Mid Atlantic Pemanente Medical Group
Health Maintenance Organization
Rockville, Maryland
NPI: 1811062763
Risk Tier
High
Total Paid
$317.6M
$317,626,964
Total Claims
10.1M
Beneficiaries
9.6M
Avg Cost/Claim
$31.41
Active billing period: 84 months (2018-01 to 2024-12)
Statistical Fraud Flags (2)
Billing Swing
Experienced over 200% change in year-over-year billing with >$1M absolute change.
Billing changed from $8.1M (2019) to $37.5M (2020) — a 361% swing with $29.4M absolute change.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 229 procedure codes: 99213 at 2.3× median, 99214 at 2.4× median.
Advanced Detection Signals
Billing Velocity
5472.3 claims per working day — may exceed physically possible volume for a single provider.
CUSUM Change Point
Billing shifted 5.4x in 2020-08 — 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