Health Care & Rehabilitation Services
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $6,461.84 per claim for 99199 (Unlisted special service, procedure, or report), which is 1198.9× the national median of $5.39.
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 $6,461.84 per claim for 99199 (Unlisted special service, procedure, or report) — 1198.9× the national median of $5.39.
Bills $1,991.17 per claim for H2022 (Community-based wrap-around services, per diem) — 5.9× the national median of $336.31.
Billing in the top 1% nationally for 1 procedure code: 99199.
This is a statistical summary, not an accusation. See our methodology.
Compared to Clinic/Center Developmental Disabilities Peers
Total spending distribution among 10 providers in this specialty
This provider's total spending of $136.1M is at the 25th percentile among 10 Clinic/Center Developmental Disabilities providers.
Total Paid
$136.1M
$136,051,609
Total Claims
466K
Beneficiaries
68K
6.8 claims/patient
Avg Cost/Claim
$292
#831 of 618K providers by total spending(top 0.1%)
🔍 Analysis
Provider Overview
Health Care & Rehabilitation Services is a Clinic/Center Developmental Disabilities provider based in Bellows Falls, VT. From the 2018–2024 period, this provider received $136.1M in Medicaid payments across 466K claims.
Why This Matters
This provider received $136.1M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 17,006 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 16 distinct procedure codes. The top code (99199 (Unlisted special service, procedure, or report)) accounts for 72% of total spending.
$97.6M
15K claims
$6,461.84
$5.39
Unlisted special service, procedure, or report
$97.6M
15K claims · 71.7%
$38.5M
19K claims
$1,991.17
$336.31
Community-based wrap-around services, per diem
$38.5M
19K claims · 28.3%
Unskilled respite care, per 15 min
$0
39K claims · 0.0%
$0
237 claims
$0.00
$215.80
Crisis intervention service, per 15 minutes
$0
237 claims · 0.0%
Day habilitation, waiver; per 15 min
$0
82K claims · 0.0%
Foster care, adult; per diem
$0
146K claims · 0.0%
Activity therapy, per 15 minutes
$0
5K claims · 0.0%
Unskilled respite care, per diem
$0
18K claims · 0.0%
$0
411 claims
$0.00
$88.91
Habilitation, prevocational, waiver; per 15 min
$0
411 claims · 0.0%
$0
435 claims
$0.00
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$0
435 claims · 0.0%
Case management, each 15 min
$0
94K claims · 0.0%
$0
28K claims
$0.00
$100.49
Ongoing support to maintain employment, per 15 min
$0
28K claims · 0.0%
$0
13K claims
$0.00
$137.32
Habilitation, residential, waiver; 15 min
$0
13K claims · 0.0%
Supported employment, per 15 min
$0
2K claims · 0.0%
$0
2K claims
$0.00
$84.12
Therapeutic behavioral services, per 15 min
$0
2K claims · 0.0%
Psychotherapy, 60 minutes
$0
1K claims · 0.0%
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