Solo Operators: Providers Billing $5M+ Entirely Themselves
Most large Medicaid billers are organizations that bill on behalf of many practitioners. But some providers bill $5M+ where 95%+ of payments go to claims where the billing and servicing NPI are the same entity. These “solo operators” are processing millions in claims essentially alone — an unusual pattern that warrants scrutiny.
85
At 100% self-billing
$85.06B
Total self-biller spending
$7.18B
Highest single provider
57
Also on fraud watchlist
What Is Self-Billing?
In Medicaid, the “billing NPI” is the entity that submits the claim, and the “servicing NPI” is the provider who actually delivered the care. Large health systems, hospital networks, and billing intermediaries typically submit claims on behalf of many individual practitioners — so their billing NPI appears on thousands of claims from different servicing providers.
Typical Pattern
Billing NPI ≠ Servicing NPI. An organization bills for many practitioners.
Self-Billing (95%+)
Billing NPI = Servicing NPI on nearly every claim. One entity does everything.
100% Self-Billing
Every single claim is billed and serviced by the same NPI. No outside practitioners involved.
The Largest Solo Operators
NPI: 1417262056
$7.18B
total paid
$6.83B
self-billed
95.2%
self-billing ratio
89.8M
total claims
NPI: 1376609297
$5.57B
total paid
$5.55B
self-billed
99.6%
self-billing ratio
63.5M
total claims
NPI: 1922467554
$3.03B
total paid
$3.03B
self-billed
100.0%
self-billing ratio
22.0M
total claims
NPI: 1538649983
$2.11B
total paid
$2.11B
self-billed
100.0%
self-billing ratio
22.2M
total claims
NPI: 1962650622
$1.68B
total paid
$1.68B
self-billed
100.0%
self-billing ratio
11.2M
total claims
We analyzed billing-vs-servicing NPI relationships across all 227 million records and identified 100 providers who bill $5M+ where at least 95% of their payments flow to claims where they are both the billing and servicing entity. Together, these solo operators account for $85.06B in total Medicaid spending across 1.0B claims.
The Scale: 85 Providers at 100% Self-Billing
Of the 100 providers on this list, 85 bill at exactly 100% self-billing ratio — meaning every single claim they submitted over seven years listed themselves as both the billing and servicing provider. For entities processing millions of claims and billions in payments, having zero involvement from any other practitioner is a striking pattern.
The highest single self-biller received $7.18B across 89.8M claims, with 95.2% of payments going to self-billed claims. At that volume, the question becomes: can one entity truly deliver that scale of services without any other providers involved in billing?
Watchlist Cross-Reference: 57 Overlap
Of the 100 self-billing providers, 57 also appear on our fraud watchlist, flagged for independent statistical anomalies like billing swings, cost-per-claim outliers, or massive new entrant patterns. The overlap between self-billing behavior and other fraud signals reinforces the value of investigating these providers further.
When self-billing is legitimate
Many providers legitimately bill for their own services. Nursing homes, DME suppliers, home health agencies, and solo medical practices often operate with a single NPI for both billing and service delivery. Government entities and managed care organizations may also show high self-billing ratios. This analysis identifies an unusual pattern at high dollar volumes — not proof of fraud, but a signal that these providers warrant closer scrutiny given the scale of their self-billed operations.
Top 30 Self-Billing Providers
| # | Provider | Total Paid | Self % | Claims |
|---|---|---|---|---|
| 1 | Public Partnerships LLC WLNPI: 1417262056 | $7.18B | 95.2% | 89.8M |
| 2 | Tempus Unlimited, Inc. NPI: 1376609297 | $5.57B | 99.6% | 63.5M |
| 3 | Freedom Care LLC NPI: 1922467554 | $3.03B | 100.0% | 22.0M |
| 4 | Consumer Direct Care Network Virginia WLNPI: 1538649983 | $2.11B | 100.0% | 22.2M |
| 5 | American Business Institute Corp NPI: 1962650622 | $1.68B | 100.0% | 11.2M |
| 6 | Premier Home Health Care Services INC NPI: 1720151046 | $1.48B | 100.0% | 7.9M |
| 7 | Assistcarehome Healthcare Services WLNPI: 1396051694 | $1.44B | 100.0% | 9.4M |
| 8 | Laboratory Corporation of America Holdings WLNPI: 1538144910 | $1.44B | 95.3% | 103.9M |
| 9 | Department of Developmental Services WLNPI: 1750504064 | $1.35B | 100.0% | 1.7M |
| 10 | City of Chicago WLNPI: 1376554592 | $1.23B | 100.0% | 1.6M |
| 11 | Commonwealth of Massachusets WLNPI: 1518096411 | $1.14B | 100.0% | 1.6M |
| 12 | Nae Edison LLC WLNPI: 1780816991 | $1.11B | 100.0% | 6.9M |
| 13 | Heart to Heart Home Care Inc. NPI: 1275657553 | $1.10B | 100.0% | 7.6M |
| 14 | Commonwealth of Mass-dds WLNPI: 1134250475 | $1.10B | 100.0% | 1.4M |
| 15 | Marks Homecare Agency INC WLNPI: 1376097303 | $1.08B | 100.0% | 6.7M |
| 16 | Yale New Haven Hospital WLNPI: 1578778726 | $1.08B | 100.0% | 23.6M |
| 17 | New Partners INC NPI: 1083783013 | $1.08B | 100.0% | 5.9M |
| 18 | Department of Health and Senior Services WLNPI: 1326168840 | $1.07B | 100.0% | 3.3M |
| 19 | Concepts of Independence Inc. WLNPI: 1184703415 | $1.06B | 100.0% | 5.0M |
| 20 | Stavros Center for Independent Living Inc. WLNPI: 1518098359 | $1.04B | 100.0% | 11.2M |
| 21 | Health Acquisition Corp. NPI: 1518049485 | $1.03B | 100.0% | 5.7M |
| 22 | Mains'l Florida, Inc. WLNPI: 1932341898 | $996.8M | 100.0% | 306K |
| 23 | Caring Professionals INC NPI: 1457410904 | $953.5M | 100.0% | 5.6M |
| 24 | Public Partnerships-colorado Inc. WLNPI: 1124304621 | $887.5M | 100.0% | 5.6M |
| 25 | Commonwealth of Massachusetts-dds WLNPI: 1245354000 | $881.9M | 100.0% | 781K |
| 26 | Platinum Home Health Care Inc. NPI: 1871821710 | $865.9M | 100.0% | 4.8M |
| 27 | C and T Homecare Services LLC WLNPI: 1033571658 | $848.2M | 100.0% | 5.7M |
| 28 | Home Family Care INC NPI: 1801060363 | $842.5M | 100.0% | 5.4M |
| 29 | Human Care LLC WLNPI: 1730438706 | $840.5M | 100.0% | 4.9M |
| 30 | Tennessee Department of Children's Services WLNPI: 1124494059 | $781.0M | 100.0% | 911K |
Key Takeaways
- ▸100 providers bill $5M+ with 95%+ self-billing ratios, totaling $85.06B across 1.0B claims.
- ▸85 providers operate at exactly 100% self-billing — every claim they submitted listed themselves as both biller and servicer.
- ▸57 of these providers also appear on the fraud watchlist, flagged independently for statistical billing anomalies.
- ▸Legitimate solo practices, nursing homes, and DME suppliers may have high self-billing ratios. This is a signal for further investigation, not proof of fraud.
Source: HHS T-MSIS Other Services File (2018–2024) · 227M records