Analysis

Provider Overview

Ideal Option, PLLC is a Preventive Medicine, Addiction Medicine provider based in Pasco, WA. From the 2018–2024 period, this provider received $259.1M in Medicaid payments across 3.9M claims.

Why This Matters

This provider received $259.1M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 32,391 Medicaid beneficiaries for a full year at average per-enrollee costs.

↑ 14% growthsince first billing year

Monthly Spending Trend

Yearly Spending

2018
$29.4M
+28%
2019
$37.6M
-1%
2020
$37.4M
+8%
2021
$40.2M
+1%
2022
$40.7M
-1%
2023
$40.3M
-17%
2024
$33.5M

Procedure Breakdown

Cost per claim compared to national benchmarks

This provider bills for 30 distinct procedure codes. The top code (99214 (Office/outpatient visit, est. patient, mod-high complexity)) accounts for 26% of total spending.

99214Top 25%

Office/outpatient visit, est. patient, mod-high complexity

$66.4M

694K claims · 25.6%

Your Cost: $95.66/claim|Median: $53.41
1.8× median
80307Top 25%

Drug test, presumptive, by chemistry analyzers

$49.2M

887K claims · 19.0%

Your Cost: $55.47/claim|Median: $35.43
1.6× median
G0482Top 25%

Drug test, definitive, 15-21 drug classes

$38.4M

281K claims · 14.8%

Your Cost: $136.65/claim|Median: $75.26
1.8× median
99213Top 25%

Office/outpatient visit, est. patient, low-mod complexity

$14.8M

230K claims · 5.7%

Your Cost: $64.68/claim|Median: $37.81
1.7× median
G0481Top 10%

Drug test, definitive, 8-14 drug classes

$13.4M

107K claims · 5.2%

Your Cost: $125.03/claim|Median: $64.72
1.9× median
99215Top 10%

Office/outpatient visit, high complexity

$12.6M

83K claims · 4.9%

Your Cost: $151.68/claim|Median: $74.09
2.0× median
H0016Normal range

Alcohol or drug abuse services, prenatal

$12.3M

97K claims · 4.8%

Your Cost: $126.78/claim|Median: $182.66
0.7× median
G0480Top 10%

Drug test, definitive, 1-7 drug classes

$11.1M

116K claims · 4.3%

Your Cost: $96.13/claim|Median: $37.56
2.6× median
82075Top 25%

Alcohol (ethanol) breath test

$11.1M

500K claims · 4.3%

Your Cost: $22.13/claim|Median: $16.59
1.3× median
Q3014Top 25%

Telehealth originating site facility fee

$8.2M

357K claims · 3.2%

Your Cost: $23.11/claim|Median: $15.37
1.5× median
H0001Top 1%

Alcohol and/or drug assessment

$6.5M

12K claims · 2.5%

Your Cost: $540.63/claim|Median: $94.22
5.7× median
G0483Top 25%

Drug test, definitive, 22+ drug classes

$5.0M

34K claims · 1.9%

Your Cost: $143.82/claim|Median: $90.89
1.6× median
99205Top 25%

Office/outpatient visit, new patient, high complexity

$2.1M

13K claims · 0.8%

Your Cost: $166.55/claim|Median: $111.09
1.5× median
80361Top 5%

$628K

20K claims · 0.2%

Your Cost: $30.75/claim|Median: $7.53
4.1× median
87491Normal range

Chlamydia detection, nucleic acid, amplified probe

$495K

15K claims · 0.2%

Your Cost: $32.66/claim|Median: $24.95
1.3× median
80346Top 5%

$493K

20K claims · 0.2%

Your Cost: $24.19/claim|Median: $8.14
3.0× median
80348Top 10%

$489K

21K claims · 0.2%

Your Cost: $23.56/claim|Median: $6.63
3.5× median
80354Top 5%

$482K

20K claims · 0.2%

Your Cost: $23.53/claim|Median: $5.61
4.2× median
87591Top 25%

Neisseria gonorrhoeae detection, nucleic acid, amplified probe

$456K

14K claims · 0.2%

Your Cost: $32.44/claim|Median: $23.39
1.4× median
80324Top 10%

$389K

20K claims · 0.2%

Your Cost: $19.08/claim|Median: $6.08
3.1× median
80362Top 5%

$380K

17K claims · 0.1%

Your Cost: $22.91/claim|Median: $5.83
3.9× median
80365Top 5%

$376K

16K claims · 0.1%

Your Cost: $23.07/claim|Median: $5.24
4.4× median
81025Normal range

Urine pregnancy test

$364K

61K claims · 0.1%

Your Cost: $5.97/claim|Median: $4.81
1.2× median
80358Top 5%

$348K

15K claims · 0.1%

Your Cost: $23.30/claim|Median: $5.06
4.6× median
87661Top 25%

Trichomonas vaginalis detection, nucleic acid, amplified probe

$338K

10K claims · 0.1%

Your Cost: $32.45/claim|Median: $21.08
1.5× median
80074Normal range

$280K

7K claims · 0.1%

Your Cost: $38.10/claim|Median: $27.54
1.4× median
80345Top 5%

Drug assay for barbiturates

$247K

11K claims · 0.1%

Your Cost: $21.68/claim|Median: $5.19
4.2× median
87389Normal range

HIV-1 antigen with HIV-1 and HIV-2 antibodies

$184K

9K claims · 0.1%

Your Cost: $21.21/claim|Median: $18.03
1.2× median
H0047Top 10%

Alcohol and/or drug abuse, not otherwise specified

$157K

335 claims · 0.1%

Your Cost: $467.62/claim|Median: $81.37
5.8× median
80353Top 5%

Benzodiazepine drug level, definitive method, each

$148K

8K claims · 0.1%

Your Cost: $19.63/claim|Median: $5.26
3.7× median

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