Consumer Direct for Tennessee, LLC
New Entrant
Started billing recently but already receiving millions in Medicaid payments.
First appeared in 2023-07 and has already billed $126.4M, averaging $7.0M/month across 18 months.
Instant Volume
New provider billing over $1M in their first year of Medicaid participation.
Billed $41.8M in first year (2023).
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:
New Entrant
New Entrant means this provider began billing Medicaid recently but is already receiving millions of dollars in payments. While some new providers legitimately grow fast (e.g., large group practices), this pattern is also common in fraud schemes that set up shell companies to bill aggressively before shutting down.
Instant Volume
Instant Volume means this provider billed over $1 million in their very first year of Medicaid participation. New providers typically ramp up gradually, so immediate high-volume billing can be a red flag.
These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.
Risk Assessment
Bills $160.10 per claim for T2003 (Non-emergency transport; encounter/trip) — 7.4× the national median of $21.70.
This is a statistical summary, not an accusation. See our methodology.
Compared to Nursing Care Peers
Total spending distribution among 10 providers in this specialty
This provider's total spending of $126.4M is at the 50th percentile among 10 Nursing Care providers.
Total Paid
$126.4M
$126,382,726
Total Claims
1.1M
Beneficiaries
78K
14.1 claims/patient
Avg Cost/Claim
$115
#930 of 618K providers by total spending(top 0.2%)
🔍 Analysis
Provider Overview
Consumer Direct for Tennessee, LLC is a Nursing Care provider based in Nashville, TN. From the 2018–2024 period, this provider received $126.4M in Medicaid payments across 1.1M 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 $126.4M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 15,797 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 (T1019 (Personal care services, per 15 min)) accounts for 53% of total spending.
$67.6M
585K claims
$115.48
$82.47
Personal care services, per 15 min
$67.6M
585K claims · 53.5%
$49.0M
408K claims
$120.20
$82.34
Attendant care services, per 15 min
$49.0M
408K claims · 38.8%
$4.4M
61K claims
$72.61
$84.46
Unskilled respite care, per 15 min
$4.4M
61K claims · 3.5%
$4.1M
30K claims
$135.83
$302.34
Companion care, adult, per 15 minutes
$4.1M
30K claims · 3.2%
$1.3M
8K claims
$160.10
$21.70
Non-emergency transport; encounter/trip
$1.3M
8K claims · 1.0%
Non-emergency transport; per trip
$27K
4K claims · 0.0%
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