Community Care Health Plan, INC
New Entrant
Started billing recently but already receiving millions in Medicaid payments.
First appeared in 2024-01 and has already billed $63.1M, averaging $5.3M/month across 12 months.
Instant Volume
New provider billing over $1M in their first year of Medicaid participation.
Billed $63.1M in first year (2024).
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:
New Entrant
New Entrant means this provider began billing Medicaid recently but is already receiving millions of dollars in payments. While some new providers legitimately grow fast (e.g., large group practices), this pattern is also common in fraud schemes that set up shell companies to bill aggressively before shutting down.
Instant Volume
Instant Volume means this provider billed over $1 million in their very first year of Medicaid participation. New providers typically ramp up gradually, so immediate high-volume billing can be a red flag.
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.
Total Paid
$63.1M
$63,056,936
Total Claims
902K
Beneficiaries
217K
4.1 claims/patient
Avg Cost/Claim
$70
🔍 Analysis
Provider Overview
Community Care Health Plan, INC is a PACE Provider Organization provider based in Brookfield, WI. From the 2018–2024 period, this provider received $63.1M in Medicaid payments across 902K claims.
Why This Matters
At $63.1M in Medicaid payments, this provider represents significant public healthcare spending. Understanding where these dollars go helps ensure the program serves those who need it most.
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