Easter Seals Delaware & Marylands Eastern Shore INC
Psychologist Intellectual & Developmental Disabilities
New Castle, Delaware
NPI: 1437156635
Risk Tier
Critical
Total Paid
$315.9M
$315,865,302
Total Claims
1.2M
Beneficiaries
391K
Avg Cost/Claim
$271.57
Active billing period: 84 months (2018-01 to 2024-12)
Statistical Fraud Flags (3)
Cost Outlier
Billing over 3× the national median for specific procedure codes.
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.
Advanced Detection Signals
CUSUM Change Point
Billing shifted 8.8x in 2019-09 — a statistically significant structural change in billing behavior was detected.
Disclaimer: Statistical flags indicate unusual billing patterns — they are not proof of fraud or wrongdoing. Some entities (government agencies, home care programs, hospitals) may legitimately bill at higher rates due to patient acuity, overhead costs, or specialized services. This report is generated from public HHS data and statistical analysis only. No clinical or investigative review has been performed.
Generated by OpenMedicaid | openmedicaid.org | Data: HHS 2018-2024