Reports

Report A1: Top 10 Highest-Paid Providers

These are the 10 providers who received the most Medicaid money in Nevada. Receiving a large amount isn't automatically bad — but the government always examines the biggest numbers first.

Report A2: Spending Outlier Scatter Plot

Each dot is a provider. The horizontal axis shows patients seen; the vertical axis shows money received. Both axes use a logarithmic scale so small and large providers are all visible. Dots are color-coded by cost per patient: blue = normal, amber = elevated (>$10K/patient), red = extreme (>$50K/patient). Providers floating above the diagonal received disproportionately high payments relative to their patient count.

Report A3: Average Pay by Specialty

Different types of providers earn different amounts from Medicaid. This shows the average (blue) and the highest-paid provider (red) for each specialty. When one provider makes far more than the average, that gap is worth investigating.

Report B1: Spending Treemap

This treemap shows the top procedure codes by spending. Bigger boxes mean more money. This is how investigators see the “big picture” at a glance.

Report C1: Year-Over-Year Growth

This shows how total Medicaid spending in Nevada has changed over time. Rapid growth can signal increased enrollment, expanded benefits, or cost increases that deserve scrutiny.

Report C2: E&M Upcoding Detection

Evaluation & Management (E&M) codes 99211–99215 represent office visits from simplest to most complex. Each level pays more. “Upcoding” means always billing the most expensive level regardless of what the visit actually required. This report flags providers whose high-complexity ratio (99214+99215) is 20+ percentage points above their specialty average.

Report C3: Procedure Concentration

Most providers bill a variety of procedure codes. When a provider puts 80% or more of their billing into a single code, it can indicate they are running a “mill” — performing the same procedure on every patient regardless of need. These providers bill over $100K with 80%+ concentrated in one code.

Report D1: OIG Excluded Provider Check

The Office of Inspector General maintains the List of Excluded Individuals/Entities (LEIE) — providers banned from federal healthcare programs. Paying an excluded provider with Medicaid funds is illegal. This cross-references every active Nevada Medicaid provider's NPI against the federal exclusion list.

Report E1: Referral Network Analysis

In Medicaid billing, the “billing provider” submits the claim and the “servicing provider” performs the service. When one entity bills on behalf of many servicing providers, it may indicate a legitimate group practice — or a kickback scheme where a billing entity extracts fees from referrals. This shows billing entities that submit claims for 5 or more distinct servicing providers.

Report F1: Behavioral Health Dashboard

Behavioral health is the #1 sector for Medicaid fraud nationally. This dashboard breaks down spending across all behavioral and mental health specialties in Nevada, and lists the highest-paid providers in these categories.

Report G1: Hospice Provider Monitor

Hospice fraud is a growing national crisis, with providers enrolling patients who are not terminally ill and billing for services never provided. California's crackdown has pushed fraudulent hospice companies into neighboring states like Nevada. This tracks all hospice providers billing Nevada Medicaid.

Report H1: Benford’s Law Analysis

Benford’s Law predicts that in naturally occurring datasets, the leading digit “1” appears about 30% of the time, “2” about 18%, and so on. Deviations from this pattern can indicate data manipulation or fabricated billing amounts. This compares the actual first-digit distribution of all Nevada Medicaid provider payment totals against the expected Benford distribution.

Specialties with Largest Deviations

Higher chi-squared values indicate greater deviation from the expected Benford distribution. This does not prove fraud — some specialties naturally produce non-Benford distributions due to standardized fee schedules.

Report H2: Per-Patient Spending Outliers

Some providers spend dramatically more per patient than others in their specialty. A provider spending 3x or more the specialty average per beneficiary may indicate over-billing, unnecessary services, or a patient population requiring unusually intensive care. This report flags providers whose per-patient cost significantly exceeds their peer average.

Report H3: Provider Billing Intensity

Fraudulent “pop-up” providers often bill at extremely high monthly rates during short operating windows, then disappear. This report ranks providers by their average monthly billing rate. Short-lived entities with high per-month spending deserve extra scrutiny, especially when their Nevada Secretary of State registration is no longer active.

Report H4: Shared Corporate Officers

When the same individual serves as an officer in multiple corporations that all bill Medicaid, it may indicate a legitimate business group — or a network of shell companies designed to maximize billing. This report identifies individuals who hold officer positions in three or more Nevada corporations that receive Medicaid payments.

Report H5: Medicaid Payments vs. Political Contributions

This scatter plot shows the relationship between total Medicaid payments received and total political contributions made by provider-associated entities. Campaign contributions are legal and this visualization does not imply wrongdoing — it provides transparency into the intersection of public healthcare spending and political donations.

Report I1: OIG Exclusion Cross-Reference

The U.S. Department of Health & Human Services Office of Inspector General (OIG) maintains a List of Excluded Individuals/Entities (LEIE) — providers barred from participating in federal healthcare programs including Medicaid. This report cross-references the LEIE against Nevada Medicaid payment records to identify excluded providers who received payments. Billing during an exclusion period may constitute fraud under federal law.

Report I2: Geographic Spending Hot Spots

Some ZIP codes have dramatically higher average Medicaid spending per provider than others. While this often reflects legitimate factors like specialty concentration or population density, extreme outliers — especially in areas with few providers and high per-provider totals — warrant closer examination for potential billing anomalies.

Report I3: Shared-Address Provider Clusters

Multiple Medicaid-billing providers operating from the same physical address can indicate legitimate medical practices, clinic buildings, or hospital systems — but may also signal shell entity networks designed to multiply billing capacity. This report identifies addresses with five or more distinct NPIs billing Medicaid, ranked by combined payments.

Report I4: Procedure Unbundling Indicators

Unbundling occurs when a provider bills individual component procedures separately instead of using a single comprehensive code — for example, billing individual lab tests rather than a panel. This report identifies providers with a high percentage of claims for known component codes (individual lab tests, basic venipuncture, low-level E/M visits) relative to their total billing. High percentages may indicate legitimate practice patterns or potential unbundling.

Report I5: Year-over-Year Spending Spikes

Sudden, dramatic increases in a provider’s annual Medicaid billing can signal changes in practice scope, new service lines, or the onset of improper billing patterns. This report identifies providers whose year-over-year spending increased by 100% or more, with a minimum threshold of $10,000 in both years to exclude noise from small accounts.