Macomb Oakland Regional Center Inc.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 26 procedure codes: T1016 at 4.7× median, H0032 at 2.8× 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 $235.56 per claim for T1016 (Case management, each 15 min) — 4.8× the national median of $49.62.
Bills $248.71 per claim for T1017 (Targeted case management, per 15 min) — 3.6× the national median of $69.56.
Bills $478.25 per claim for H0031 (Mental health assessment by non-physician) — 5.0× the national median of $96.18.
Billing in the top 1% nationally for 3 procedure codes: 0365T, H0002, T1001.
This is a statistical summary, not an accusation. See our methodology.
Compared to Community/Behavioral Health Peers
Total spending distribution among 218 providers in this specialty
This provider's total spending of $342.6M is at the 90th percentile among 218 Community/Behavioral Health providers.
Above 90th percentile for this specialty — higher spending than 196 of 218 peers
Total Paid
$342.6M
$342,635,898
Total Claims
2.6M
Beneficiaries
581K
4.5 claims/patient
Avg Cost/Claim
$130
#203 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Macomb Oakland Regional Center Inc. is a Community/Behavioral Health provider based in Auburn Hills, MI. From the 2018–2024 period, this provider received $342.6M in Medicaid payments across 2.6M claims.
Why This Matters
This provider received $342.6M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 42,829 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 30 distinct procedure codes. The top code (H0043 (Supported housing, per diem)) accounts for 20% of total spending.
Supported housing, per diem
$69.6M
372K claims · 20.3%
$52.8M
546K claims
$96.76
$321.53
Comprehensive community support services, per 15 min
$52.8M
546K claims · 15.4%
$45.1M
545K claims
$82.68
$296.27
Personal care services, per diem
$45.1M
545K claims · 13.2%
Case management, each 15 min
$44.0M
187K claims · 12.8%
$42.0M
169K claims
$248.71
$69.56
Targeted case management, per 15 min
$42.0M
169K claims · 12.3%
$30.4M
397K claims
$76.70
$96.24
Comprehensive community support services, per 15 min
$30.4M
397K claims · 8.9%
$11.2M
49K claims
$227.31
$80.64
Mental health service plan development
$11.2M
49K claims · 3.3%
$10.4M
22K claims
$478.25
$96.18
Mental health assessment by non-physician
$10.4M
22K claims · 3.0%
$5.4M
121K claims
$44.59
$71.40
Respite care services, per 15 minutes
$5.4M
121K claims · 1.6%
$4.6M
23K claims
$203.48
$167.38
Adaptive behavior treatment by protocol, per 15 min
$4.6M
23K claims · 1.3%
$4.5M
13K claims
$339.01
$106.05
Adaptive behavior treatment, each additional thirty minutes
$4.5M
13K claims · 1.3%
$2.6M
47K claims
$53.91
$124.39
Waiver services, NOS; per 15 min
$2.6M
47K claims · 0.7%
$2.0M
13K claims
$151.48
$114.71
Comprehensive multidisciplinary evaluation
$2.0M
13K claims · 0.6%
$1.9M
7K claims
$293.01
$87.13
Home care training, family member, per session
$1.9M
7K claims · 0.6%
$1.6M
20K claims
$78.53
$25.06
Office/outpatient visit, low complexity
$1.6M
20K claims · 0.5%
$1.4M
2K claims
$590.72
$300.13
Community transition, waiver; per service
$1.4M
2K claims · 0.4%
$1.2M
18K claims
$63.95
$88.93
Specialized transportation, waiver, per trip, extra
$1.2M
18K claims · 0.3%
$1.0M
6K claims
$169.28
$146.45
Adaptive behavior treatment with protocol modification, per 15 minutes
$1.0M
6K claims · 0.3%
Unskilled respite care, per diem
$817K
8K claims · 0.2%
Psychotherapy, 60 minutes
$814K
4K claims · 0.2%
$793K
5K claims
$171.73
$28.63
Miscellaneous therapeutic items and supplies
$793K
5K claims · 0.2%
$767K
15K claims
$51.35
$83.88
Skills training & development, per 15 min
$767K
15K claims · 0.2%
Behavior identification assessment
$695K
2K claims · 0.2%
$686K
12K claims · 0.2%
RN services, per 15 minutes
$657K
3K claims · 0.2%
$631K
4K claims
$145.31
$119.19
Respite care services, not in the home, per diem
$631K
4K claims · 0.2%
Behavioral health screening
$613K
998 claims · 0.2%
$609K
3K claims · 0.2%
$495K
1K claims
$455.03
$49.05
Nursing assessment/evaluation, per visit
$495K
1K claims · 0.1%
Psychiatric diagnostic evaluation
$449K
1K claims · 0.1%
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