When Two Codes Have the Same Number of Claims, Something May Be Wrong
When a provider bills two different procedure codes with nearly identical claim counts across tens of thousands of services, it suggests every single encounter is being billed twice — once under each code.
Code 1
T2016
Habilitation, residential, waiver; per diem
82,639
claims
$929.6M
Code 2
T2023
Community transition, waiver; per service
82,963
claims
$28.1M
The Closest Matches
These providers have the lowest percentage difference between claim counts for two different procedure codes. A 0.01% difference across 800,000+ claims is statistically extraordinary.
What Is Dual-Billing?
Dual-billing occurs when a provider systematically bills two procedure codes for the same service encounter. In legitimate medicine, some services do naturally pair together — a residential care per-diem (T2016) might always include a community transition service (T2023). But when the claim counts for two codes match within 0.4% across 82,000+ claims, it indicates that virtually every single encounter generates two bills.
The NEMT Connection
This exact pattern was documented in confirmed NEMT (Non-Emergency Medical Transportation) fraud cases. In the Pedro Denga case, investigators found near-equal claim counts for A0130 (wheelchair van) and A0380 (mileage), indicating every single trip was billed for both vehicle dispatch and mileage — a common fraud scheme in transportation billing.
The data shows this pattern at massive scale. County of Riverside bills H0034 (targeted case management) and T1017 (case management, 15 min) with 865,462 vs 865,575 claims — a 0.01% difference across nearly a million claims, totaling $370.2M.
Lab companies show particularly striking patterns. Laboratory Corporation of America appears multiple times, billing STI test codes 87491 and 87591 with near-identical counts (3.98M vs 3.97M, 0.26% difference). This is more likely legitimate — chlamydia and gonorrhea tests are typically ordered together — but it shows how the pattern can appear in both suspicious and routine contexts.
Context matters
Some dual-billing is legitimate — a provider may always perform two services together, or a lab may always run two tests as a panel. But when claim counts match within 1-3% across hundreds of thousands of claims worth hundreds of millions of dollars, it suggests systematic pairing that deserves scrutiny — especially when the two codes represent conceptually different services.
Top Dual-Billing Pairs by Combined Spending
| # | Provider | Code 1 | Claims 1 | Code 2 | Claims 2 | Diff | Combined $ |
|---|---|---|---|---|---|---|---|
| 1 | County Of Riverside | H0034 | 865K | T1017 | 866K | 0.01% | $370.2M |
| 2 | Motivational Services Inc | H0019 | 178K | T1020 | 178K | 0.01% | $92.1M |
| 3 | Moka Corporation | H2016 | 296K | T1020 | 297K | 0.04% | $96.7M |
| 4 | Employment Specialists Of Maine Inc. | H0019 | 24K | T1020 | 24K | 0.04% | $84.2M |
| 5 | Centerstone Of Tennessee Inc. | 90837 | 463K | S0280 | 462K | 0.05% | $116.3M |
| 6 | Macomb Oakland Regional Center Inc. | H2016 | 546K | T1020 | 545K | 0.05% | $97.9M |
| 7 | NPI: 1013074509 | H2016 | 78K | T1020 | 78K | 0.12% | $77.0M |
| 8 | Bay Human Services Inc | H2016 | 52K | T1020 | 52K | 0.14% | $88.9M |
| 9 | Lovable Family Home Care Llc | S5130 | 996K | T1019 | 994K | 0.15% | $67.1M |
| 10 | New York Network Ipa Inc | U0003 | 1.4M | U0005 | 1.4M | 0.17% | $132.1M |
| 11 | Laboratory Corporation Of America Holdings | 87491 | 1.7M | 87591 | 1.7M | 0.18% | $99.0M |
| 12 | Alameda County Behavioral Health Care | H2010 | 303K | T1017 | 303K | 0.19% | $152.6M |
| 13 | Looking Upwards Inc. | T2017 | 31K | T2033 | 31K | 0.24% | $95.0M |
| 14 | Guardiantrac. Llc | S5126 | 234K | T2025 | 233K | 0.25% | $92.2M |
| 15 | Modivcare Solutions, Llc | A0090 | 9.5M | T2003 | 9.5M | 0.26% | $332.0M |
| 16 | Laboratory Corporation Of America Holdings | 87491 | 4.0M | 87591 | 4.0M | 0.26% | $164.5M |
| 17 | Aeroflow Inc | E0603 | 715K | T4541 | 713K | 0.29% | $114.0M |
| 18 | Gentech Laboratories Llc | 87636 | 286K | 87637 | 286K | 0.32% | $72.3M |
