Waypoint Maine Inc.
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $8,943.45 per claim for T2016 (Habilitation, residential, waiver; per diem), which is 26.9× the national median of $331.94.
Consistent Billing
Monthly billing amounts show almost no natural variation (CV < 0.1).
Monthly billing coefficient of variation: 0.0793 (near-zero variation).
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
▼
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.
Consistent Billing
Consistent Billing means this provider's monthly billing amounts show almost no natural variation. Real medical practices tend to have some fluctuation in monthly billing, so unnaturally steady billing can indicate automated or fabricated claims.
These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.
Compared to Case Management Peers
Total spending distribution among 137 providers in this specialty
This provider's total spending of $110.5M is at the 25th percentile among 137 Case Management providers.
Total Paid
$110.5M
$110,462,287
Total Claims
192K
Beneficiaries
42K
4.5 claims/patient
Avg Cost/Claim
$574
🔍 Analysis
Provider Overview
Waypoint Maine Inc. is a Case Management provider based in Sanford, ME. From the 2018–2024 period, this provider received $110.5M in Medicaid payments across 192K 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 $110.5M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 13,807 Medicaid beneficiaries for a full year at average per-enrollee costs.
Other Top Providers in Maine
View all →Granite Bay Care INC
Residential Treatment Facility Intellectual and/o
$281.7M
John F Murphy Homes Inc.
Nursing Facility/Intermediate Care Facility
$260.0M
Mainegeneral Medical Center
General Acute Care Hospital
$167.8M
Eastern Maine Medical Center
General Acute Care Hospital
$159.2M
Creative Works
Day Training Developmentally Disabled Services
$144.1M
Similar Providers
Other top providers in Case Management