Investigations

Each investigation is generated from billing data, provider records, and peer comparison analysis. Anomalies are not accusations — they are patterns that warrant further investigation.

Provider	Top Finding	NPI
South Dakota facility bills 10x more frequently than peers — $26.6M from a single code AURORA PLAINS ACADEMY LLC	100% code concentration: All 78,357 claims over 78 months used a single billing code (T2048)...	1003942095
An Ohio Hospice Bills 12x More Claims Per Patient Than Peers TRIDIA HOSPICE CARE, LLC	12.1x beneficiary intensity ratio for T2046: 26.74 claims per patient vs. 2.21 median among 823 peer...	1013181205
Massachusetts Home Health Provider Bills at 7-24x Peer Rates Across $39.4M in Medicaid Claims BAYADA HOME HEALTH CARE, INC.	Billed $279.95 per RN visit versus $38.65 peer median—a 7.24x cost premium across $26.4M in T1002 cl...	1013358118
Pittsburgh Home Health Provider Billed $79.9M — Charges Up to 20x Peer Median INTERIM HEALTHCARE OF PITTSBURGH, INC.	Billed $79.9 million across 184,620 Medicaid claims from 2018-2024, averaging $433.26 per claim...	1033213186
New Jersey home health agency billed Medicaid $224.6M — with nursing visits costing 16× the median PREFERRED HOME HEALTH CARE & NURSING SERVICES, INC.	Billed $428.91 per nursing visit (T1003) versus peer median of $26.13 — a 16.41× markup generating $...	1043279011
Michigan nonprofit billed Medicaid 8.8× more intensively than peers for developmental services THE ARC OF NORTHWEST WAYNE COUNTY	Billed 28.33 claims per beneficiary for H2015 services — 8.78× the national median of 3.23 claims pe...	1043420847
Detroit Home Care Provider Bills $34.4M Over 7 Years—At 10X Peer Intensity SERENITY FACILITY LLC	Billed 33.42 claims per beneficiary for H2015 vs. peer median of 3.23—a 10.36x intensity ratio acros...	1043622970
Minnesota Opioid Clinic Bills $28.2M for Single Service—849% More Visits Per Patient Than Peers LEECH LAKE OPIATE TREATMENT PROGRAM	849% intensity: 17.69 claims per patient vs. 2.08 median among 421 peers billing H0047...	1053478164
Delaware disability provider billed Medicaid $86M — 5.5× peer rate for identical service RESOURCES FOR HUMAN DEVELOPMENT INC.	Billed $786.69 per T2025 claim vs. $144.34 peer median — a 445% premium across $33.9M in payments...	1083743678
A Michigan Contractor Bills $192.7M With Claims-Per-Patient 8.7x the Median PAS-PERSONAL ACCOUNTING SERVICES, INC.	H2015 billed at 28.10 claims/beneficiary -- 8.71x the median of 3.23 among 3,753 peers, generating $...	1083810055
Massachusetts mental health provider billed $185.8M over 7 years — 1,950,809 claims flagged JUSTICE RESOURCE INSTITUTE, INC	Billed $185.8 million across 1,950,809 Medicaid claims over 84 months (Jan 2018 - Dec 2024)...	1093787095
Ohio hospice billed 29 visits per patient vs. peer median of 2 — $38M paid over 7 years SOUTHERNCARE, INC.	29.16 claims per beneficiary vs. peer median of 2.21 — a 13.21x intensity ratio on code T2046...	1104864198
Tribal clinic bills Medicaid $28.2M for single drug code—at 3.5x peer rates JAMESTOWN S'KLALLAM TRIBE	Single code (T1015) represents 93.99% of $30M in total billing—extreme concentration triggering 70.0...	1104901941
A Delaware Disability Provider Bills 15.5x More Waiver Claims Per Patient Than Peers CHIMES METRO, INC.	15.5x beneficiary intensity ratio for T2025: 31.66 claims per patient vs. 2.04 median among 635 peer...	1104931625
Boston behavioral health provider billed 27 Medicaid visits per child — 16× the state median CHILDREN'S SERVICES OF ROXBURY, INC.	H0023 billed 27.2 times per child vs. 1.71 state median — 15.87× more intensive than peers...	1124253794
Minnesota home health provider bills Medicaid $40.4M using single code at 20× peer intensity STONECREST LIVING INC	Billed $40,437,024.52 over 52 months using exclusively code T2031 (assisted living waiver)...	1134773047
A Detroit Facility Bills 235 Services Per Patient While Peers Average 3 STARR'S WATCHFUL EYE	235 claims per beneficiary — 78.9x the national median of 3.2 for code H2015...	1144989351
