Stavros Center for Independent Living Inc.
Single-Code
Billing almost exclusively for 1-2 procedure codes despite high total volume.
Bills primarily for code T1019 (2 unique codes).
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:
Single-Code
Single-Code Billing means this provider bills almost exclusively for one or two procedure codes despite high total volume. Legitimate specialists may focus on specific codes, but extreme concentration can indicate a scheme billing repeatedly for the same service.
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
Extreme procedure concentration — 99% of all billing flows through just 2 codes (T1019, 99509).
This is a statistical summary, not an accusation. See our methodology.
Compared to Case Management Peers
Total spending distribution among 137 providers in this specialty
This provider's total spending of $1.04B is at the 90th percentile among 137 Case Management providers.
Above 90th percentile for this specialty — higher spending than 123 of 137 peers
Extreme procedure concentration — 99% of $1.04B billed through just 2 codes
Total Paid
$1.04B
$1,037,216,238
Total Claims
11.2M
Beneficiaries
427K
26.2 claims/patient
Avg Cost/Claim
$93
#35 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Stavros Center for Independent Living Inc. is a Case Management provider based in Amherst, MA. From the 2018–2024 period, this provider received $1.0B in Medicaid payments across 11.2M claims.
Important Context
- ℹ️This provider appears to operate as a fiscal intermediary or management organization, processing payments on behalf of many individual caregivers. High aggregate billing is expected for this type of entity.
Why This Matters
This provider received $1.0B in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 129,652 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 2 distinct procedure codes. The top code (T1019 (Personal care services, per 15 min)) accounts for 99% of total spending.
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