State of Connecticut
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 44 procedure codes: 99285 at 3.7× median, 96372 at 24.3× 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 $80.45 per claim for G0463 (Hospital outpatient clinic visit) — 3.0× the national median of $26.41.
Bills $318.25 per claim for 99285 (Emergency dept visit, high/urgent complexity) — 3.7× the national median of $85.65.
Bills $232.06 per claim for 96372 (Therapeutic injection, subcutaneous/intramuscular) — 24.3× the national median of $9.56.
Billing in the top 1% nationally for 2 procedure codes: 96372, 27130.
This is a statistical summary, not an accusation. See our methodology.
Compared to Counselor, Professional Peers
Total spending distribution among 23 providers in this specialty
This provider's total spending of $205.9M is at the 99th percentile among 23 Counselor, Professional providers.
Above 99th percentile for this specialty — higher spending than 22 of 23 peers
Total Paid
$205.9M
$205,921,864
Total Claims
6.3M
Beneficiaries
4.5M
1.4 claims/patient
Avg Cost/Claim
$33
#434 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
State of Connecticut is a Counselor, Professional provider based in Farmington, CT. From the 2018–2024 period, this provider received $205.9M in Medicaid payments across 6.3M claims.
Important Context
- ℹ️This is a government entity that may serve as a fiscal agent for large populations. Government providers often bill at high volumes due to the scale of public programs they administer.
Why This Matters
This provider received $205.9M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 25,740 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 (G0463 (Hospital outpatient clinic visit)) accounts for 10% of total spending.
Hospital outpatient clinic visit
$20.9M
259K claims · 10.1%
$17.1M
2K claims
$7,798.51
$14,026.53
Ustekinumab (Stelara) injection, 1 mg
$17.1M
2K claims · 8.3%
$14.5M
103K claims
$140.91
$69.51
Emergency dept visit, high complexity
$14.5M
103K claims · 7.0%
$12.3M
691 claims
$17,731.65
$17,264.74
Ocrelizumab (Ocrevus) injection, 1 mg
$12.3M
691 claims · 6.0%
$10.5M
33K claims
$318.25
$85.65
Emergency dept visit, high/urgent complexity
$10.5M
33K claims · 5.1%
$8.3M
79K claims
$104.36
$42.48
Emergency dept visit, moderate complexity
$8.3M
79K claims · 4.0%
$6.7M
29K claims
$232.06
$9.56
Therapeutic injection, subcutaneous/intramuscular
$6.7M
29K claims · 3.2%
$5.9M
6K claims · 2.9%
$5.0M
245 claims · 2.4%
$4.4M
1K claims · 2.2%
Therapeutic exercises, each 15 min
$4.1M
67K claims · 2.0%
$4.0M
35K claims
$114.73
$21.76
Therapeutic/prophylactic/diagnostic IV push, single substance
$4.0M
35K claims · 1.9%
$3.6M
2K claims
$1,684.28
$1,587.53
Injection, infliximab, excludes biosimilar, 10 mg
$3.6M
2K claims · 1.7%
$3.6M
5K claims · 1.7%
$2.9M
26K claims
$111.88
$54.77
IV infusion, therapeutic/prophylactic/diagnostic, initial, up to 1 hour
$2.9M
26K claims · 1.4%
$2.8M
14K claims
$190.50
$75.28
Chemotherapy administration, IV infusion, up to 1 hour
$2.8M
14K claims · 1.3%
$2.6M
312 claims
$8,420.49
$1,115.75
Total knee replacement surgery, both components
$2.6M
312 claims · 1.3%
$2.4M
10K claims
$245.78
$54.68
Echocardiography, transthoracic, complete, with Doppler
$2.4M
10K claims · 1.2%
Upper GI endoscopy with biopsy
$1.9M
4K claims · 0.9%
$1.8M
41K claims
$44.65
$38.92
IV infusion, hydration, each additional hour
$1.8M
41K claims · 0.9%
$1.6M
4K claims · 0.8%
$1.6M
11K claims
$143.09
$65.76
CT abdomen and pelvis with contrast
$1.6M
11K claims · 0.8%
$1.6M
6K claims
$261.69
$133.68
MRI brain without contrast, then with contrast
$1.6M
6K claims · 0.8%
Colonoscopy with biopsy
$1.6M
2K claims · 0.8%
$1.6M
171 claims
$9,084.62
$2,763.80
Total hip replacement arthroplasty procedure
$1.6M
171 claims · 0.8%
$1.4M
1K claims
$1,159.95
$763.43
Unlisted procedure, dentoalveolar structures
$1.4M
1K claims · 0.7%
$1.3M
41K claims
$32.02
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$1.3M
41K claims · 0.6%
$1.3M
38K claims
$34.14
$14.92
Therapeutic/prophylactic/diagnostic IV push, each additional substance
$1.3M
38K claims · 0.6%
$1.2M
11K claims
$112.91
$61.57
IV infusion, hydration, initial, 31 minutes to 1 hour
$1.2M
11K claims · 0.6%
$1.2M
2K claims
$574.33
$255.17
Colonoscopy with polyp removal, snare technique
$1.2M
2K claims · 0.6%
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