Michigan disability provider billed $166.7M over 7 years, charging 22% more per claim than peers SPECTRUM COMMUNITY SERVICES	Billed $166.7 million across 852,318 claims for 92,409 beneficiaries from 2018-2024...	1164577391
Pennsylvania Home Health Agency Bills Medicaid $27.9M Using Single Code at 4x Peer Rate BAYADA HOME HEALTH CARE, INC.	100% code concentration: All 47,735 claims over 83 months used the identical procedure code T2025...	1184665168
A Plymouth Home Care Agency Charges 8x the Median Rate Per Claim CENTRUS PREMIER HOME CARE INC	$201 million in total Medicaid payments over 7 years for approximately 29,909 patients...	1194711226
Michigan Home Health Provider Billed Medicaid $67.6M With 14x Higher Claim Intensity Than Peers INDEPENDENT COMMUNITY CARE SERVICES	Claim intensity 14.53x higher than median: 46.88 claims per beneficiary vs. peer median of 3.23 for ...	1194815837
Ohio Hospice Billed Medicaid 8.7x More Frequently Per Patient Than Peers—$47.5M Over 7 Years CROSSROADS HOSPICE OF NORTHEAST	Billed $47.5 million to Medicaid over 83 months for 13,483 beneficiaries across 259,910 claims...	1205876653
New Jersey facility bills $94M for single code at 85% above peers, serving 4,837 patients UNIVERSAL REHABILITATION AND FITNESS, INC.	Single code H2016 generated $94M (49% of all revenue) at $673.86 per claim—85% above the $364.57 pee...	1205927928
Louisiana mental health clinic billed Medicaid $40.5M with rates 70% below peers—14 visits per patient BEHAVIORAL SERVICES OF LOUISIANA, L.L.C.	Processed 2,023,746 Medicaid claims totaling $40.5 million over 84 months at $19.99 per claim—71% be...	1215365689
Ohio hospice billed Medicaid 12.7x more claims per patient than peers, generating $41.5M HEARTLAND HOSPICE SERVICES LLC	Billed 28.07 claims per beneficiary for code T2046—12.71 times the peer median of 2.21...	1215981329
Ghost Provider: NPI 1225042542 Has No Billing Data But Flags Maximum Fraud Risk Score Unknown	Composite fraud score: 100 out of 100, indicating maximum algorithmic risk...	1225042542
Connecticut psychiatric facility billed Medicaid 8.5× more intensively than peers—$28.5M over 7 years THE VILLAGE FOR FAMILIES & CHILDREN, INC.	Billed 25.66 claims per child vs. peer median of 3.0—an 8.55× intensity ratio triggering composite f...	1245304096
Mississippi Nursing Provider Bills 7× Peer Average for Personal Care—$67M Over 7 Years STATEWIDE HEALTHCARE SERVICES, INC	Delivered 28.22 skilled nursing visits per patient vs. 3.79 peer median—7.45× the typical intensity...	1245368521
Ghost Provider: NPI 1245430438 Exists in Fraud Database But Has Zero Billing Records Unknown	Composite fraud risk score: 100/100 (maximum possible)...	1245430438
Virginia Mental Health Center Billed $210M to Medicaid—$55M From a Single Service Code MOUNT ROGERS COMMUNITY SERVICES	Billed $337 per crisis intervention claim vs. $91 peer median—3.7x higher for code representing 26% ...	1255365599
Ohio hospice billed 13x more claims per patient than peers for $29M in routine home care HOSPICE OF NORTHWEST OHIO	Billed 29.46 claims per patient for routine hospice care versus peer median of 2.21 claims—a 13.34x ...	1265435499
Indiana psychiatric facility billed $27.3M with 9.4x treatment intensity vs. peers COLUMBUS HOSPITAL, LLC	Generated 28.19 claims per patient vs. 3.0 median — 9.4x treatment intensity...	1275580003
Kansas nonprofit billed Medicaid $133M in 7 years—11.9x the national rate for one service code SOUTHEAST KANSAS INDEPENDENT LIVING RESOURCE CENTER INC	T2025 billed at 24.35 claims per beneficiary—11.92x the national median of 2.04 claims per beneficia...	1275683260
Colorado Home Health Agency Bills Medicaid 10x More Visits Than Peers for Same Patients EVERGREEN HOME HEALTHCARE, LLC	Billed $28,599,401.01 to Colorado Medicaid across 88,523 claims from December 2020 to December 2024...	1285290510
Georgia home care provider billed Medicaid $57M serving patients 11× more intensively than peers COASTAL HOME CARE, LLC	Served patients at 10.66× median intensity: 21.77 claims per beneficiary vs. 2.04 national median fo...	1285777490
