Macomb County Community Mental Health
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $281.97 per claim for T1017 (Targeted case management, per 15 min), which is 4.1× the national median of $69.56.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 32 procedure codes: T1017 at 4.1× median, 99214 at 5.6× 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:
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.
These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.
Risk Assessment
Bills $281.97 per claim for T1017 (Targeted case management, per 15 min) — 4.0× the national median of $69.56.
Bills $297.53 per claim for 99214 (Office/outpatient visit, est. patient, mod-high complexity) — 5.6× the national median of $53.41.
Bills $259.39 per claim for T1016 (Case management, each 15 min) — 5.2× the national median of $49.62.
Billing in the top 1% nationally for 6 procedure codes: 99214, 90792, 90791.
This is a statistical summary, not an accusation. See our methodology.
Compared to Clinic/Center Mental Health (Including Community Mental Health Center) Peers
Total spending distribution among 28 providers in this specialty
This provider's total spending of $300.0M is at the 75th percentile among 28 Clinic/Center Mental Health (Including Community Mental Health Center) providers.
Total Paid
$300.0M
$299,955,612
Total Claims
1.2M
Beneficiaries
712K
1.7 claims/patient
Avg Cost/Claim
$247
#244 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Macomb County Community Mental Health is a Clinic/Center Mental Health (Including Community Mental Health Center) provider based in Clinton Twp, MI. From the 2018–2024 period, this provider received $300.0M in Medicaid payments across 1.2M 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 $300.0M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 37,494 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 30 distinct procedure codes. The top code (T1040 (Medicaid certified CCBHC services)) accounts for 26% of total spending.
$79.1M
365K claims
$217.10
$130.29
Medicaid certified CCBHC services
$79.1M
365K claims · 26.4%
$63.8M
226K claims
$281.97
$69.56
Targeted case management, per 15 min
$63.8M
226K claims · 21.3%
$23.4M
79K claims
$297.53
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$23.4M
79K claims · 7.8%
$15.7M
55K claims
$287.81
$132.62
Assertive community treatment, per diem
$15.7M
55K claims · 5.2%
Case management, each 15 min
$12.4M
48K claims · 4.1%
Psychotherapy, 60 minutes
$8.6M
34K claims · 2.9%
Psychotherapy, 45 minutes
$8.3M
51K claims · 2.8%
$7.8M
11K claims
$722.56
$108.91
Psychiatric diagnostic evaluation with medical services
$7.8M
11K claims · 2.6%
Psychiatric diagnostic evaluation
$7.2M
17K claims · 2.4%
$7.2M
38K claims
$189.19
$73.58
Mental health clubhouse services, per 15 minutes
$7.2M
38K claims · 2.4%
$5.6M
16K claims
$352.25
$76.05
Community psychiatric supportive treatment, per 15 min
$5.6M
16K claims · 1.9%
$5.3M
22K claims
$237.75
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$5.3M
22K claims · 1.8%
$5.1M
15K claims
$337.34
$96.18
Mental health assessment by non-physician
$5.1M
15K claims · 1.7%
$5.1M
9K claims
$543.52
$106.70
Screening to determine appropriateness of consideration for program
$5.1M
9K claims · 1.7%
$5.0M
11K claims
$450.80
$215.80
Crisis intervention service, per 15 minutes
$5.0M
11K claims · 1.7%
$5.0M
24K claims
$211.11
$87.13
Home care training, family member, per session
$5.0M
24K claims · 1.7%
$3.8M
23K claims
$162.07
$80.64
Mental health service plan development
$3.8M
23K claims · 1.3%
$3.7M
28K claims
$133.38
$96.24
Comprehensive community support services, per 15 min
$3.7M
28K claims · 1.2%
$3.5M
10K claims
$357.32
$84.12
Therapeutic behavioral services, per 15 min
$3.5M
10K claims · 1.2%
$3.2M
16K claims
$199.95
$55.04
Self-help/peer services, per 15 minutes
$3.2M
16K claims · 1.1%
$3.1M
23K claims
$132.19
$9.56
Therapeutic injection, subcutaneous/intramuscular
$3.1M
23K claims · 1.0%
$2.8M
6K claims
$477.17
$74.09
Office/outpatient visit, high complexity
$2.8M
6K claims · 0.9%
$2.6M
7K claims
$346.89
$169.11
Community-based wrap-around services, per 15 min
$2.6M
7K claims · 0.9%
Psychotherapy, 30 minutes
$2.6M
21K claims · 0.9%
$1.7M
19K claims
$89.82
$71.40
Respite care services, per 15 minutes
$1.7M
19K claims · 0.6%
$1.7M
3K claims
$491.06
$300.13
Community transition, waiver; per service
$1.7M
3K claims · 0.6%
$1.6M
5K claims
$343.87
$336.31
Community-based wrap-around services, per diem
$1.6M
5K claims · 0.5%
Group psychotherapy
$1.4M
7K claims · 0.5%
$437K
3K claims
$170.46
$77.33
Family psychotherapy with patient, 50 min
$437K
3K claims · 0.1%
$432K
2K claims
$174.74
$25.06
Office/outpatient visit, low complexity
$432K
2K claims · 0.1%
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