Pyramid Health Care Inc.
Billing Swing
Experienced over 200% change in year-over-year billing with >$1M absolute change.
Billing changed from $7.1M (2021) to $28.5M (2022) — a 301% swing with $21.4M absolute change.
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:
Billing Swing
Billing Swing means this provider's total billing changed dramatically from one year to the next — increasing or decreasing by more than 200% with over $1M in absolute change. This could indicate a change in practice scope, a billing scheme ramping up, or legitimate growth.
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 Substance Abuse Rehabilitation Facility Peers
Total spending distribution among 20 providers in this specialty
This provider's total spending of $128.8M is at the 75th percentile among 20 Substance Abuse Rehabilitation Facility providers.
Total Paid
$128.8M
$128,752,810
Total Claims
423K
Beneficiaries
39K
10.9 claims/patient
Avg Cost/Claim
$305
#907 of 618K providers by total spending(top 0.1%)
🔍 Analysis
Provider Overview
Pyramid Health Care Inc. is a Substance Abuse Rehabilitation Facility provider based in Wilkinsburg, PA. From the 2018–2024 period, this provider received $128.8M in Medicaid payments across 423K claims.
Why This Matters
This provider received $128.8M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 16,094 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 4 distinct procedure codes. The top code (H2036 (Alcohol/drug treatment, per hour)) accounts for 79% of total spending.
$101.6M
343K claims
$295.92
$253.79
Alcohol/drug treatment, per hour
$101.6M
343K claims · 78.9%
$22.8M
63K claims · 17.7%
$3.7M
14K claims
$263.03
$467.51
Behavioral health; short-term residential, per diem
$3.7M
14K claims · 2.9%
$645K
2K claims
$260.50
$1,437.23
Behavioral health; long-term residential, per diem
$645K
2K claims · 0.5%
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