Ghost Provider: NPI 1295898393 Has Perfect Fraud Score But Zero Billing Records Unknown	Composite fraud score: 100/100 — the maximum possible risk rating in the MedicaidWatch system...	1295898393
A Colorado Home Care Agency Billed $101.7M on a Single Service Code A CIRCLE OF CARE COLORADO, LLC.	$101.7 million in total Medicaid payments over 62 months — 100% from a single code (H0038)...	1306303680
New Mexico facility bills 21 daily services per patient—11x the state median ALIANZA FAMILY SERVICES, LLC	Billed 21.39 services per patient vs. state median of 2.0 for primary code T2033—a 10.69x intensity ...	1316111446
Arkansas Day Training Provider Billed Medicaid $69.9M With 16x Higher Service Intensity Than Peers PATHFINDER, INC.	Delivered 18.93 claims per beneficiary for T1015 vs. peer median of 1.15—a 16.49x intensity ratio...	1326004466
A Washington Methadone Clinic Billed $248M in 5 Years at 8x the Median Intensity WE CARE DAILY CLINICS LLC	$248.2 million billed under T1015 in just 5 years -- 95.25% of all revenue concentrated in one code...	1326502865
North Dakota behavioral health provider billed $104.6M while splitting patients into 30 daily visits COMMUNITY LIVING SERVICES, INC	Billed $104.6 million to North Dakota Medicaid across 419,874 claims (2018-2024)...	1326657602
A Dayton Hospice Bills 30 Claims Per Patient While Peers Average 2 THE HOSPICE OF DAYTON, INC.	30.55 claims per beneficiary under T2046 — 13.8x the national median of 2.21 among 823 peers...	1346220142
A Michigan Disability Facility Bills 59 Services Per Patient Per Month MONEY MINDERS PLUS, LLC	59.19 claims per beneficiary for H2015 — 18.3x the national median of 3.23 among 3,753 peers...	1346451796
Colorado home care provider billed Medicaid $59.3M serving patients 8x more intensively than peers PEOPLECARE OF WESTERN COLORADO, LLC	Served beneficiaries 7.69 times more intensively than peer median (22.15 vs 2.88 H0038 claims per pa...	1356613244
An Arizona Transit Company Billed 11 Million Medicaid Rides in 7 Years TOTAL TRANSIT INC	11.1 million claims totaling $124.6M over 84 months — 7.51 claims per beneficiary on A0425 (6.08x me...	1376695163
Medicaid Provider NPI 1396716858 Flags High-Risk Alert Despite Zero Billing Records Unknown	Composite fraud risk score: 100 out of 100 (maximum possible)...	1396716858
Alaska Mental Health Org Billed $43.6M for 4,480 Patients — 10× National Service Intensity FAMILY CENTERED SERVICES OF AK	H2019 code generated 27.27 claims per beneficiary vs. national median of 2.63 — a 10.37× intensity r...	1417001942
Michigan case manager billed Medicaid at 11× peer intensity—$145M across 149K patients in 7 years RELIANCE COMMUNITY CARE PARTNERS	H2015 billed at 10.9× peer intensity: 35.18 claims per patient versus 3.23 median nationwide...	1417005257
A Colorado Home Care Agency Billed $248M While Serving Just 600 Patients A PHYSICIANS HOME CARE	$234.4 million billed under a single code (H0038) -- 94.6% of all revenue...	1417486531
Florida hospice billed Medicaid $45.8M with 24 claims per patient—peers average 2 TIDEWELL HOSPICE, INC.	Billed 24.14 claims per beneficiary vs. peer median of 2.21—intensity ratio of 10.93...	1417954645
Florida hospice billed 16x more claims per patient than peers—yet charged 91% less per claim CATHOLIC HOSPICE, INC	Billed 24.85 claims per patient vs. peer median of 1.5—a 16.57x intensity ratio—for routine hospice ...	1427051325
Massachusetts Home Health Provider Bills Medicaid 7.8x Peer Rate Per Claim — $47.8M Over 7 Years PEDIATRIA HEALTHCARE, LLC	Billed $47.76 million across 170,229 Medicaid claims over 7 years for 7,919 pediatric beneficiaries...	1427225523
Arkansas therapy clinic billed 436,000 claims for single code—15x more per patient than peers FULL POTENTIAL	Generated $28.8 million from a single billing code (T1015) across 436,142 claims—52% of all revenue...	1427379387
Denver Home Health Agency Bills Medicaid $27.8M — 9.5x More Visits Per Patient Than Peers ESTRELLA HOME HEALTH CARE INC.	Billed 27.41 services per patient vs. median of 2.88 — a 9.52x intensity ratio across 6,651 benefici...	1437417078
