Acumen Fiscal Agent LLC
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 5 procedure codes: 99509 at 2.6× median, G0226 at 1.0× 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 $258.63 per claim for T1999 (Miscellaneous therapeutic items and supplies) — 9.0× the national median of $28.63.
Billing above the 90th percentile for 3 procedure codes simultaneously.
This is a statistical summary, not an accusation. See our methodology.
Compared to Community/Behavioral Health Peers
Total spending distribution among 218 providers in this specialty
This provider's total spending of $1.06B is at the 90th percentile among 218 Community/Behavioral Health providers.
Above 90th percentile for this specialty — higher spending than 196 of 218 peers
Total Paid
$1.06B
$1,061,171,577
Total Claims
10.5M
Beneficiaries
655K
16.1 claims/patient
Avg Cost/Claim
$101
#32 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Acumen Fiscal Agent LLC is a Community/Behavioral Health provider based in Mesa, AZ. From the 2018–2024 period, this provider received $1.1B in Medicaid payments across 10.5M claims.
Why This Matters
This provider received $1.1B in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 132,646 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 (S5125 (Attendant care services, per 15 min)) accounts for 64% of total spending.
$676.0M
6.9M claims
$98.67
$82.34
Attendant care services, per 15 min
$676.0M
6.9M claims · 63.7%
$63.0M
317K claims
$198.56
$124.39
Waiver services, NOS; per 15 min
$63.0M
317K claims · 5.9%
$47.6M
286K claims
$166.19
$158.23
Habilitation, residential, waiver, per hour
$47.6M
286K claims · 4.5%
$44.2M
361K claims
$122.43
$331.94
Habilitation, residential, waiver; per diem
$44.2M
361K claims · 4.2%
$23.6M
247K claims
$95.57
$84.46
Unskilled respite care, per 15 min
$23.6M
247K claims · 2.2%
$23.5M
330K claims
$71.26
$82.47
Personal care services, per 15 min
$23.5M
330K claims · 2.2%
$23.1M
124K claims
$186.87
$177.54
Habilitation, educational; per 15 min
$23.1M
124K claims · 2.2%
$22.8M
146K claims
$156.65
$79.30
Specialized supply, NOS; per unit
$22.8M
146K claims · 2.2%
$21.7M
136K claims
$159.28
$1,051.57
Residential care, NOS; per diem
$21.7M
136K claims · 2.0%
$18.8M
187K claims
$100.54
$169.11
Community-based wrap-around services, per 15 min
$18.8M
187K claims · 1.8%
$14.8M
671K claims
$22.10
$108.97
Financial management, self-directed; per month
$14.8M
671K claims · 1.4%
$12.7M
153K claims
$82.97
$96.24
Comprehensive community support services, per 15 min
$12.7M
153K claims · 1.2%
$12.3M
167K claims
$73.18
$71.40
Respite care services, per 15 minutes
$12.3M
167K claims · 1.2%
Home visit, assistance w/ ADLs
$8.5M
63K claims · 0.8%
$7.7M
95K claims
$80.75
$137.32
Habilitation, residential, waiver; 15 min
$7.7M
95K claims · 0.7%
$7.2M
41K claims · 0.7%
$6.6M
52K claims
$127.67
$150.51
Day habilitation, waiver; per 15 min
$6.6M
52K claims · 0.6%
$4.0M
64K claims
$62.09
$187.28
Respite care, in the home, per diem
$4.0M
64K claims · 0.4%
$3.5M
27K claims
$130.38
$100.49
Ongoing support to maintain employment, per 15 min
$3.5M
27K claims · 0.3%
$3.4M
23K claims · 0.3%
$3.4M
11K claims · 0.3%
$3.1M
71K claims · 0.3%
$2.9M
25K claims · 0.3%
$901K
5K claims · 0.1%
$872K
15K claims · 0.1%
$822K
7K claims · 0.1%
$804K
4K claims · 0.1%
$674K
4K claims · 0.1%
$448K
5K claims
$85.77
$48.76
Homemaker service, NOS; per 15 min
$448K
5K claims · 0.0%
$405K
2K claims
$258.63
$28.63
Miscellaneous therapeutic items and supplies
$405K
2K claims · 0.0%
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