Fishing Point Health Care LLC
General Practice
Portsmouth, Virginia
NPI: 1679279046
Risk Tier
Critical
Total Paid
$169.8M
$169,838,122
Total Claims
139K
Beneficiaries
13K
Avg Cost/Claim
$1,218.12
Active billing period: 20 months (2023-05 to 2024-12)
Statistical Fraud Flags (6)
Cost Outlier
Billing over 3× the national median for specific procedure codes.
Bills $1,302.95 per claim for S5121 (Attendant care services, in-home, per 15 min), which is 11.7× the national median of $111.06.
Billing Swing
Experienced over 200% change in year-over-year billing with >$1M absolute change.
Billing changed from $34.8M (2023) to $135.1M (2024) — a 288% swing with $100.3M absolute change.
New Entrant
Started billing recently but already receiving millions in Medicaid payments.
First appeared in 2023-05 and has already billed $169.8M, averaging $8.5M/month across 20 months.
Instant Volume
New provider billing over $1M in their first year of Medicaid participation.
Billed $34.8M in first year (2023).
High Cost Per Claim
Average payment per claim is much higher than peers billing the same procedures.
High Claims Per Patient
Filing an unusually high number of claims per beneficiary compared to peers.
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