Daybreak Community Services Texas LLC
Billing Swing
Experienced over 200% change in year-over-year billing with >$1M absolute change.
Billing changed from $1.1M (2020) to $54.3M (2021) — a 4757% swing with $53.2M absolute change.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 3 procedure codes: D9220 at 2.1× median, D0120 at 17.1× median.
Explosive Growth
Billing increased over 500% year-over-year — far beyond normal growth patterns.
Billing grew 4757% from 2020 to 2021.
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:
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.
Explosive Growth
Explosive Growth means this provider's billing increased by more than 500% year-over-year. While rapid expansion can be legitimate, this pattern has been observed in fraud schemes that ramp up billing quickly before detection.
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 $416.10 per claim for D0120 (Periodic oral evaluation, established patient) — 17.1× the national median of $24.34.
Bills $56.95 per claim for S5199 (Personal care item, NOS, each) — 5.3× the national median of $10.82.
Billing in the top 1% nationally for 1 procedure code: D0120.
This is a statistical summary, not an accusation. See our methodology.
Compared to Community Based Residential Treatment Facility Intellectual and/or Developmental Disabilities Peers
Total spending distribution among 19 providers in this specialty
This provider's total spending of $243.2M is at the 90th percentile among 19 Community Based Residential Treatment Facility Intellectual and/or Developmental Disabilities providers.
Above 90th percentile for this specialty — higher spending than 17 of 19 peers
Total Paid
$243.2M
$243,167,426
Total Claims
2.3M
Beneficiaries
209K
11.0 claims/patient
Avg Cost/Claim
$106
#342 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Daybreak Community Services Texas LLC is a Community Based Residential Treatment Facility Intellectual and/or Developmental Disabilities provider based in Fort Worth, TX. From the 2018–2024 period, this provider received $243.2M in Medicaid payments across 2.3M claims.
Why This Matters
This provider received $243.2M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 30,395 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 (H2016 (Comprehensive community support services, per 15 min)) accounts for 55% of total spending.
$133.3M
564K claims
$236.29
$321.53
Comprehensive community support services, per 15 min
$133.3M
564K claims · 54.8%
$16.4M
101K claims · 6.7%
$14.0M
272K claims
$51.37
$83.88
Skills training & development, per 15 min
$14.0M
272K claims · 5.8%
$9.8M
56K claims · 4.0%
$8.6M
113K claims · 3.5%
$5.7M
35K claims · 2.4%
$5.5M
76K claims · 2.3%
$5.5M
68K claims
$80.97
$87.34
Day habilitation, waiver; per diem
$5.5M
68K claims · 2.3%
$5.3M
251K claims · 2.2%
$4.9M
32K claims · 2.0%
$3.8M
25K claims · 1.6%
$3.6M
18K claims · 1.5%
$3.3M
35K claims · 1.4%
RN services, per 15 minutes
$2.9M
78K claims · 1.2%
$2.5M
42K claims
$60.29
$84.12
Therapeutic behavioral services, per 15 min
$2.5M
42K claims · 1.0%
$2.5M
101K claims · 1.0%
$2.1M
120K claims · 0.9%
$2.1M
17K claims · 0.8%
$1.5M
39K claims · 0.6%
LPN/LVN services, per 15 minutes
$1.4M
90K claims · 0.6%
$1.2M
13K claims
$92.77
$331.94
Habilitation, residential, waiver; per diem
$1.2M
13K claims · 0.5%
$1.2M
40K claims · 0.5%
$1.1M
3K claims · 0.5%
$1.0M
17K claims · 0.4%
$840K
51K claims · 0.3%
$830K
2K claims · 0.3%
$578K
6K claims · 0.2%
$365K
5K claims · 0.2%
$275K
660 claims
$416.10
$24.34
Periodic oral evaluation, established patient
$275K
660 claims · 0.1%
Personal care item, NOS, each
$161K
3K claims · 0.1%
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