Commonwealth of Massachusetts-dds
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $9,656.56 per claim for T2016 (Habilitation, residential, waiver; per diem), which is 29.1× the national median of $331.94.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 2 procedure codes: T2016 at 29.1× median, H2015 at 3.9× median.
Consistent Billing
Monthly billing amounts show almost no natural variation (CV < 0.1).
Monthly billing coefficient of variation: 0.0658 (near-zero variation).
Statistical flags are not proof of wrongdoing. Some entities (government agencies, home care programs) may legitimately bill at high rates. Hospitals, government entities, and large care organizations may legitimately bill at higher rates due to patient acuity, overhead costs, or specialized services. Read our methodology.
Red Flags Explained
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Each flag represents a statistical test that identified unusual billing patterns. Here's what each flag on this provider means in plain English:
Cost Outlier
Cost Outlier means this provider charges significantly more per claim than other providers billing the same procedure codes. This could indicate upcoding, inflated charges, or specialized services that justify higher costs.
Rate Outlier
Rate Outlier means this provider charges above the 90th percentile for multiple different procedure codes simultaneously. While one high-cost code could reflect specialization, consistently high rates across many codes may indicate systematic overbilling.
Consistent Billing
Consistent Billing means this provider's monthly billing amounts show almost no natural variation. Real medical practices tend to have some fluctuation in monthly billing, so unnaturally steady billing can indicate automated or fabricated claims.
These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.
Risk Assessment
Bills $9,656.56 per claim for T2016 (Habilitation, residential, waiver; per diem) — 29.1× the national median of $331.94.
Bills $374.34 per claim for H2015 (Comprehensive community support services, per 15 min) — 3.9× the national median of $96.24.
Billing above the 90th percentile for 2 procedure codes simultaneously.
This is a statistical summary, not an accusation. See our methodology.
Compared to Case Management Peers
Total spending distribution among 137 providers in this specialty
This provider's total spending of $218.1M is at the 50th percentile among 137 Case Management providers.
Total Paid
$218.1M
$218,126,935
Total Claims
216K
Beneficiaries
68K
3.2 claims/patient
Avg Cost/Claim
$1K
#394 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Commonwealth of Massachusetts-dds is a Case Management provider based in Fall River, MA. From the 2018–2024 period, this provider received $218.1M in Medicaid payments across 216K claims.
Important Context
- ℹ️This provider appears to operate as a fiscal intermediary or management organization, processing payments on behalf of many individual caregivers. High aggregate billing is expected for this type of entity.
Why This Matters
This provider received $218.1M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 27,265 Medicaid beneficiaries for a full year at average per-enrollee costs.
Monthly Spending Trend
Yearly Spending
Procedure Breakdown
Cost per claim compared to national benchmarks
This provider bills for 9 distinct procedure codes. The top code (T2016 (Habilitation, residential, waiver; per diem)) accounts for 83% of total spending.
$180.2M
19K claims
$9,656.56
$331.94
Habilitation, residential, waiver; per diem
$180.2M
19K claims · 82.6%
$12.1M
32K claims
$374.34
$96.24
Comprehensive community support services, per 15 min
$12.1M
32K claims · 5.5%
$8.1M
24K claims
$338.14
$300.13
Community transition, waiver; per service
$8.1M
24K claims · 3.7%
$5.2M
33K claims
$155.77
$88.91
Habilitation, prevocational, waiver; per 15 min
$5.2M
33K claims · 2.4%
$4.5M
25K claims
$183.27
$67.58
Day care services, adult, per half day
$4.5M
25K claims · 2.1%
Supported employment, per 15 min
$3.7M
23K claims · 1.7%
$3.2M
20K claims
$161.40
$150.51
Day habilitation, waiver; per 15 min
$3.2M
20K claims · 1.5%
$1.1M
39K claims
$28.00
$21.70
Non-emergency transport; encounter/trip
$1.1M
39K claims · 0.5%
Companion care, adult, per diem
$19K
136 claims · 0.0%
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