Statistical flags indicate unusual patterns — not proof of fraud or wrongdoing. Read our methodology

Seven Counties Services, Inc.

Counselor·Louisville, KY·NPI: 1598793671SharePrint Report

Red Flags Explained

Each flag represents a statistical test that identified unusual billing patterns. Here's what each flag on this provider means in plain English:

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.

These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.

Risk Assessment

Billing above the 90th percentile for 2 procedure codes simultaneously.

This is a statistical summary, not an accusation. See our methodology.

Compared to Counselor Peers

Total spending distribution among 9 providers in this specialty

P25MedianP75P90

This provider's total spending of $194.2M is at the 99th percentile among 9 Counselor providers.

Above 99th percentile for this specialty — higher spending than 8 of 9 peers

Active Billing Period:2018-012024-12(84 months)

Total Paid

$194.2M

$194,182,599

Total Claims

2.4M

Beneficiaries

1.3M

1.8 claims/patient

Avg Cost/Claim

$82

#477 of 618K providers by total spending(top <0.1%)

🔍 Analysis

Provider Overview

Seven Counties Services, Inc. is a Counselor provider based in Louisville, KY. From the 2018–2024 period, this provider received $194.2M in Medicaid payments across 2.4M claims.

Why This Matters

This provider received $194.2M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 24,272 Medicaid beneficiaries for a full year at average per-enrollee costs.

56% growthsince first billing year

Monthly Spending Trend

Yearly Spending

2018
$40.5M
-8%
2019
$37.2M
-20%
2020
$29.9M
-14%
2021
$25.7M
-22%
2022
$20.1M
+14%
2023
$22.9M
-22%
2024
$17.9M

Procedure Breakdown

Cost per claim compared to national benchmarks

This provider bills for 30 distinct procedure codes. The top code (90837 (Psychotherapy, 60 minutes)) accounts for 20% of total spending.

90837Normal range

Psychotherapy, 60 minutes

$38.5M

380K claims · 19.8%

Your Cost: $101.39/claim|Median: $85.66
1.2× median
T2023Normal range

Community transition, waiver; per service

$24.5M

89K claims · 12.6%

Your Cost: $275.14/claim|Median: $300.13
0.9× median
H0011Normal range

Alcohol and/or drug services, acute detoxification, per diem

$21.3M

81K claims · 11.0%

Your Cost: $264.81/claim|Median: $317.54
0.8× median
90834Normal range

Psychotherapy, 45 minutes

$12.7M

174K claims · 6.5%

Your Cost: $72.68/claim|Median: $63.65
1.1× median
99214Normal range

Office/outpatient visit, est. patient, mod-high complexity

$10.9M

178K claims · 5.6%

Your Cost: $60.82/claim|Median: $53.41
1.1× median
90887Top 25%

Interpretation/explanation of results

$10.3M

102K claims · 5.3%

Your Cost: $101.37/claim|Median: $47.55
2.1× median
H0015Normal range

Alcohol and/or drug abuse, intensive outpatient, per hour

$9.5M

71K claims · 4.9%

Your Cost: $133.67/claim|Median: $129.75
1.0× median
90847Top 25%

Family psychotherapy with patient, 50 min

$9.0M

88K claims · 4.6%

Your Cost: $102.03/claim|Median: $77.33
1.3× median
H0018Normal range

Behavioral health; short-term residential, per diem

$8.1M

45K claims · 4.2%

Your Cost: $179.32/claim|Median: $467.51
0.4× median
90832Normal range

Psychotherapy, 30 minutes

$6.7M

144K claims · 3.5%

Your Cost: $46.76/claim|Median: $41.28
1.1× median
H0040Normal range

Assertive community treatment, face-to-face, per 15 minutes

$5.3M

8K claims · 2.7%

Your Cost: $702.12/claim|Median: $266.41
2.6× median
H0009Normal range

$4.1M

15K claims · 2.1%

Your Cost: $265.67/claim|Median: $300.57
0.9× median
90791Normal range

Psychiatric diagnostic evaluation

$3.7M

38K claims · 1.9%

Your Cost: $97.55/claim|Median: $99.21
1.0× median
T1040Normal range

Medicaid certified CCBHC services

$3.4M

519K claims · 1.8%

Your Cost: $6.62/claim|Median: $130.29
0.1× median
S9485Normal range

Crisis intervention mental health services, per diem

$2.8M

8K claims · 1.4%

Your Cost: $332.98/claim|Median: $501.33
0.7× median
H0038Normal range

Self-help/peer services, per 15 minutes

$2.4M

101K claims · 1.2%

Your Cost: $23.79/claim|Median: $55.04
0.4× median
H2036Normal range

Alcohol/drug treatment, per hour

$2.3M

7K claims · 1.2%

Your Cost: $334.23/claim|Median: $253.79
1.3× median
H2034Normal range

Alcohol and/or drug abuse halfway house services, per hour

$2.2M

9K claims · 1.2%

Your Cost: $243.93/claim|Median: $164.03
1.5× median
90833Top 10%

Psychotherapy, 30 min, add-on to E/M service

$2.2M

30K claims · 1.1%

Your Cost: $72.74/claim|Median: $38.83
1.9× median
90853Normal range

Group psychotherapy

$2.1M

87K claims · 1.1%

Your Cost: $24.35/claim|Median: $25.02
1.0× median
H2021Normal range

Community-based wrap-around services, per 15 min

$2.0M

14K claims · 1.0%

Your Cost: $139.07/claim|Median: $169.11
0.8× median
H2019Top 25%

Therapeutic behavioral services, per 15 min

$1.5M

7K claims · 0.8%

Your Cost: $198.69/claim|Median: $84.12
2.4× median
H2015Normal range

Comprehensive community support services, per 15 min

$1.5M

17K claims · 0.7%

Your Cost: $88.00/claim|Median: $96.24
0.9× median
99213Normal range

Office/outpatient visit, est. patient, low-mod complexity

$1.2M

37K claims · 0.6%

Your Cost: $31.91/claim|Median: $37.81
0.8× median
90792Normal range

Psychiatric diagnostic evaluation with medical services

$1.1M

8K claims · 0.6%

Your Cost: $136.56/claim|Median: $108.91
1.3× median
80307Normal range

Drug test, presumptive, by chemistry analyzers

$1.1M

26K claims · 0.6%

Your Cost: $43.56/claim|Median: $35.43
1.2× median
99354Normal range

$731K

17K claims · 0.4%

Your Cost: $42.71/claim|Median: $54.96
0.8× median
H2011Normal range

Crisis intervention service, per 15 minutes

$397K

4K claims · 0.2%

Your Cost: $99.77/claim|Median: $215.80
0.5× median
90846Top 25%

Family psychotherapy without patient, 50 min

$323K

3K claims · 0.2%

Your Cost: $105.34/claim|Median: $76.61
1.4× median
96101Top 10%

$305K

909 claims · 0.2%

Your Cost: $335.61/claim|Median: $196.08
1.7× median