An Ohio Hospice Bills 31 Claims Per Patient While Peers Average 2 QUEEN CITY HOSPICE, LLC	31.28 claims per beneficiary for T2046 -- 14.17x the national median of 2.21 among 823 peers...	1437432929
A Pasadena Transport Company Billed $724M for 26.6 Million Medicaid Rides CALL THE CAR	$723.9 million in total Medicaid billing across 26.6 million claims and 3.4 million beneficiaries...	1457601965
Ohio hospice billed 9x more claims per patient than peers—$32M in routine home care at fraction of typical cost TRADITIONS HOSPICE OF HIGHLAND HEIGHTS, LLC	Delivered 20.31 claims per beneficiary vs. peer median of 2.21—a 9.2x intensity ratio across 7,976 p...	1497758189
Georgia behavioral health org billed 30.67 claims per patient—15x the median for same service RESCARE GEORGIA	Billed 30.67 claims per beneficiary for T2033—15.33x the national median of 2.0 claims per patient...	1518135599
A Rural Arkansas Provider Bills $169M Across 41 Service Codes FRIENDSHIP COMMUNITY CARE INC.	18.1 claims per beneficiary for T1015 clinic services -- 15.76x the national median of 1.15 among 12...	1528144318
Kansas behavioral health provider billed Medicaid $48M in 7 years—95% from one code KIDSTLC, INC.	95.63% of $48 million billed from single code T2048 (behavioral health day treatment)...	1528183381
Massachusetts Hospice Billed 26 Claims Per Patient vs. Peer Average of 2 — $30.4M Over 7 Years SEASONS HOSPICE & PALLIATIVE CARE OF MASSACHUSETTS, LLC	Billed 26.62 claims per patient vs. peer median of 2.21 — an intensity ratio of 12.05:1...	1538369129
Rhode Island Hospice Billed 5x Expected Volume Per Patient Over $47 Million in Medicaid Claims BEACON HOSPICE, LLC	Billed 11.27 claims per beneficiary vs. 2.21 national median—5.1 times expected intensity...	1558445569
Ohio Hospice Bills 13× More Claims Per Patient Than Peers, Collects $44M from Medicaid VITAS HEALTHCARE CORPORATION OF OHIO	Billed 29.8 claims per patient vs. peer median of 2.21 claims—13.49× higher intensity for code T2046...	1568505105
A Delaware IDD Provider Charges 4x the Median While Billing 15x the Volume KEYSTONE SERVICE SYSTEMS, INC.	30.35 claims per beneficiary for T2025 -- 14.86x the national median of 2.04 among 635 peers...	1568525640
Minnesota facility billed 19× more claims per patient than peers — $26.2M from single code MIDWEST RESIDENTIAL INC	Billed 29.33 claims per beneficiary on average — 19.07× the median of 1.54 for peer providers billin...	1578075750
Massachusetts hospice billed $38.4M with 99.97% from single code at 12x peer frequency ATHENA HOSPICE SERVICES OF MASSACHUSETTS, LLC	99.97% revenue concentration: $38.37M of $38.38M total came from a single billing code (T2046)...	1578864377
A Delaware IDD Provider Bills $109M in Four Years With 14x Volume NATIONAL MENTOR HEALTHCARE, LLC	28.18 claims per beneficiary for T2025 -- 13.8x the national median of 2.04 among 635 peers...	1588937486
A Michigan Facility Bills $2,926 Per Claim Where Peers Bill $153 LIVING ALTERNATIVES FOR THE DEVELOPMENTALLY DISABLED, INC.	$2,926.33 per H0043 claim -- 19.15x the peer median of $152.78 among 691 providers...	1598000549
Colorado Mental Health Center Bills 9× More Services Per Patient Than Peers — $66.8M Over 7 Years COLORADO SPRINGS INDEPENDENCE CENTER	Billed 26.68 claims per beneficiary for psychosocial rehab (H0038) versus median of 2.88—a 9.26× int...	1598201618
Cincinnati Hospice Bills Medicaid 12X More Often Per Patient Than Peers, $54M Over 7 Years HOSPICE OF CINCINNATI INCORPORATED	Bills T2046 (routine hospice home care) 27.06 times per patient—12.25X the peer median of 2.21 claim...	1598740011
An Arkansas Children's Clinic Bills $141M Through 602 Servicing Providers KID SUCCESS, INC.	12.64 claims per beneficiary for T1015 — 11x the national median of 1.15 among 12,833 peers...	1609997311
Massachusetts nursing provider bills $62.7M — charges 10x-25x peer rates for basic care codes SHRIVER NURSING SERVICES, INC	Billed $395.17 per claim for LPN nursing care (code T1002) — 10.22 times the $38.65 median of 2,489 ...	1619051810
