14 Providers Bill Like Clockwork — Is That Normal?
Real medical practices have natural variation — flu season, holidays, staff changes. But 14 providers billing $100K+/month maintain less than 5% variation for years. The smoothest bills ~$379K/month for 83 months with almost no change.
14
Smooth billers
0.03
Lowest CV
83
Months of data
50
Most volatile
What is Coefficient of Variation?
The coefficient of variation (CV) measures how uniform a set of numbers is. It's the standard deviation divided by the mean — essentially, how much the monthly bills bounce around their average.
CV = 0.00
Exactly $100,000 every single month. Perfect uniformity.
CV = 0.15
Some months $85K, others $115K. Normal medical practice variation.
CV = 2.00+
Wild swings — $10K one month, $500K the next. Often pandemic-related spikes.
Real medical practices typically have a CV between 0.15 and 0.40. These providers are all under 0.05 — meaning their monthly billing varies by less than 5%.
The Smoothest Billers
70 months · $447.5M total
CV = 0.0494
coefficient of variation
70 months · $275.0M total
CV = 0.0463
coefficient of variation
82 months · $80.2M total
CV = 0.0461
coefficient of variation
44 months · $77.1M total
CV = 0.0413
coefficient of variation
44 months · $56.7M total
CV = 0.0430
coefficient of variation
44 months · $39.9M total
CV = 0.0400
coefficient of variation
Senior Resources of West Michigan: The Flatline
This provider billed an average of $379K/month for 83 consecutive months with a CV of just 0.0299. Their lowest month was $346K and their highest was $396K — a max/min ratio of only 1.14x. That's nearly 7 years of billing that barely budges.
To put this in perspective: imagine a medical practice that sees patients every day. Some months are busier (flu season, back-to-school physicals). Some are slower (holidays, summer). Staff take vacations, patients cancel appointments, insurance reimbursement rates change. All of this creates natural variation in monthly billing.
Yet these 14 providers bill with less variation than most people's monthly grocery spending. The top provider on the list bills over $6.4M/month for 70 months with a CV of 0.0494 — totaling $447.5M.
When smooth billing is legitimate
Government contracts and per-diem arrangements can produce legitimately smooth billing. A group home that houses 20 residents at a fixed daily rate will bill nearly the same amount each month. But extreme uniformity in medical billing — where patient needs fluctuate by nature — deserves a closer look, especially when the amounts are in the millions.
All 14 Smooth Billers (CV < 0.05, $100K+/month)
| # | Provider | CV | Avg/Month | Total Paid | Months | Max/Min |
|---|---|---|---|---|---|---|
| 1 | Commonwealth Of Massachusetts-dds | 0.0494 | $6.4M | $447.5M | 70 | 1.29x |
| 2 | Department Of Developmental Services | 0.0463 | $3.9M | $275.0M | 70 | 1.27x |
| 3 | Exceptional Persons Inc | 0.0461 | $978K | $80.2M | 82 | 1.29x |
| 4 | Crf First Choice Inc. | 0.0413 | $1.8M | $77.1M | 44 | 1.24x |
| 5 | Normal Life Of Indiana | 0.0430 | $1.3M | $56.7M | 44 | 1.27x |
| 6 | Quinton Residential Living | 0.0400 | $906K | $39.9M | 44 | 1.21x |
| 7 | Senior Resources Of West Michigan | 0.0299 | $379K | $31.5M | 83 | 1.14x |
| 8 | Berkshire County Arc, Inc. | 0.0422 | $237K | $19.7M | 83 | 1.25x |
| 9 | Northeast Michigan Community Service Agency, Inc. | 0.0467 | $234K | $19.4M | 83 | 1.21x |
| 10 | NPI: 1578506093 | 0.0401 | $317K | $10.5M | 33 | 1.17x |
| 11 | NPI: 1265569818 | 0.0475 | $226K | $9.9M | 44 | 1.29x |
| 12 | NPI: 1285859736 | 0.0478 | $202K | $6.1M | 30 | 1.19x |
| 13 | NPI: 1043889009 | 0.0465 | $151K | $5.3M | 35 | 1.24x |
| 14 | NPI: 1952368219 | 0.0313 | $104K | $2.5M | 24 | 1.17x |
For Comparison: The Most Volatile Billers
These providers show the opposite pattern — extreme variation in monthly billing (CV > 2.0). Many are pandemic-related (COVID testing labs, dialysis centers with capacity surges).
| # | Provider | CV | Avg/Month | Total Paid | Months |
|---|---|---|---|---|---|
| 1 | Infinity Diagnostics Laboratory Inc | 2.4617 | $2.2M | $138.0M | 64 |
| 2 | NPI: 1073587937 | 2.4051 | $696K | $56.4M | 81 |
| 3 | Liberty Dialysis - Hawaii Llc | 2.8254 | $515K | $42.7M | 83 |
| 4 | Wellspace Health | 2.7707 | $525K | $42.5M | 81 |
| 5 | Mvml Inc. | 2.2001 | $834K | $27.5M | 33 |
| 6 | Tempus Unlimited Inc. | 2.6180 | $314K | $26.3M | 84 |
| 7 | Suffolk Primary Health Llc | 2.8672 | $265K | $22.2M | 84 |
| 8 | Faculty Physicians And Surgeons Of Llusm | 2.1082 | $293K | $21.4M | 73 |
| 9 | Southeast Alaska Regional Health Consortium | 2.0293 | $240K | $19.9M | 83 |
| 10 | Liberty Dialysis - Hawaii Llc | 2.7320 | $234K | $19.4M | 83 |
| 11 | Liberty Dialysis - Hawaii Llc | 2.2656 | $229K | $19.2M | 84 |
| 12 | Usa Biosciences Llc | 2.4127 | $371K | $18.5M | 50 |
| 13 | Accredo Health Group Inc | 2.7646 | $226K | $18.1M | 80 |
| 14 | Southern California Permanente Medical Group | 2.1994 | $211K | $17.8M | 84 |
| 15 | Uvalde County Hospital Authority | 2.1098 | $297K | $16.3M | 55 |
| 16 | Southern California Permanente Medical Group | 2.1153 | $186K | $15.7M | 84 |
| 17 | Liberty Dialysis - Hawaii Llc | 2.3809 | $186K | $15.6M | 84 |
| 18 | Nhs Northstar, Inc. | 2.0956 | $180K | $15.1M | 84 |
| 19 | NPI: 1427099332 | 2.9146 | $177K | $14.7M | 83 |
| 20 | Oxford Clinical Laboratory Inc. | 3.0193 | $205K | $14.0M | 68 |
Key Takeaways
- ▸14 providers billing $100K+ per month maintain less than 5% variation over 2+ years of data.
- ▸The smoothest biller has a CV of 0.0299 — normal medical practices range from 0.15 to 0.40.
- ▸Per-diem and government contract arrangements can produce legitimately smooth billing, but the extreme uniformity of these providers warrants closer inspection.
- ▸The most volatile biller (CV = 2.46) is Infinity Diagnostics Laboratory Inc — a COVID testing lab whose billing spiked and crashed.
Source: HHS T-MSIS Other Services File (2018–2024) · 227M records