{
  "slug": "high-risk-cohort",
  "title": "High-risk provider cohort",
  "hypotheses": [
    "H23"
  ],
  "status": "published",
  "release_date": "2026-05-08",
  "generated_at": "2026-05-14T22:26:11+00:00",
  "methodology_version": "0.4.0",
  "commit_sha": "bcf9b81",
  "headline": "64,156 of 7,441,211 (0.86%) NDH practitioner NPIs score at or above the 1.0 composite threshold, including 8,002 at the critical 1.5 threshold (LEIE- or SAM-excluded). Anchored in 42 CFR \u00a7 455.436 federal database checks. Reason codes: oig_excluded (7,887), sam_excluded (4,517), not_in_nppes (56,156), nppes_deactivated (260,534), luhn_fail (2).",
  "numerator": 64156,
  "denominator": 7441211,
  "chart": {
    "type": "bar",
    "unit": "count",
    "data": [
      {
        "label": "critical",
        "value": 8002
      },
      {
        "label": "high",
        "value": 56154
      },
      {
        "label": "medium",
        "value": 259608
      },
      {
        "label": "clean",
        "value": 7117447
      }
    ]
  },
  "notes": "v0.4 composite combines five signals: OIG LEIE active exclusion match (1.5), SAM.gov active exclusion match (1.5), NPPES match (1.0), NPPES deactivation (0.8), and Luhn validity (1.0). H13 specialty mismatch (weight 0.4) wires in via the cohort_specialty_mismatch derived table from analysis/h10_h13_with_crosswalk.py. LEIE and SAM are scored independently \u2014 the HHS slice of SAM overlaps LEIE by design, but they are distinct legal sources under 42 CFR \u00a7 455.436, and a doubly-flagged NPI is genuinely higher triage confidence than a singly-flagged one. SSA-DMF (weight 2.0) is the last roadmap leg \u2014 until then, state Medicaid agencies must run independent monthly SSA-DMF checks. Composite score is a data-quality flag, NOT a fraud determination \u2014 each NPI carries reason codes for transparent triage."
}