City of New York
Billing Swing
Experienced over 200% change in year-over-year billing with >$1M absolute change.
Billing changed from $123K (2018) to $34.4M (2019) — a 27921% swing with $34.3M absolute change.
Explosive Growth
Billing increased over 500% year-over-year — far beyond normal growth patterns.
Billing grew 27921% from 2018 to 2019.
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:
Billing Swing
Billing Swing means this provider's total billing changed dramatically from one year to the next — increasing or decreasing by more than 200% with over $1M in absolute change. This could indicate a change in practice scope, a billing scheme ramping up, or legitimate growth.
Explosive Growth
Explosive Growth means this provider's billing increased by more than 500% year-over-year. While rapid expansion can be legitimate, this pattern has been observed in fraud schemes that ramp up billing quickly before detection.
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.
Compared to Local Education Agency (LEA) Peers
Total spending distribution among 12 providers in this specialty
This provider's total spending of $298.9M is at the 90th percentile among 12 Local Education Agency (LEA) providers.
Above 90th percentile for this specialty — higher spending than 10 of 12 peers
Total Paid
$298.9M
$298,943,538
Total Claims
8.8M
Beneficiaries
2.5M
3.5 claims/patient
Avg Cost/Claim
$34
#247 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
City of New York is a Local Education Agency (LEA) provider based in Brooklyn, NY. From the 2018–2024 period, this provider received $298.9M in Medicaid payments across 8.8M 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 $298.9M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 37,367 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 15 distinct procedure codes. The top code (92508 (Treatment of speech/language disorder, group, 2+ patients)) accounts for 30% of total spending.
$89.6M
3.7M claims
$24.52
$13.22
Treatment of speech/language disorder, group, 2+ patients
$89.6M
3.7M claims · 30.0%
$80.9M
1.7M claims
$47.17
$33.11
Therapeutic activities, each 15 min
$80.9M
1.7M claims · 27.1%
Speech/hearing/language treatment
$43.8M
522K claims · 14.7%
$17.7M
966K claims
$18.37
$12.12
Therapeutic procedure, group (2+ patients)
$17.7M
966K claims · 5.9%
$15.5M
527K claims · 5.2%
$15.2M
413K claims
$36.81
$24.49
Therapeutic exercises, each 15 min
$15.2M
413K claims · 5.1%
$13.6M
351K claims
$38.58
$20.04
Therapeutic procedure, neuromuscular reeducation, per 15 minutes
$13.6M
351K claims · 4.5%
$12.9M
400K claims · 4.3%
$4.4M
105K claims
$41.64
$18.18
Self-care/home management training, per 15 minutes
$4.4M
105K claims · 1.5%
Gait training
$4.0M
126K claims · 1.3%
$766K
20K claims · 0.3%
$320K
9K claims
$34.08
$16.79
Manual therapy techniques, per 15 minutes
$320K
9K claims · 0.1%
Wheelchair management training
$141K
3K claims · 0.0%
$73K
3K claims · 0.0%
$3K
51 claims · 0.0%
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