West Bay Residential Services Inc.
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $7,528.22 per claim for T2033 (Residential care, NOS; per diem), which is 7.2× the national median of $1,051.57.
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.
These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.
Risk Assessment
Bills $7,528.22 per claim for T2033 (Residential care, NOS; per diem) — 7.2× the national median of $1,051.57.
Bills $1,150.48 per claim for T2021 (Day habilitation, waiver; per 15 min) — 7.6× the national median of $150.51.
Bills $1,388.87 per claim for T2017 (Habilitation, residential, waiver; 15 min) — 10.1× the national median of $137.32.
Billing above the 90th percentile for 6 procedure codes simultaneously.
This is a statistical summary, not an accusation. See our methodology.
Compared to Day Training Developmentally Disabled Services Peers
Total spending distribution among 22 providers in this specialty
This provider's total spending of $145.8M is at the 50th percentile among 22 Day Training Developmentally Disabled Services providers.
Total Paid
$145.8M
$145,845,269
Total Claims
70K
Beneficiaries
49K
1.4 claims/patient
Avg Cost/Claim
$2K
#744 of 618K providers by total spending(top 0.1%)
🔍 Analysis
Provider Overview
West Bay Residential Services Inc. is a Day Training Developmentally Disabled Services provider based in Warwick, RI. From the 2018–2024 period, this provider received $145.8M in Medicaid payments across 70K claims.
Why This Matters
This provider received $145.8M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 18,230 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 12 distinct procedure codes. The top code (T2033 (Residential care, NOS; per diem)) accounts for 71% of total spending.
$103.7M
14K claims
$7,528.22
$1,051.57
Residential care, NOS; per diem
$103.7M
14K claims · 71.1%
$24.4M
21K claims
$1,150.48
$150.51
Day habilitation, waiver; per 15 min
$24.4M
21K claims · 16.7%
$7.6M
5K claims
$1,388.87
$137.32
Habilitation, residential, waiver; 15 min
$7.6M
5K claims · 5.2%
Day habilitation, waiver; per diem
$3.7M
4K claims · 2.5%
$3.2M
9K claims
$339.86
$21.70
Non-emergency transport; encounter/trip
$3.2M
9K claims · 2.2%
Case management, per month
$2.0M
13K claims · 1.4%
Respite care services, per 15 minutes
$863K
1K claims · 0.6%
RN services, per 15 minutes
$366K
2K claims · 0.3%
Psychiatric diagnostic evaluation
$48K
358 claims · 0.0%
Therapeutic exercises, each 15 min
$36K
382 claims · 0.0%
$8K
166 claims
$45.90
$82.34
Attendant care services, per 15 min
$8K
166 claims · 0.0%
$4K
12 claims
$333.70
$88.91
Habilitation, prevocational, waiver; per 15 min
$4K
12 claims · 0.0%
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