New Jersey Division of Developmental Disabilities
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $3,700.51 per claim for H2016 (Comprehensive community support services, per 15 min), which is 11.5× the national median of $321.53.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 3 procedure codes: H2016 at 11.5× median, T2020 at 3.9× median.
High Cost Per Claim
Average payment per claim is much higher than peers billing the same procedures.
Spending Spike
Experienced a dramatic increase in billing over a short period.
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.
High Cost Per Claim
High Cost Per Claim means each individual claim from this provider costs significantly more than what other providers charge for the same services. This could indicate upcoding (billing for more expensive services than provided) or legitimate specialized care.
Spending Spike
Spending Spike means this provider experienced a dramatic, sudden increase in billing over a short period. Legitimate causes include new contracts or expanded services, but this pattern also appears in billing fraud ramp-ups.
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 $3,700.51 per claim for H2016 (Comprehensive community support services, per 15 min) — 11.5× the national median of $321.53.
Bills $336.89 per claim for T2020 (Day habilitation, waiver; per diem) — 3.9× the national median of $87.34.
Bills $1,522.89 per claim for S9125 (Respite care, in the home, per diem) — 8.1× the national median of $187.28.
Billing above the 90th percentile for 3 procedure codes simultaneously.
This is a statistical summary, not an accusation. See our methodology.
Compared to Day Training Developmentally Disabled Services Peers
Total spending distribution among 22 providers in this specialty
This provider's total spending of $333.9M is at the 99th percentile among 22 Day Training Developmentally Disabled Services providers.
Above 99th percentile for this specialty — higher spending than 21 of 22 peers
Total Paid
$333.9M
$333,873,625
Total Claims
738K
Beneficiaries
145K
5.1 claims/patient
Avg Cost/Claim
$453
#210 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
New Jersey Division of Developmental Disabilities is a Day Training Developmentally Disabled Services provider based in Hamilton, NJ. From the 2018–2024 period, this provider received $333.9M in Medicaid payments across 738K claims.
Why This Matters
This provider received $333.9M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 41,734 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 11 distinct procedure codes. The top code (H2016 (Comprehensive community support services, per 15 min)) accounts for 64% of total spending.
$215.2M
58K claims
$3,700.51
$321.53
Comprehensive community support services, per 15 min
$215.2M
58K claims · 64.5%
$61.5M
393K claims
$156.54
$96.24
Comprehensive community support services, per 15 min
$61.5M
393K claims · 18.4%
Day habilitation, waiver; per diem
$41.2M
122K claims · 12.4%
$5.8M
37K claims
$157.45
$162.29
Supports brokerage, self-directed; per 15 min
$5.8M
37K claims · 1.7%
Respite care, in the home, per diem
$4.9M
3K claims · 1.5%
$1.3M
32K claims
$40.10
$88.27
Habilitation, prevocational, waiver, per diem
$1.3M
32K claims · 0.4%
$1.2M
4K claims
$278.85
$331.94
Habilitation, residential, waiver; per diem
$1.2M
4K claims · 0.4%
$1000K
9K claims
$107.74
$71.40
Respite care services, per 15 minutes
$1000K
9K claims · 0.3%
$884K
4K claims · 0.3%
$874K
75K claims
$11.68
$10.45
Non-emergency transport, per mile
$874K
75K claims · 0.3%
Emergency response system, per month
$4K
105 claims · 0.0%
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