Habit Opco, LLC
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 2 procedure codes: 99211 at 4.8× median, 99213 at 1.9× median.
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:
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.
These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.
Advanced Detection Signals
Additional statistical tests from advanced fraud detection methods
These signals use advanced statistical methods including digit distribution analysis, change-point detection, and market concentration metrics. Learn more.
Risk Assessment
Bills $61.94 per claim for 99211 (Office/outpatient visit, minimal complexity) — 4.8× the national median of $12.93.
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 $224.1M is at the 50th percentile among 137 Case Management providers.
Total Paid
$224.1M
$224,149,167
Total Claims
9.6M
Beneficiaries
845K
11.4 claims/patient
Avg Cost/Claim
$23
#379 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Habit Opco, LLC is a Case Management provider based in Springfield, MA. From the 2018–2024 period, this provider received $224.1M in Medicaid payments across 9.6M 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 $224.1M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 28,018 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 28 distinct procedure codes. The top code (H0020 (Alcohol/drug services; methadone administration)) accounts for 53% of total spending.
$117.7M
8.4M claims
$13.95
$18.95
Alcohol/drug services; methadone administration
$117.7M
8.4M claims · 52.5%
$64.0M
534K claims
$119.69
$73.29
Medication-assisted treatment, opioid use disorder, per month
$64.0M
534K claims · 28.5%
$15.3M
131K claims
$117.06
$121.16
Clinic visit/encounter, all-inclusive
$15.3M
131K claims · 6.8%
$10.7M
40K claims
$267.10
$137.85
Other specified case management service, per 15 minutes
$10.7M
40K claims · 4.8%
$3.9M
180K claims · 1.7%
$3.4M
46K claims · 1.5%
$2.1M
39K claims
$52.99
$74.63
Behavioral health counseling & therapy, per 15 min
$2.1M
39K claims · 0.9%
$1.7M
108K claims
$16.17
$47.35
Alcohol and/or drug services, group counseling
$1.7M
108K claims · 0.8%
Group psychotherapy
$1.4M
40K claims · 0.6%
$1.1M
8K claims · 0.5%
Psychotherapy, 30 minutes
$1.1M
26K claims · 0.5%
$500K
3K claims
$193.69
$108.91
Psychiatric diagnostic evaluation with medical services
$500K
3K claims · 0.2%
Psychotherapy, 45 minutes
$359K
4K claims · 0.2%
$232K
2K claims
$114.51
$99.21
Psychiatric diagnostic evaluation
$232K
2K claims · 0.1%
Psychotherapy, 60 minutes
$183K
2K claims · 0.1%
$113K
2K claims
$61.94
$12.93
Office/outpatient visit, minimal complexity
$113K
2K claims · 0.1%
$90K
7K claims
$13.63
$96.24
Comprehensive community support services, per 15 min
$90K
7K claims · 0.0%
$84K
1K claims
$76.25
$56.90
Medication training and management, per 15 min
$84K
1K claims · 0.0%
$82K
1K claims
$71.59
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$82K
1K claims · 0.0%
$51K
8K claims · 0.0%
$36K
3K claims · 0.0%
$27K
274 claims
$100.30
$321.53
Comprehensive community support services, per 15 min
$27K
274 claims · 0.0%
$25K
2K claims · 0.0%
$15K
6K claims · 0.0%
Alcohol and/or drug assessment
$9K
141 claims · 0.0%
$8K
2K claims · 0.0%
$4K
3K claims · 0.0%
$3K
48 claims
$70.44
$74.09
Office/outpatient visit, high complexity
$3K
48 claims · 0.0%
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