Commonwealth of Mass-dds
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $317.97 per claim for S5100 (Day care services, adult, per half day), which is 4.7× the national median of $67.58.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 3 procedure codes: T2016 at 33.9× median, S5100 at 4.7× median.
Unusually High Spending
This provider's total payments are significantly above the median for their specialty.
High Cost Per Claim
Average payment per claim is much higher than peers billing the same procedures.
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:
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.
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 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.
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.
Risk Assessment
Bills $11,249.09 per claim for T2016 (Habilitation, residential, waiver; per diem) — 33.9× the national median of $331.94.
Bills $317.97 per claim for S5100 (Day care services, adult, per half day) — 4.7× the national median of $67.58.
Bills $372.03 per claim for H2015 (Comprehensive community support services, per 15 min) — 3.9× the national median of $96.24.
Billing in the top 1% nationally for 1 procedure code: T2016.
This is a statistical summary, not an accusation. See our methodology.
Compared to Case Management Peers
Total spending distribution among 137 providers in this specialty
This provider's total spending of $1.10B is at the 90th percentile among 137 Case Management providers.
Above 90th percentile for this specialty — higher spending than 123 of 137 peers
Total Paid
$1.10B
$1,097,550,708
Total Claims
1.4M
Beneficiaries
259K
5.5 claims/patient
Avg Cost/Claim
$766
#25 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Commonwealth of Mass-dds is a Case Management provider based in Hyde Park, MA. From the 2018–2024 period, this provider received $1.1B in Medicaid payments across 1.4M claims.
Important Context
- ℹ️This provider appears to operate as a fiscal intermediary or management organization, processing payments on behalf of many individual caregivers. High aggregate billing is expected for this type of entity.
Why This Matters
This provider received $1.1B in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 137,193 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 10 distinct procedure codes. The top code (T2016 (Habilitation, residential, waiver; per diem)) accounts for 85% of total spending.
$929.6M
83K claims
$11,249.09
$331.94
Habilitation, residential, waiver; per diem
$929.6M
83K claims · 84.7%
$61.5M
193K claims
$317.97
$67.58
Day care services, adult, per half day
$61.5M
193K claims · 5.6%
$28.1M
83K claims
$338.95
$300.13
Community transition, waiver; per service
$28.1M
83K claims · 2.6%
$24.2M
65K claims
$372.03
$96.24
Comprehensive community support services, per 15 min
$24.2M
65K claims · 2.2%
$22.6M
841K claims
$26.82
$21.70
Non-emergency transport; encounter/trip
$22.6M
841K claims · 2.1%
Supported employment, per 15 min
$13.6M
60K claims · 1.2%
$7.7M
37K claims
$206.23
$150.51
Day habilitation, waiver; per 15 min
$7.7M
37K claims · 0.7%
Attendant care services, per 15 min
$5.8M
23K claims · 0.5%
$4.2M
45K claims
$94.23
$88.91
Habilitation, prevocational, waiver; per 15 min
$4.2M
45K claims · 0.4%
Companion care, adult, per diem
$350K
3K claims · 0.0%
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