Mental Health Cooperative INC
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $176.37 per claim for S0280 (Medical home program, comprehensive care management), which is 3.6× the national median of $48.38.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 3 procedure codes: T2022 at 1.9× median, H2015 at 3.4× 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:
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.
These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.
Risk Assessment
Bills $176.37 per claim for S0280 (Medical home program, comprehensive care management) — 3.6× the national median of $48.38.
Bills $325.98 per claim for H2015 (Comprehensive community support services, per 15 min) — 3.4× the national median of $96.24.
Bills $153.58 per claim for H0033 (Oral medication administration, direct observation) — 4.9× the national median of $31.37.
Billing in the top 1% nationally for 1 procedure code: 90839.
This is a statistical summary, not an accusation. See our methodology.
Compared to Clinic/Center Mental Health (Including Community Mental Health Center) Peers
Total spending distribution among 28 providers in this specialty
This provider's total spending of $363.8M is at the 75th percentile among 28 Clinic/Center Mental Health (Including Community Mental Health Center) providers.
Total Paid
$363.8M
$363,787,663
Total Claims
5.7M
Beneficiaries
4.3M
1.3 claims/patient
Avg Cost/Claim
$64
#182 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Mental Health Cooperative INC is a Clinic/Center Mental Health (Including Community Mental Health Center) provider based in Nashville, TN. From the 2018–2024 period, this provider received $363.8M in Medicaid payments across 5.7M claims.
Why This Matters
This provider received $363.8M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 45,473 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 (S0280 (Medical home program, comprehensive care management)) accounts for 67% of total spending.
$243.9M
1.4M claims
$176.37
$48.38
Medical home program, comprehensive care management
$243.9M
1.4M claims · 67.0%
$55.7M
1.0M claims
$54.11
$300.13
Community transition, waiver; per service
$55.7M
1.0M claims · 15.3%
Supported housing, per diem
$12.7M
58K claims · 3.5%
$11.7M
179K claims
$65.09
$225.50
Community psychiatric supportive treatment program, per diem
$11.7M
179K claims · 3.2%
Case management, per month
$8.6M
22K claims · 2.4%
$5.9M
195K claims
$30.09
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$5.9M
195K claims · 1.6%
Psychotherapy, 45 minutes
$5.4M
114K claims · 1.5%
$4.7M
61K claims
$76.98
$99.21
Psychiatric diagnostic evaluation
$4.7M
61K claims · 1.3%
$3.5M
28K claims
$125.00
$321.53
Comprehensive community support services, per 15 min
$3.5M
28K claims · 1.0%
$3.0M
9K claims
$325.98
$96.24
Comprehensive community support services, per 15 min
$3.0M
9K claims · 0.8%
Psychotherapy, 30 minutes
$1.8M
53K claims · 0.5%
$1.6M
96K claims
$16.44
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$1.6M
96K claims · 0.4%
$1.5M
35K claims
$43.80
$108.91
Psychiatric diagnostic evaluation with medical services
$1.5M
35K claims · 0.4%
$1.1M
19K claims
$58.86
$77.33
Family psychotherapy with patient, 50 min
$1.1M
19K claims · 0.3%
$604K
4K claims
$153.58
$31.37
Oral medication administration, direct observation
$604K
4K claims · 0.2%
Psychotherapy, 60 minutes
$506K
8K claims · 0.1%
$484K
2K claims
$205.65
$182.66
Alcohol or drug abuse services, prenatal
$484K
2K claims · 0.1%
Patient-focused health risk assessment
$257K
28K claims · 0.1%
Group psychotherapy
$179K
13K claims · 0.0%
$171K
593 claims
$287.79
$119.19
Respite care services, not in the home, per diem
$171K
593 claims · 0.0%
$132K
2K claims
$55.20
$76.61
Family psychotherapy without patient, 50 min
$132K
2K claims · 0.0%
$130K
579 claims
$224.18
$81.37
Alcohol and/or drug abuse, not otherwise specified
$130K
579 claims · 0.0%
$77K
4K claims · 0.0%
$59K
2K claims
$34.58
$74.09
Office/outpatient visit, high complexity
$59K
2K claims · 0.0%
Psychotherapy for crisis, first 60 min
$58K
90 claims · 0.0%
$50K
189 claims · 0.0%
$46K
306 claims
$148.88
$99.39
Hospital observation service, per hour
$46K
306 claims · 0.0%
$37K
3K claims
$12.99
$55.04
Self-help/peer services, per 15 minutes
$37K
3K claims · 0.0%
$27K
5K claims
$5.63
$625.59
Family stabilization services, per 15 minutes
$27K
5K claims · 0.0%
$19K
9K claims
$2.08
$1.57
Collection of venous blood by venipuncture
$19K
9K claims · 0.0%
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