New Hampshire nonprofit billed Medicaid $63M using single code—at 2.6x the median cost per claim NFI NORTH, INC	H0019 billing cost jumped from $333 per claim (2018-2021) to $4,823 per claim starting January 2022—...	1619148277
Massachusetts nursing provider billed Medicaid at 10x peer rates for $47.8M over 7 years PEDIATRIC SERVICES OF AMERICA, LLC	Charged $302 per RN visit vs. $38.65 peer median—7.8x higher across $26.1M in billing...	1619908985
Philadelphia Home Health Agency Billed Medicaid $820 Per Visit — 5.7x the Median Rate VISITING NURSE GROUP, INC	Charged $820.60 per nursing visit vs. $144.34 median — 5.69x higher than 635 peer providers...	1639176522
Massachusetts mental health center billed Medicaid $127M serving clients at 26× the peer average COMMUNITY HEALTHLINK INC	Billed 26.48 claims per beneficiary for code H0023 vs. peer median of 1.71 (15.5× higher intensity)...	1649293028
New Mexico residential facility billed Medicaid at 10× the intensity of peers for $35.8M EXPRESSIONS OF LIFE	Billed T2033 at 9.68× the median intensity: 19.36 claims per beneficiary versus peer median of 2.0...	1649296252
Minnesota assisted living chain billed Medicaid $39M using single code 109,561 times THE LODGES COMPANY	100% revenue concentration: Every dollar of $39.1 million came from a single billing code (T2031) ov...	1649669193
Ohio Hospice Billed Medicaid $23.9M Using Single Code — 10x Peer Intensity ABSOLUTE HOSPICE, INC.	100% revenue concentration: All $23.9 million from a single billing code (T2046) over 83 months...	1649694068
Pennsylvania nonprofit billed Medicaid $227M — 5x more claims per patient than peers NORTHEAST PENNSYLVANIA CENTER FOR INDEPENDENT LIVING	Billed $227.19 million across 3.23 million Medicaid claims (2018-2024) serving 180,891 beneficiaries...	1659601979
A Virginia Clinic Charges $719 for a $1.90 Blood Draw Across Nearly Every Service FISHING POINT HEALTH CARE LLC	Blood draw (36415) billed at $719 vs. median $1.90 -- a 377.5x cost ratio among 28,602 peers...	1679279046
A Massachusetts Home Health Agency Charges 6.4x the Median Rate Per Claim NORTHEAST ARC INC	$248.05 per T1002 claim — 6.4x the national median of $38.65 among 2,489 peers...	1679570113
A Delaware Residential Facility Charges $1,400 Per Claim -- 9.7x the Median MOSAIC	T2025 billed at $1,399.60/claim vs. $144.34 median -- 9.7x the national rate among 635 peers...	1689742439
New Mexico behavioral health provider billed 15x more claims per patient than typical — $36.4M paid ALTA MIRA SPECIALIZED FAMILY SERVICES, INC.	15.02x intensity ratio: Alta Mira averaged 30 therapy sessions per child monthly vs. peer median of ...	1699833640
A Minnesota Home Health Agency Bills 38 Claims Per Patient — 36x the Median ALLIANCE HEALTH SVCS FISCAL SUPPORT	38.19 claims per beneficiary for T2028 — 35.7x the national median of 1.07 among 291 peers...	1699860650
Ghost Provider: NPI 1700099959 Flags Maximum Risk Score Despite Zero Billing Records Unknown	Composite fraud risk score: 100 out of 100, the maximum possible alert level...	1700099959
Ghost Provider: NPI 1710931357 Flagged With Perfect 100 Fraud Score But Zero Claims Found Unknown	Composite fraud risk score: 100 out of 100—the maximum possible alert level...	1710931357
Bancroft, NJ nonprofit billed Medicaid $560M over 7 years—billing same clients 29 times monthly BANCROFT, A NEW JERSEY NONPROFIT CORPORATION	Billed $560.4 million to Medicaid over 84 months, averaging $6.7 million monthly...	1720121106
A Virginia Residential Facility Charges 83x the Median for Group Therapy GRAFTON SCHOOL, INC.	$1,133 per group therapy claim (97150) — 83.5x the national median of $13.57 among 3,426 peers...	1720159676
Ohio hospice billed Medicaid 10x normal rate for dying patients—1 every 90 minutes for 7 years CROSSROADS HOSPICE OF CLEVELAND LLC	172,207 routine hospice care claims submitted—10.16x the peer median intensity of 2.21 claims per be...	1730329681
A Tennessee Behavioral Health Firm Bills $286M Across 52 Service Codes HEALTH CONNECT AMERICA, INC	$285.5M in total Medicaid billings across 52 service codes over 84 months -- among the largest behav...	1730366824
