Statistical flags indicate unusual patterns — not proof of fraud or wrongdoing. Read our methodology

Concepts of Independence Inc.

Home Health·New York, NY·NPI: 1184703415SharePrint Report

Red Flags Explained

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.

These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.

Risk Assessment

Bills $442.17 per claim for 99199 (Unlisted special service, procedure, or report) — 82.0× the national median of $5.39.

Billing in the top 1% nationally for 1 procedure code: 99199.

This is a statistical summary, not an accusation. See our methodology.

Compared to Home Health Peers

Total spending distribution among 322 providers in this specialty

P25MedianP75P90

This provider's total spending of $1.06B is at the 90th percentile among 322 Home Health providers.

Above 90th percentile for this specialty — higher spending than 289 of 322 peers

Active Billing Period:2018-012024-11(83 months)

Total Paid

$1.06B

$1,061,917,966

Total Claims

5.0M

Beneficiaries

228K

22.0 claims/patient

Avg Cost/Claim

$212

#31 of 618K providers by total spending(top <0.1%)

🔍 Analysis

Provider Overview

Concepts of Independence Inc. is a Home Health provider based in New York, NY. From the 2018–2024 period, this provider received $1.1B in Medicaid payments across 5.0M claims.

Why This Matters

This provider received $1.1B in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 132,739 Medicaid beneficiaries for a full year at average per-enrollee costs.

13% growthsince first billing year

Monthly Spending Trend

Yearly Spending

2018
$117.0M
+30%
2019
$152.3M
+22%
2020
$186.4M
-9%
2021
$170.3M
-14%
2022
$147.1M
+7%
2023
$157.0M
-16%
2024
$131.8M

Procedure Breakdown

Cost per claim compared to national benchmarks

This provider bills for 6 distinct procedure codes. The top code (T1019 (Personal care services, per 15 min)) accounts for 89% of total spending.

T1019Top 25%

Personal care services, per 15 min

$945.8M

4.6M claims · 89.1%

Your Cost: $204.43/claim|Median: $82.47
2.5× median
T1020Normal range

Personal care services, per diem

$114.2M

380K claims · 10.7%

Your Cost: $300.37/claim|Median: $296.27
1.0× median
99199Top 1%

Unlisted special service, procedure, or report

$827K

2K claims · 0.1%

Your Cost: $442.17/claim|Median: $5.39
82.0× median
S5126Normal range

Attendant care services, per diem

$671K

4K claims · 0.1%

Your Cost: $155.06/claim|Median: $156.98
1.0× median
S5125Top 25%

Attendant care services, per 15 min

$296K

1K claims · 0.0%

Your Cost: $211.23/claim|Median: $82.34
2.6× median
T1022Normal range

$162K

868 claims · 0.0%

Your Cost: $186.77/claim|Median: $184.03
1.0× median