| 19 | Yale New Haven Hospital | 99283 | 231K | U0003 | 230K | 0.37% | $69.1M |
| 20 | NPI: 1649833286 | S5125 | 401K | T2017 | 399K | 0.38% | $103.7M |
| 21 | Commonwealth Of Mass-dds | T2016 | 83K | T2023 | 83K | 0.39% | $957.7M |
| 22 | Gateways Community Services | H2015 | 53K | T2025 | 53K | 0.43% | $69.6M |
| 23 | Hennepin Healthcare System Inc | 99232 | 261K | 99284 | 262K | 0.44% | $66.9M |
| 24 | Guardiantrac. Llc | S5150 | 369K | T1005 | 371K | 0.45% | $68.2M |
| 25 | Yale New Haven Hospital | 83735 | 158K | 99285 | 159K | 0.49% | $112.7M |
| 26 | Res-care New Jersey Inc. | H2016 | 72K | T2021 | 73K | 0.49% | $81.8M |
| 27 | Laboratory Corporation Of America Holdings | 87491 | 2.7M | 87591 | 2.7M | 0.53% | $70.5M |
| 28 | Spectrum Community Services | H2016 | 178K | T1020 | 177K | 0.54% | $110.9M |
| 29 | Unilab Corporation | 87491 | 3.4M | 87591 | 3.3M | 0.54% | $72.7M |
| 30 | Laboratory Corporation Of America Holdings | 84443 | 2.7M | 87661 | 2.8M | 0.57% | $72.1M |
| 31 | Nationwide Children's Hospital | 96110 | 187K | 96127 | 185K | 0.76% | $67.6M |
| 32 | Stillaguamish Tribe Of Indians | H0020 | 939K | T1015 | 946K | 0.77% | $346.7M |
| 33 | NPI: 1184009235 | H2016 | 127K | T2021 | 128K | 0.79% | $98.9M |
| 34 | Infinity Diagnostics Laboratory Inc | U0003 | 2.3M | U0005 | 2.3M | 0.82% | $129.1M |
| 35 | Laboratory Corporation Of America Holdings | 82607 | 929K | U0003 | 921K | 0.82% | $71.0M |
| 36 | Moka Corporation | H2015 | 294K | H2016 | 296K | 0.84% | $83.8M |
| 37 | Dignity Health | 0450 | 142K | 0456 | 143K | 0.89% | $69.6M |
| 38 | Jersey City Medical Center | 99283 | 100K | A0429 | 99K | 0.91% | $66.7M |
| 39 | Yukon-kuskokwim Health Corporation | A0140 | 175K | A0170 | 173K | 0.94% | $96.2M |
| 40 | City Of Phoenix Arizona | A0398 | 127K | A0427 | 128K | 1% | $69.0M |
| 41 | County Of Ventura | H0019 | 190K | H2010 | 192K | 1.04% | $105.5M |
| 42 | Alameda County Behavioral Health Care | H0018 | 55K | S9484 | 56K | 1.08% | $179.7M |
| 43 | Nyu Langone Hospitals | 90832 | 253K | 99213 | 256K | 1.1% | $66.9M |
| 44 | Help At Home, Llc | S5125 | 547K | T2016 | 541K | 1.16% | $145.7M |
| 45 | County Of Santa Clara | 90837 | 80K | H2019 | 79K | 1.17% | $78.0M |
| 46 | Texas Children's Hospital | 99214 | 85K | 99285 | 84K | 1.3% | $81.1M |
| 47 | Laboratory Corporation Of America Holdings | 80307 | 2.2M | 82306 | 2.2M | 1.32% | $108.0M |
| 48 | Commonwealth Of Massachusetts-dds | H2015 | 62K | T2016 | 63K | 1.35% | $823.9M |
| 49 | Hartford Hospital | 99284 | 107K | 99285 | 105K | 1.36% | $86.2M |
| 50 | Aoc Tx Llc | 92507 | 147K | S9124 | 145K | 1.41% | $75.6M |
| 51 | Accra Care | S5130 | 991K | S5135 | 977K | 1.42% | $191.4M |
| 52 | County Of Ventura | H0020 | 466K | T1017 | 473K | 1.43% | $104.2M |
| 53 | Hennepin Healthcare System Inc | 99215 | 93K | A0427 | 94K | 1.47% | $76.9M |
| 54 | NPI: 1578013017 | H0038 | 158K | T1019 | 156K | 1.5% | $66.8M |
| 55 | New York Network Ipa Inc | 99211 | 1.4M | U0003 | 1.4M | 1.52% | $133.9M |
| 56 | Hennepin Healthcare System Inc | 80048 | 93K | A0427 | 94K | 1.55% | $68.9M |
| 57 | Laboratory Corporation Of America Holdings | 87661 | 1.4M | U0003 | 1.4M | 1.64% | $112.3M |
| 58 | NPI: 1871754473 | A0430 | 14K | A0435 | 14K | 1.64% | $67.4M |
| 59 | New York Network Ipa Inc | 99211 | 1.4M | U0005 | 1.4M | 1.68% | $67.7M |
| 60 | Millennium Health Llc | 80353 | 976K | G0483 | 993K | 1.72% | $133.3M |
Key Takeaways
- ▸The top dual-billing pair bills T2016 and T2023 with a 0.39% difference across 83K claims, worth $957.7M.
- ▸Some matches as close as 0.01% across hundreds of thousands of claims — meaning virtually every encounter generates exactly two bills.
- ▸Lab companies (LabCorp) show legitimate dual-billing from paired tests, but home care and behavioral health providers show patterns that merit investigation.
- ▸This pattern has been documented in confirmed NEMT fraud cases, where every trip generated matched ambulance and mileage claims.
Source: HHS T-MSIS Other Services File (2018–2024) · 227M records