Easter Seals Delaware & Marylands Eastern Shore INC
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $452.95 per claim for T1019 (Personal care services, per 15 min), which is 5.5× the national median of $82.47.
Billing Swing
Experienced over 200% change in year-over-year billing with >$1M absolute change.
Billing changed from $6.1M (2018) to $21.5M (2019) — a 255% swing with $15.5M absolute change.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 5 procedure codes: S5130 at 12.2× median, T1019 at 5.5× 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.
Billing Swing
Billing Swing means this provider's total billing changed dramatically from one year to the next — increasing or decreasing by more than 200% with over $1M in absolute change. This could indicate a change in practice scope, a billing scheme ramping up, or legitimate growth.
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.
Advanced Detection Signals
Additional statistical tests from advanced fraud detection methods
These signals use advanced statistical methods including digit distribution analysis, change-point detection, and market concentration metrics. Learn more.
Risk Assessment
Bills $593.06 per claim for S5130 (Homemaker service, NOS; per 15 min) — 12.2× the national median of $48.76.
Bills $452.95 per claim for T1019 (Personal care services, per 15 min) — 5.5× the national median of $82.47.
Bills $258.51 per claim for S5150 (Unskilled respite care, per 15 min) — 3.1× the national median of $84.46.
Billing above the 90th percentile for 5 procedure codes simultaneously.
This is a statistical summary, not an accusation. See our methodology.
Compared to Psychologist Intellectual & Developmental Disabilities Peers
Total spending distribution among 6 providers in this specialty
This provider's total spending of $315.9M is at the 99th percentile among 6 Psychologist Intellectual & Developmental Disabilities providers.
Above 99th percentile for this specialty — higher spending than 5 of 6 peers
Total Paid
$315.9M
$315,865,302
Total Claims
1.2M
Beneficiaries
391K
3.0 claims/patient
Avg Cost/Claim
$272
#230 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Easter Seals Delaware & Marylands Eastern Shore INC is a Psychologist Intellectual & Developmental Disabilities provider based in New Castle, DE. From the 2018–2024 period, this provider received $315.9M in Medicaid payments across 1.2M claims.
Why This Matters
This provider received $315.9M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 39,483 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 (S5130 (Homemaker service, NOS; per 15 min)) accounts for 55% of total spending.
$174.0M
293K claims
$593.06
$48.76
Homemaker service, NOS; per 15 min
$174.0M
293K claims · 55.1%
Personal care services, per 15 min
$69.2M
153K claims · 21.9%
$24.6M
140K claims
$175.77
$108.97
Financial management, self-directed; per month
$24.6M
140K claims · 7.8%
$19.4M
216K claims
$90.11
$87.34
Day habilitation, waiver; per diem
$19.4M
216K claims · 6.2%
$5.1M
63K claims
$79.95
$72.81
Day care services, adult, per hour
$5.1M
63K claims · 1.6%
$3.5M
33K claims
$105.17
$72.77
Speech therapy, in the home, per diem
$3.5M
33K claims · 1.1%
Unskilled respite care, per 15 min
$3.0M
11K claims · 0.9%
$2.5M
38K claims
$67.63
$74.75
Habilitation, prevocational, waiver, per hour
$2.5M
38K claims · 0.8%
$2.5M
14K claims
$179.25
$88.91
Habilitation, prevocational, waiver; per 15 min
$2.5M
14K claims · 0.8%
$2.2M
23K claims
$97.82
$90.35
Physical therapy, in the home, per diem
$2.2M
23K claims · 0.7%
$1.9M
33K claims
$56.12
$49.45
Speech/hearing/language treatment
$1.9M
33K claims · 0.6%
OT, in the home, per diem
$1.7M
17K claims · 0.5%
Respite care services, per 15 minutes
$1.5M
9K claims · 0.5%
$1.2M
23K claims
$52.30
$33.11
Therapeutic activities, each 15 min
$1.2M
23K claims · 0.4%
$1.1M
9K claims
$131.35
$88.27
Habilitation, prevocational, waiver, per diem
$1.1M
9K claims · 0.4%
Therapeutic exercises, each 15 min
$778K
17K claims · 0.2%
Supported employment, per 15 min
$594K
2K claims · 0.2%
$376K
44K claims
$8.48
$8.80
Non-emergency transportation, commercial carrier, encounter trip
$376K
44K claims · 0.1%
$250K
152 claims
$1,646.72
$119.19
Respite care services, not in the home, per diem
$250K
152 claims · 0.1%
Non-emergency taxi transport
$248K
21K claims · 0.1%
$161K
2K claims
$75.73
$49.74
Treatment of swallowing dysfunction and/or oral function
$161K
2K claims · 0.1%
$134K
1K claims
$122.21
$110.87
Evaluation of speech sound production with language comprehension
$134K
1K claims · 0.0%
$45K
202 claims
$221.54
$150.51
Day habilitation, waiver; per 15 min
$45K
202 claims · 0.0%
OT evaluation, low complexity
$12K
136 claims · 0.0%
OT evaluation, moderate complexity
$3K
71 claims · 0.0%
$2K
46 claims
$46.70
$47.89
Physical therapy evaluation, low complexity
$2K
46 claims · 0.0%
PT evaluation, moderate complexity
$1K
15 claims · 0.0%
OT evaluation, high complexity
$1K
17 claims · 0.0%
OT re-evaluation
$497
28 claims · 0.0%
$322
1K claims
$0.27
$53.00
Family training and counseling, per 15 minutes
$322
1K claims · 0.0%
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