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Data Sources: Centers for Medicare & Medicaid Services (CMS), Medicare Provider Utilization and Payment Data
Disclaimer: This site is an independent journalism project. Data analysis and editorial content are not affiliated with or endorsed by CMS or any government agency. All spending figures are based on publicly available Medicare payment records.
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Methodology•Download Data
  1. Home
  2. Specialties
  3. Clinical Laboratory
  4. Fraud Risk

Medicare Fraud Risk in Clinical Laboratory

103 flagged Clinical Laboratory providers identified through statistical anomaly detection.

Share:

Flagged Providers

103

of 29.8K total

Average Risk Score

75/100

Specialty Markup

3.7x

Total Payments

$57.2B

Most Common Fraud Flags

Types of billing anomalies most frequently detected among flagged Clinical Laboratory providers.

💰 Outlier Spending103 providers
👥 Beneficiary Stuffing103 providers
📊 Volume Anomaly103 providers
📈 High Markup78 providers

Top Flagged Clinical Laboratory Providers

ProviderLocationRisk ScoreTotal PaymentsMarkupFlags
Quest Diagnostics IncorporatedClifton, NJ90$111.2M9.3xoutlier spending, high markup
Laboratory Corporation Of America HoldingsBurlington, NC89$214.6M9.0xoutlier spending, high markup
Laboratory Corporation Of America HoldingsRaritan, NJ89$143.3M8.6xoutlier spending, high markup
Quest Diagnostics Clinical Laboratories IncTampa, FL89$107.1M9.1xoutlier spending, high markup
Unilab CorporationWest Hills, CA89$94.0M9.1xoutlier spending, high markup
Laboratory Corporation Of America HoldingsBirmingham, AL86$60.5M8.3xoutlier spending, high markup
Laboratory Corporation Of AmericaSan Diego, CA86$59.8M8.7xoutlier spending, high markup
Quest Diagnostics Clinical Laboratories IncTucker, GA86$53.3M9.3xoutlier spending, high markup
Labone LlcLenexa, KS86$46.0M9.3xoutlier spending, high markup
Sunrise Medical Laboratories, Inc.Hicksville, NY86$30.3M11.8xoutlier spending, high markup
Laboratory Corporation Of America HoldingsDublin, OH85$56.9M8.2xoutlier spending, high markup
Laboratory Corporation Of AmericaTampa, FL85$47.4M8.5xoutlier spending, high markup
Unilab CorporationSacramento, CA85$47.1M9.2xoutlier spending, high markup
Quest Diagnostics Clinical Laboratories IncIrving, TX85$46.7M8.8xoutlier spending, high markup
Quest Diagnostics Clinical Laboratories IncMiramar, FL85$42.2M9.2xoutlier spending, high markup
Quest Diagnostics Llc IlWood Dale, IL85$40.2M9.6xoutlier spending, high markup
Centers Lab Nj LlcCedar Knolls, NJ85$15.4M14.3xoutlier spending, high markup
Sonora Quest Laboratories LlcPhoenix, AZ84$57.8M7.1xoutlier spending, high markup
Clinical Pathology Laboratories, Inc.Austin, TX84$47.7M8.4xoutlier spending, high markup
Laboratory Corporation Of AmericaPhoenix, AZ84$38.5M9.1xoutlier spending, high markup
Alpha Medical Laboratory LlcTulsa, OK84$6.6M60.9xoutlier spending, high markup
Bioreference Health, LlcElmwood Park, NJ83$66.8M6.3xoutlier spending, high markup
Laboratory Corporation Of AmericaDallas, TX83$34.0M8.4xoutlier spending, high markup
Quest Diagnostics Clinical Laboratories IncHouston, TX83$31.0M8.9xoutlier spending, high markup
Northwell Health LaboratoriesNew Hyde Park, NY82$48.5M6.9xoutlier spending, high markup
Enigma Management Corp Dba Alliance LaboratoryBrooklyn, NY82$28.3M8.2xoutlier spending, high markup
Quest Diagnostics Massachusetts LlcMarlborough, MA82$27.8M8.7xoutlier spending, high markup
Quest Diagnostics Incorporated MdBaltimore, MD82$27.3M9.0xoutlier spending, high markup
Laboratory Corporation Of AmericaHouston, TX82$27.2M8.3xoutlier spending, high markup
Quest Diagnostics LlcMarlborough, MA82$27.2M8.9xoutlier spending, high markup

Markup by Specialty

How Clinical Laboratory markup compares to other specialties.

Anesthesiology Assistant
12.2x
Dental Anesthesiology
12.2x
Certified Registered Nurse Anesthetist (CRNA)
9.7x
Anesthesiologist Assistants
9.6x
Anesthesiology
8.8x
CRNA
7.4x
Emergency Medicine
7.1x
Radiation Therapy Center
7.1x
Radiation Therapy
6.1x
Ambulatory Surgical Center
6.1x
Independent Diagnostic Testing Facility (IDTF)
6.1x
Neurosurgery
5.9x
Independent Diagnostic Testing Facility
5.5x
Diagnostic Radiology
5.4x
Interventional Radiology
5.1x

⚠️ Disclaimer: Being flagged does not imply fraud. These providers were identified through statistical analysis of billing patterns that deviate significantly from peers. Unusual billing may have legitimate explanations. This data is provided for transparency and public accountability purposes only.

Data Sources

  • • Centers for Medicare & Medicaid Services (CMS)
  • • Medicare Provider Utilization and Payment Data (2014-2023)
  • • OpenMedicare Statistical Anomaly Detection

Note: All data is from publicly available Medicare records. OpenMedicare is an independent journalism project not affiliated with CMS.