Alabama Department of Mental Health and Mental Retardation
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 2 procedure codes: 96101 at 3.4× median, 96102 at 6.1× median.
Unusually High Spending
This provider's total payments are significantly above the median for their specialty.
High Claims Per Patient
Filing an unusually high number of claims per beneficiary compared to peers.
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.
Unusually High Spending
Unusually High Spending means this provider's total Medicaid payments are significantly above the median for their specialty. This doesn't necessarily indicate fraud — high volume practices and those serving complex populations may legitimately bill more.
High Claims Per Patient
High Claims Per Patient means this provider files an unusually high number of claims per individual patient. This could indicate legitimate intensive treatment or a pattern of billing for services not actually rendered.
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 $664.40 per claim for 96101 — 3.4× the national median of $196.08.
Bills $183.99 per claim for 96102 — 6.1× the national median of $30.11.
Billing above the 90th percentile for 2 procedure codes simultaneously.
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 $559.5M 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
$559.5M
$559,483,344
Total Claims
11.2M
Beneficiaries
4.0M
2.8 claims/patient
Avg Cost/Claim
$50
#100 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Alabama Department of Mental Health and Mental Retardation is a Community/Behavioral Health provider based in Montgomery, AL. From the 2018–2024 period, this provider received $559.5M in Medicaid payments across 11.2M claims.
Important Context
- ℹ️This is a government entity that may serve as a fiscal agent for large populations. Government providers often bill at high volumes due to the scale of public programs they administer.
Why This Matters
This provider received $559.5M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 69,935 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 (H0036 (Community psychiatric supportive treatment, per 15 min)) accounts for 23% of total spending.
$131.1M
2.9M claims
$45.77
$76.05
Community psychiatric supportive treatment, per 15 min
$131.1M
2.9M claims · 23.4%
Psychotherapy, 60 minutes
$68.6M
609K claims · 12.3%
$53.5M
760K claims
$70.41
$137.86
Behavioral health day treatment, per hour
$53.5M
760K claims · 9.6%
$47.1M
807K claims
$58.40
$91.63
Psychosocial rehabilitation services, per 15 min
$47.1M
807K claims · 8.4%
$37.0M
1.0M claims
$36.23
$266.41
Assertive community treatment, face-to-face, per 15 minutes
$37.0M
1.0M claims · 6.6%
$35.7M
595K claims
$60.04
$74.63
Behavioral health counseling & therapy, per 15 min
$35.7M
595K claims · 6.4%
Psychotherapy, 30 minutes
$32.0M
562K claims · 5.7%
$21.5M
266K claims
$80.83
$336.31
Community-based wrap-around services, per diem
$21.5M
266K claims · 3.8%
$21.2M
176K claims
$120.57
$99.21
Psychiatric diagnostic evaluation
$21.2M
176K claims · 3.8%
$18.2M
102K claims
$178.40
$148.53
Mental health partial hospitalization, treatment, per hour
$18.2M
102K claims · 3.3%
$15.8M
732K claims
$21.54
$80.64
Mental health service plan development
$15.8M
732K claims · 2.8%
Psychotherapy, 45 minutes
$12.0M
159K claims · 2.2%
$10.6M
491K claims
$21.61
$56.90
Medication training and management, per 15 min
$10.6M
491K claims · 1.9%
$9.3M
726K claims
$12.86
$31.37
Oral medication administration, direct observation
$9.3M
726K claims · 1.7%
$9.2M
451K claims
$20.36
$82.72
Psychoeducational service, per 15 minutes
$9.2M
451K claims · 1.6%
$9.1M
296K claims
$30.89
$85.02
Mental health services, not otherwise specified
$9.1M
296K claims · 1.6%
$5.5M
30K claims
$182.60
$169.11
Community-based wrap-around services, per 15 min
$5.5M
30K claims · 1.0%
$5.0M
75K claims
$66.37
$215.80
Crisis intervention service, per 15 minutes
$5.0M
75K claims · 0.9%
$4.3M
48K claims
$89.81
$77.33
Family psychotherapy with patient, 50 min
$4.3M
48K claims · 0.8%
$3.9M
196K claims
$19.69
$9.56
Therapeutic injection, subcutaneous/intramuscular
$3.9M
196K claims · 0.7%
Group psychotherapy
$3.3M
132K claims · 0.6%
$2.5M
84K claims
$29.26
$49.05
Nursing assessment/evaluation, per visit
$2.5M
84K claims · 0.4%
$640K
3K claims
$186.05
$133.38
Psychological testing evaluation, each additional hour
$640K
3K claims · 0.1%
$468K
16K claims
$29.19
$55.04
Self-help/peer services, per 15 minutes
$468K
16K claims · 0.1%
$320K
4K claims
$85.70
$79.21
Psychological testing evaluation by professional, first hour
$320K
4K claims · 0.1%
$265K
2K claims
$153.13
$92.96
Psychological/neuropsychological testing, each additional 30 min
$265K
2K claims · 0.0%
$256K
3K claims
$91.45
$76.61
Family psychotherapy without patient, 50 min
$256K
3K claims · 0.0%
$235K
353 claims · 0.0%
Behavioral health screening
$225K
5K claims · 0.0%
$198K
1K claims · 0.0%
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