Virginia Tribal Clinic Billed $75.6M in 3 Years—96% from Two Obscure Codes UPPER MATTAPONI INDIAN TRIBE	Billed $75.6 million over 29 months with 96% of revenue from just two codes (S5121 and Q5009)...	1750969168
A Rhode Island Disability Services Provider Bills 28 Claims Per Patient Daily SEVEN HILLS RHODE ISLAND	T2033 residential habilitation billed at 27.8 claims per beneficiary -- 13.9x the national median of...	1760779045
A Colorado Home Care Provider Grew From 23 Patients to $83M in Under 5 Years PREMIER HEALTHCARE SERVICES, LLC	H0038 self-directed care billed at 28.22 claims per beneficiary -- 9.8x the national median of 2.88 ...	1780286781
Ghost Provider: NPI 1780708263 Scores Maximum Fraud Risk With Zero Billing Records Unknown	Perfect 100/100 peer deviation fraud score with $0 in documented billing across 227 million national...	1780708263
Mystery Medicaid Provider Billed $29.6M Using Single Code — Identity Not Found in Registry NOT FOUND	Provider billed $29,558,105.28 over 81 months but returns "NOT FOUND" in federal NPI registry...	1780801837
Virginia Mental Health Agency Billed $142M—At 5× Peer Intensity and 100× Cost Anomalies RAPPAHANNOCK AREA COMMUNITY SERVICES BOARD	Code 97150 billed at $1,365.77 per claim—100× the national median of $13.57...	1790742153
Minnesota Mental Health Facility Billed Medicaid 19× More Per Patient Than Peers: $28.5M TOUCHSTONE MENTAL HEALTH	Filed 28.89 claims per beneficiary vs. statewide median of 1.54 — an 18.78× intensity ratio...	1790819423
A Tribal Counseling Center Billed $334M on One Code at 14x the Median Intensity STILLAGUAMISH TRIBE OF INDIANS	$333.8 million billed under T1015 (substance abuse clinic visits) -- 95.6% of all revenue through on...	1790826600
An Arkansas Supports Broker Billed $435.6M Across 23 Service Codes in 7 Years PALCO, INC.	$435.6 million billed over 7 years through a single self-billing NPI with zero external servicing pr...	1801276738
Alabama's Youth Services Agency Bills 34 Claims Per Patient for a Single Code ALABAMA DEPARTMENT OF YOUTH SERVICES	H0036 community treatment billed at 33.57 claims per beneficiary -- 10.85x the national median of 3....	1831361773
An Atlanta Disability Provider Bills $165M With Intensity Ratios Up to 15x NORMAL LIFE OF GEORGIA	T2033 residential habilitation billed at 29.88 claims per beneficiary -- 14.94x the national median ...	1851569834
Tennessee day training provider billed 14.6x typical service frequency, collecting $25M since 2020 CAPITOL CITY RESIDENTIAL HEALTHCARE TN LLC	Delivered day training services (T2033) at 14.6x the state median frequency—29.28 claims per benefic...	1851657761
NJ hospice billed Medicaid $24.2M with 13× the peer volume — at 22% of the normal cost per claim CARE ALTERNATIVES, INC.	Billed 12.93 claims per patient versus peer median of 2.21 — a 5.86× intensity ratio flagged with ma...	1861454886
Wisconsin hospice billed 14x more claims per patient than peers, costing 90% less per claim AGRACE HOSPICECARE, INCORPORATED	Billed 30.86 claims per patient vs. median of 2.21—a 13.97x intensity ratio across 6,225 beneficiari...	1861503534
Florida transport broker billed $136.5M for 6.2M rides—547K patients averaging 11 trips each RIDE2MD INC	Billed $136.5 million for 6.2 million rides across 547,881 beneficiaries from 2018-2024...	1881051167
Tribal Substance Abuse Center Bills $36.7M via Single Code at 3.6x Peer Rate QUINAULT INDIAN NATION	Single code (T1015) generated $36.7M—93.6% of all revenue over 27 months...	1881320711
Ohio hospice billed 32 visits per patient — 14x the peer median — for $24.8 million HOSPICE OF CENTRAL OHIO	32.25 claims per patient — 14.61 times the peer median of 2.21 for routine hospice home care (T2046)...	1881693125
Minnesota home health provider billed 17× more frequently per patient than peers for $30M code SPECTRUM COMMUNITY HEALTH, INC.	Billed T2031 code 26.29 times per patient vs. national median of 1.54 times — 17× more frequent...	1881767069
