Washington County Mental Health Services Inc.
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $6,288.46 per claim for 99199 (Unlisted special service, procedure, or report), which is 1166.7× the national median of $5.39.
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.
These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.
Risk Assessment
Bills $6,288.46 per claim for 99199 (Unlisted special service, procedure, or report) — 1166.7× the national median of $5.39.
Bills $2,057.42 per claim for H2022 (Community-based wrap-around services, per diem) — 6.1× the national median of $336.31.
Billing in the top 1% nationally for 1 procedure code: 99199.
This is a statistical summary, not an accusation. See our methodology.
Compared to Clinic/Center Developmental Disabilities Peers
Total spending distribution among 10 providers in this specialty
This provider's total spending of $145.0M is at the 25th percentile among 10 Clinic/Center Developmental Disabilities providers.
Total Paid
$145.0M
$145,015,404
Total Claims
418K
Beneficiaries
54K
7.7 claims/patient
Avg Cost/Claim
$347
#757 of 618K providers by total spending(top 0.1%)
🔍 Analysis
Provider Overview
Washington County Mental Health Services Inc. is a Clinic/Center Developmental Disabilities provider based in Barre, VT. From the 2018–2024 period, this provider received $145.0M in Medicaid payments across 418K claims.
Important Context
- ℹ️This is a government entity that may serve as a fiscal agent for large populations. Government providers often bill at high volumes due to the scale of public programs they administer.
Why This Matters
This provider received $145.0M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 18,126 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 21 distinct procedure codes. The top code (99199 (Unlisted special service, procedure, or report)) accounts for 70% of total spending.
$101.7M
16K claims
$6,288.46
$5.39
Unlisted special service, procedure, or report
$101.7M
16K claims · 70.1%
$42.9M
21K claims
$2,057.42
$336.31
Community-based wrap-around services, per diem
$42.9M
21K claims · 29.6%
Psychotherapy, 60 minutes
$307K
4K claims · 0.2%
$77K
1K claims
$56.08
$91.63
Psychosocial rehabilitation services, per 15 min
$77K
1K claims · 0.1%
$13K
158 claims
$81.48
$96.24
Comprehensive community support services, per 15 min
$13K
158 claims · 0.0%
Psychotherapy, 30 minutes
$11K
278 claims · 0.0%
Psychotherapy, 45 minutes
$9K
127 claims · 0.0%
$2K
236 claims
$9.80
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$2K
236 claims · 0.0%
Case management, each 15 min
$0
56K claims · 0.0%
$0
58 claims · 0.0%
Supported employment, per 15 min
$0
778 claims · 0.0%
$0
11K claims
$0.00
$100.49
Ongoing support to maintain employment, per 15 min
$0
11K claims · 0.0%
Companion care, adult, per diem
$0
5K claims · 0.0%
Residential care, NOS; per diem
$0
17K claims · 0.0%
Unskilled respite care, per diem
$0
7K claims · 0.0%
$0
12K claims
$0.00
$331.94
Habilitation, residential, waiver; per diem
$0
12K claims · 0.0%
Foster care, adult; per diem
$0
131K claims · 0.0%
Day habilitation, waiver; per 15 min
$0
61K claims · 0.0%
$0
20 claims · 0.0%
$0
42K claims
$0.00
$137.32
Habilitation, residential, waiver; 15 min
$0
42K claims · 0.0%
Unskilled respite care, per 15 min
$0
31K claims · 0.0%
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