National Mentor Healthcare LLC
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $523.58 per claim for T2025 (Waiver services, NOS; per 15 min), which is 4.2× the national median of $124.39.
Instant Volume
New provider billing over $1M in their first year of Medicaid participation.
Billed $22.6M in first year (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:
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.
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.
Compared to Psychologist Intellectual & Developmental Disabilities Peers
Total spending distribution among 6 providers in this specialty
This provider's total spending of $108.7M is at the 25th percentile among 6 Psychologist Intellectual & Developmental Disabilities providers.
Total Paid
$108.7M
$108,675,194
Total Claims
309K
Beneficiaries
26K
12.0 claims/patient
Avg Cost/Claim
$352
🔍 Analysis
Provider Overview
National Mentor Healthcare LLC is a Psychologist Intellectual & Developmental Disabilities provider based in Millsboro, DE. From the 2018–2024 period, this provider received $108.7M in Medicaid payments across 309K claims.
Why This Matters
This provider received $108.7M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 13,584 Medicaid beneficiaries for a full year at average per-enrollee costs.
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