Medicaid Provider 1912080482: Ghost in the System with Maximum Fraud Risk Score Unknown	Composite fraud risk score: 100/100, the maximum possible rating across all detection algorithms...	1912080482
An Arkansas Group Home Bills $128M Through 87 Linked Providers FIRST STEP, INC.	$128.3M in total Medicaid payments over 7 years from a group home facility in Hot Springs, AR...	1922157403
California home health agency billed 114 visits per patient—24x the state median NATHAN O OGBATUE	Billed 113.92 visits per patient for skilled nursing (G0300)—24 times the California median of 4.74 ...	1922477975
Pennsylvania psychology org billed $33.5M with 15x more visits per patient than peers KENCREST SERVICES	Billed Medicaid $34.1 million over 41 months, with 98.2% from a single code...	1922683473
Phoenix Homeless Clinic Bills $30.7M — 99.95% From Single Code That Paid Zero for 108,748 Claims CIRCLE THE CITY	99.95% of $30.7M in billings came from single code T1015 — extreme concentration vs. peers...	1932588795
Virginia mental health board billed Medicaid $116.8M — with 30x higher intensity on single code REGION TEN COMMUNITY COMMUNITY SERVICES BOARD	H2022 billed 29.61 times per patient vs. national median of 5.27 — a 5.62x intensity ratio generatin...	1942270699
Ghost Provider: NPI 1942304126 Triggers Maximum Fraud Alert With Zero Billing Records Unknown	Composite fraud score: 100/100, the maximum alert threshold in the detection system...	1942304126
A Nashville Home Care Provider Bills $78M With Zero External Providers D&S RESIDENTIAL SERVICES, LP	$77.7M in total Medicaid payments over 7 years with T2033 (residential habilitation) accounting for ...	1952538951
Miami Home Health Agency Bills $44.9M, Delivers Nursing Visits at 7.5x Industry Intensity NOVA REHABILITATION INC.	Delivered nursing visits (S9123) at 7.52x peer intensity: 28.47 visits per patient versus median of ...	1952853988
$399.8M billed by Texas home care provider serving 410K beneficiaries over 7 years ADVANCE HI-TECH NURSING, INC.	Billed $399,821,248.65 across 6,348,236 Medicaid claims serving 409,806 beneficiaries (2018-2024)...	1962432682
A Colorado Home Care Agency Bills 31 Claims Per Patient While Peers Average 3 PERSONAL ASSISTANCE SERVICES OF COLORADO, LLC	H0038 billed at 31.21 claims/beneficiary -- 10.84x the median of 2.88 among 3,634 peers, generating ...	1972954923
Michigan home health provider billed Medicaid $85.8M, then vanished overnight in May 2021 COORDINATED COMMUNITY LIVING	Billed 26.34 claims per beneficiary for H2015 services — 8.16 times the median rate of 3.23 among 3,...	1982705661
A Delaware Provider Bills $97M on Just Three Codes in Four Years COMMUNITY SYSTEMS, INC.	$96.7M billed in just 49 months using only 3 service codes, with 99.3% of revenue from T2025 and T20...	1992863583
$35M billed by 'ghost' provider in 16 months—NPI shows 'NOT FOUND' in federal registry NOT FOUND	Provider NPI A014098800 returns 'NOT FOUND' in federal registry but billed $35,069,789.10 across 552...	A014098800
Ghost Provider: NPI A236660300 Flags Fraud Detection System With Perfect Anomaly Score Unknown	Composite fraud risk score of 100 out of 100—the maximum possible alert level...	A236660300
An Unidentified Entity Bills $71M in 18 Months, Then Vanishes A342131700	$70.7M billed in just 18 months through an entity with no NPPES identity -- no name, address, or reg...	A342131700
Ghost Provider Billed $28.3M in 11 Months—Then Vanished Without a Trace NOT FOUND	Billed $28,363,321.23 across 434,995 claims in just 11 months before disappearing from Medicaid syst...	A514465200
Ghost Provider Billed $31M in One Year With 40x Industry Intensity — Then Vanished NOT FOUND	Billed $31,000,908.97 across 467,353 claims in exactly 12 months (Nov 2018-Oct 2019), then ceased al...	A542640100
Ghost Provider Billed $39.6M in Medicaid Before Vanishing—With Claims 44× Peer Average NOT FOUND	Provider identity returns 'NOT FOUND' despite billing $39.6 million across 20 months...	A669467502
Unidentified Provider Billed Medicaid $30.5M in 15 Months — Then Vanished NOT FOUND	Filed 456,266 claims totaling $30.5 million in just 15 months before all billing stopped in March 20...	A705719901
