Universal Rehabilitation and Fitness, Inc.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 8 procedure codes: 97110 at 4.7× median, 97535 at 4.7× median.
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.
These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.
Risk Assessment
Bills $116.22 per claim for 97110 (Therapeutic exercises, each 15 min) — 4.8× the national median of $24.49.
Bills $85.87 per claim for 97535 (Self-care/home management training, per 15 minutes) — 4.7× the national median of $18.18.
Bills $89.89 per claim for 97150 (Therapeutic procedure, group (2+ patients)) — 7.4× the national median of $12.12.
Billing in the top 1% nationally for 2 procedure codes: 92508, 96164.
This is a statistical summary, not an accusation. See our methodology.
Total Paid
$191.0M
$191,010,017
Total Claims
824K
Beneficiaries
74K
11.1 claims/patient
Avg Cost/Claim
$232
#486 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Universal Rehabilitation and Fitness, Inc. is a Clinic/Center, Rehabilitation provider based in Livingston, NJ. From the 2018–2024 period, this provider received $191.0M in Medicaid payments across 824K claims.
Why This Matters
This provider received $191.0M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 23,876 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 19 distinct procedure codes. The top code (H2016 (Comprehensive community support services, per 15 min)) accounts for 49% of total spending.
$94.0M
139K claims
$673.86
$321.53
Comprehensive community support services, per 15 min
$94.0M
139K claims · 49.2%
$40.5M
173K claims
$234.85
$1,051.57
Residential care, NOS; per diem
$40.5M
173K claims · 21.2%
$22.4M
93K claims
$240.22
$150.51
Day habilitation, waiver; per 15 min
$22.4M
93K claims · 11.7%
$9.6M
122K claims
$78.86
$67.58
Day care services, adult, per half day
$9.6M
122K claims · 5.0%
Therapeutic exercises, each 15 min
$4.6M
40K claims · 2.4%
$4.1M
48K claims
$85.87
$18.18
Self-care/home management training, per 15 minutes
$4.1M
48K claims · 2.2%
$2.9M
32K claims
$89.89
$12.12
Therapeutic procedure, group (2+ patients)
$2.9M
32K claims · 1.5%
$2.2M
27K claims · 1.1%
Speech/hearing/language treatment
$2.1M
22K claims · 1.1%
$2.0M
23K claims
$89.22
$13.22
Treatment of speech/language disorder, group, 2+ patients
$2.0M
23K claims · 1.1%
$1.6M
20K claims · 0.8%
Health/behavior intervention, group
$1.2M
11K claims · 0.6%
$1.1M
23K claims
$46.66
$15.54
Health behavior intervention, family, each additional fifteen minutes
$1.1M
23K claims · 0.6%
$1.1M
24K claims · 0.6%
$923K
7K claims · 0.5%
$648K
20K claims · 0.3%
$334
165 claims
$2.03
$25.06
Office/outpatient visit, low complexity
$334
165 claims · 0.0%
$0
14 claims
$0.00
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$0
14 claims · 0.0%
$0
12 claims · 0.0%