Consumer Directed Choices, Inc.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 2 procedure codes: 99199 at 48.5× median, T1022 at 1.6× 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.
Risk Assessment
Bills $261.22 per claim for 99199 (Unlisted special service, procedure, or report) — 48.5× the national median of $5.39.
Billing above the 90th percentile for 2 procedure codes simultaneously.
This is a statistical summary, not an accusation. See our methodology.
Total Paid
$238.2M
$238,168,727
Total Claims
1.4M
Beneficiaries
65K
21.4 claims/patient
Avg Cost/Claim
$170
#354 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Consumer Directed Choices, Inc. is a Technician, Attendant Care Provider provider based in Albany, NY. From the 2018–2024 period, this provider received $238.2M in Medicaid payments across 1.4M claims.
Important Context
- ℹ️This provider is a known fiscal management organization for self-directed care programs. They manage billing on behalf of thousands of individual caregivers, so aggregate billing is high by design. However, the self-directed care category has been identified as fraud-prone by regulators.
Why This Matters
This provider received $238.2M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 29,771 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 4 distinct procedure codes. The top code (T1019 (Personal care services, per 15 min)) accounts for 100% of total spending.
$237.4M
1.4M claims
$169.60
$82.47
Personal care services, per 15 min
$237.4M
1.4M claims · 99.7%
$562K
2K claims
$312.69
$296.27
Personal care services, per diem
$562K
2K claims · 0.2%
$240K
918 claims
$261.22
$5.39
Unlisted special service, procedure, or report
$240K
918 claims · 0.1%
$11K
36 claims · 0.0%