Arizona Consumer Direct Personal Care
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $316.65 per claim for S5125 (Attendant care services, per 15 min), which is 3.8× the national median of $82.34.
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 $316.65 per claim for S5125 (Attendant care services, per 15 min) — 3.9× the national median of $82.34.
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
This provider's total spending of $121.5M is at the 25th percentile among 322 Home Health providers.
Total Paid
$121.5M
$121,450,350
Total Claims
412K
Beneficiaries
79K
5.2 claims/patient
Avg Cost/Claim
$295
#985 of 618K providers by total spending(top 0.2%)
🔍 Analysis
Provider Overview
Arizona Consumer Direct Personal Care is a Home Health provider based in Tucson, AZ. From the 2018–2024 period, this provider received $121.5M in Medicaid payments across 412K claims.
Important Context
- ℹ️This provider is a known fiscal management organization for self-directed care programs. They manage billing on behalf of thousands of individual caregivers, so aggregate billing is high by design. However, the self-directed care category has been identified as fraud-prone by regulators.
Why This Matters
This provider received $121.5M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 15,181 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 6 distinct procedure codes. The top code (S5125 (Attendant care services, per 15 min)) accounts for 92% of total spending.
$112.3M
355K claims
$316.65
$82.34
Attendant care services, per 15 min
$112.3M
355K claims · 92.5%
Unskilled respite care, per 15 min
$8.1M
47K claims · 6.7%
$660K
6K claims
$106.05
$108.97
Financial management, self-directed; per month
$660K
6K claims · 0.5%
Companion care, adult, per diem
$253K
3K claims · 0.2%
Homemaker service, NOS; per 15 min
$72K
698 claims · 0.1%
$312
15 claims
$20.79
$107.36
Home care training to home care client, per 15 minutes
$312
15 claims · 0.0%
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