Modivcare Solutions, LLC
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 9 procedure codes: A0426 at 3.8× median, 93005 at 38.1× median.
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:
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.
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
Bills $394.97 per claim for A0426 (Ambulance service, ALS, non-emergency transport, level 1) — 3.8× the national median of $104.69.
Bills $285.43 per claim for 93005 (Electrocardiogram, tracing only, without interpretation) — 38.1× the national median of $7.50.
Bills $132.64 per claim for 93041 — 30.4× the national median of $4.36.
Billing in the top 1% nationally for 2 procedure codes: 93005, A0010.
This is a statistical summary, not an accusation. See our methodology.
Compared to Transportation Broker Peers
Total spending distribution among 12 providers in this specialty
This provider's total spending of $3.09B is at the 99th percentile among 12 Transportation Broker providers.
Above 99th percentile for this specialty — higher spending than 11 of 12 peers
Total Paid
$3.09B
$3,093,063,113
Total Claims
107.7M
Beneficiaries
16.4M
6.6 claims/patient
Avg Cost/Claim
$29
#4 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Modivcare Solutions, LLC is a Transportation Broker provider based in Denver, CO. From the 2018–2024 period, this provider received $3.1B in Medicaid payments across 107.7M 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 $3.1B in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 386,632 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 30 distinct procedure codes. The top code (A0100 (Non-emergency transportation; per trip)) accounts for 41% of total spending.
$1.27B
38.4M claims
$33.06
$24.72
Non-emergency transportation; per trip
$1.27B
38.4M claims · 41.1%
$659.8M
12.8M claims
$51.36
$29.37
Non-emergency wheelchair van transport
$659.8M
12.8M claims · 21.3%
$291.2M
7.7M claims
$38.03
$16.09
Non-emergency mini-bus transport
$291.2M
7.7M claims · 9.4%
$285.9M
2.2M claims
$129.43
$58.05
Ambulance service, BLS, non-emergency transport
$285.9M
2.2M claims · 9.2%
$204.9M
9.5M claims
$21.60
$10.45
Non-emergency transport, per mile
$204.9M
9.5M claims · 6.6%
$127.2M
9.5M claims
$13.44
$21.70
Non-emergency transport; encounter/trip
$127.2M
9.5M claims · 4.1%
$80.7M
8.9M claims
$9.10
$23.36
Ground mileage, per statute mile
$80.7M
8.9M claims · 2.6%
Non-emergency taxi transport
$36.6M
11.7M claims · 1.2%
$25.6M
193K claims
$132.61
$132.60
Non-emergency transportation, per diem
$25.6M
193K claims · 0.8%
$21.5M
4.2M claims
$5.16
$21.33
Non-invasive prenatal screening, fetal chromosomal abnormalities
$21.5M
4.2M claims · 0.7%
$17.9M
67K claims · 0.6%
$11.5M
29K claims
$394.97
$104.69
Ambulance service, ALS, non-emergency transport, level 1
$11.5M
29K claims · 0.4%
$10.8M
38K claims
$285.43
$7.50
Electrocardiogram, tracing only, without interpretation
$10.8M
38K claims · 0.3%
$9.1M
69K claims · 0.3%
$8.0M
234K claims
$34.27
$164.22
Ambulance, ALS emergency transport Level 1
$8.0M
234K claims · 0.3%
$6.7M
205K claims
$32.64
$138.19
Ambulance, BLS emergency transport
$6.7M
205K claims · 0.2%
BLS mileage, per mile
$4.0M
54K claims · 0.1%
$3.2M
304K claims · 0.1%
$2.7M
16K claims
$171.69
$39.01
Non-emergency transport, air, fixed wing, per mile
$2.7M
16K claims · 0.1%
$2.7M
474K claims
$5.66
$18.24
Outpatient psychiatric services, partial hospitalization, per hour
$2.7M
474K claims · 0.1%
$2.5M
51K claims · 0.1%
$2.3M
1K claims
$1,515.47
$1,650.68
Ambulance service, conventional air, transport, one way
$2.3M
1K claims · 0.1%
$1.5M
39K claims · 0.0%
$1.4M
8K claims · 0.0%
ALS mileage, per mile
$1.2M
9K claims · 0.0%
$1.1M
38K claims · 0.0%
$938K
3K claims · 0.0%
$481K
2K claims · 0.0%
$326K
910K claims · 0.0%
ALS mileage, per mile, level 2
$207K
1K claims · 0.0%
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