Ghost Provider Surfaces in Medicaid Database with Maximum Fraud Risk Score Unknown	Composite fraud risk score: 100 out of 100 (maximum possible)...	A747024001
An Unregistered Entity Bills $56M in 13 Months Across a 20-Entity Network A981940000	$55.9M billed in just 13 months through an entity with no NPPES identity -- no name, address, or reg...	A981940000
A Home Health Giant Bills 16x the Median Cost for LPN Services BAYADA HOME HEALTH CARE, INC.	$421 per LPN claim (T1003) vs. national median of $26 -- a 16.1x cost ratio among 1,176 peers...	1003847807
A Homeless Health Clinic Bills 12x the Visit Rate for Home Visits BOSTON HEALTH CARE FOR THE HOMELESS PROGRAM, INC.	$513 per 99350 claim vs. national median of $35 -- a 14.7x cost ratio among 1,381 peers...	1013131804
A Michigan Behavioral Health Center Bills $343M Across 54 Codes MACOMB OAKLAND REGIONAL CENTER INC.	29.4 claims per beneficiary for H0043 vs. median of 3.3 -- an 8.8x intensity ratio among 691 peers...	1023199965
A NJ Home Care Agency Charges 15x the Median for LPN Visits STARLIGHT HOME CARE AGENCY, INC	$400 per LPN claim (T1003) vs. national median of $26 -- a 15.3x cost ratio among 1,176 peers...	1033370317
A Boston-Based Fiscal Intermediary Billed $864M on a Single Code for Colorado PUBLIC PARTNERSHIPS-COLORADO, INC.	$864.1 million billed under a single code (T2025) -- 97.4% revenue concentration in one service...	1124304621
A Tribal Wellness Center Bills $187M for Clinic Visits at 3x the Median Cost SWINOMISH HEALTH SERVICES	$186.6 million billed under a single code (T1015, clinic visits) -- 95.3% of all revenue...	1134632599
Tennessee's Second DIDD Billing Entity Channeled $1.45 Billion Through 49 Providers DEPARTMENT OF INTELLECTUAL AND DEVELOPMENTAL DISABILITIES, STATE OF TN	$1.45 billion billed through a single NPI -- combined with sibling NPI 1629436241, total exceeds $4 ...	1356709976
A 'Voluntary' Organization Quietly Became Medicaid's Third-Largest Billing Entity at $5.6 Billion TEMPUS UNLIMITED, INC.	$5.57 billion in Medicaid payments — third-highest billing entity nationally...	1376609297
A Nashville Mental Health Center Bills $364M Across 40 Service Codes CENTERSTONE OF TENNESSEE, INC.	H2018 (psychosocial rehab): 13.33 claims per beneficiary, 11.59x the median of 1.15 among 271 peers...	1396767430
A Single Supports Broker Billed $7.2 Billion for Self-Directed Home Care PUBLIC PARTNERSHIPS LLC	$7.18 billion in total Medicaid billing -- 89.8 million claims across 5.6 million beneficiaries...	1417262056
A Missouri State Entity Bills $494M Across 16 Servicing Providers for Behavioral Health STATE OF MISSOURI	$493.6 million in total billing across 20 codes, 845,819 beneficiaries, and 84 months...	1447886288
A Tennessee State Agency Billed $2.6 Billion Across 97 Servicing Providers DEPARTMENT OF INTELLECTUAL AND DEVELOPMENTAL DISABILITIES, STATE OF TN	$2.6 billion billed through a single NPI from Jan 2018 to Jun 2024 -- among the largest in the datas...	1629436241
A Michigan Nonprofit Bills 9x More Community Support Claims Per Patient Than Peers COMMUNITY LIVING NETWORK	9.0x beneficiary intensity ratio for H2015: 29.0 claims per patient vs. 3.23 median among 3,753 peer...	1649342775
A Denver Transportation Broker Billed $3.1 Billion in Medicaid Over 7 Years MODIVCARE SOLUTIONS, LLC	$3.09 billion in total Medicaid payments — one of the largest single-NPI totals in the 227M-row data...	1699725143
Alabama's Child Welfare Agency Bills 27 Community Support Claims Per Client SATE OF ALABAMA DEPT OF FINANCE	$137.3 million on code H0036 alone at 27.3 claims/beneficiary -- 8.82x the median of 3.09 among 2,48...	1902999022
One Company Billed $3 Billion for a Single Home Care Service Code FREEDOM CARE LLC	$3.03 billion in total Medicaid payments — 99.3% from a single code (T1019)...	1922467554
An Ohio Hospice Bills 10x the Visit Intensity at 1/9th the Price HOSPICE OF THE WESTERN RESERVE, INC.	$170 per T2046 claim vs. national median of $1,536 -- a 0.11x cost ratio (1/9th the typical rate) am...	1255333753