Health Connect America INC
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $153.21 per claim for S0280 (Medical home program, comprehensive care management), which is 3.2× the national median of $48.38.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 2 procedure codes: T2023 at 2.9× median, H2020 at 15.9× median.
High Cost Per Claim
Average payment per claim is much higher than peers billing the same procedures.
High Claims Per Patient
Filing an unusually high number of claims per beneficiary compared to peers.
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.
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.
High Cost Per Claim
High Cost Per Claim means each individual claim from this provider costs significantly more than what other providers charge for the same services. This could indicate upcoding (billing for more expensive services than provided) or legitimate specialized care.
High Claims Per Patient
High Claims Per Patient means this provider files an unusually high number of claims per individual patient. This could indicate legitimate intensive treatment or a pattern of billing for services not actually rendered.
These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.
Risk Assessment
Bills $153.21 per claim for S0280 (Medical home program, comprehensive care management) — 3.2× the national median of $48.38.
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 $285.5M 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
$285.5M
$285,527,372
Total Claims
3.8M
Beneficiaries
1.7M
2.2 claims/patient
Avg Cost/Claim
$74
#266 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Health Connect America INC is a Community/Behavioral Health provider based in Franklin, TN. From the 2018–2024 period, this provider received $285.5M in Medicaid payments across 3.8M claims.
Why This Matters
This provider received $285.5M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 35,690 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 (S0280 (Medical home program, comprehensive care management)) accounts for 29% of total spending.
$83.2M
543K claims
$153.21
$48.38
Medical home program, comprehensive care management
$83.2M
543K claims · 29.2%
$75.7M
872K claims
$86.76
$225.50
Community psychiatric supportive treatment program, per diem
$75.7M
872K claims · 26.5%
Psychotherapy, 60 minutes
$18.2M
220K claims · 6.4%
$18.1M
220K claims
$82.22
$148.53
Mental health partial hospitalization, treatment, per hour
$18.1M
220K claims · 6.3%
$11.8M
158K claims
$74.43
$108.80
Coordinated care fee, maintenance period
$11.8M
158K claims · 4.1%
$10.0M
110K claims
$91.01
$129.75
Alcohol and/or drug abuse, intensive outpatient, per hour
$10.0M
110K claims · 3.5%
$9.2M
67K claims
$137.06
$137.86
Behavioral health day treatment, per hour
$9.2M
67K claims · 3.2%
$8.1M
62K claims
$130.97
$227.82
Multisystemic therapy for juveniles, per 15 minutes
$8.1M
62K claims · 2.8%
$6.5M
114K claims
$57.05
$96.24
Comprehensive community support services, per 15 min
$6.5M
114K claims · 2.3%
$4.2M
81K claims
$51.71
$84.12
Therapeutic behavioral services, per 15 min
$4.2M
81K claims · 1.5%
Psychotherapy, 45 minutes
$4.2M
104K claims · 1.5%
$3.9M
64K claims
$60.83
$99.21
Psychiatric diagnostic evaluation
$3.9M
64K claims · 1.4%
$3.2M
101K claims
$31.96
$69.56
Targeted case management, per 15 min
$3.2M
101K claims · 1.1%
$3.1M
38K claims
$81.83
$321.53
Comprehensive community support services, per 15 min
$3.1M
38K claims · 1.1%
$2.9M
29K claims
$100.98
$76.05
Community psychiatric supportive treatment, per 15 min
$2.9M
29K claims · 1.0%
$2.9M
73K claims
$40.29
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$2.9M
73K claims · 1.0%
$2.1M
28K claims
$74.11
$96.18
Mental health assessment by non-physician
$2.1M
28K claims · 0.7%
$2.0M
2K claims
$876.08
$300.13
Community transition, waiver; per service
$2.0M
2K claims · 0.7%
$2.0M
7K claims
$286.49
$336.31
Community-based wrap-around services, per diem
$2.0M
7K claims · 0.7%
Psychotherapy, 30 minutes
$1.8M
59K claims · 0.6%
$1.8M
31K claims
$58.00
$77.33
Family psychotherapy with patient, 50 min
$1.8M
31K claims · 0.6%
$1.7M
27K claims
$63.03
$76.61
Family psychotherapy without patient, 50 min
$1.7M
27K claims · 0.6%
$1.3M
16K claims
$81.66
$150.51
Day habilitation, waiver; per 15 min
$1.3M
16K claims · 0.5%
$1.3M
10K claims
$131.11
$167.38
Adaptive behavior treatment by protocol, per 15 min
$1.3M
10K claims · 0.4%
RN services, per 15 minutes
$895K
17K claims · 0.3%
$859K
13K claims
$65.77
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$859K
13K claims · 0.3%
$847K
9K claims
$96.23
$108.91
Psychiatric diagnostic evaluation with medical services
$847K
9K claims · 0.3%
$675K
7K claims
$94.38
$216.31
Foster care, therapeutic, child, per diem
$675K
7K claims · 0.2%
$657K
14K claims
$47.99
$38.83
Psychotherapy, 30 min, add-on to E/M service
$657K
14K claims · 0.2%
$511K
17K claims
$29.92
$80.64
Mental health service plan development
$511K
17K claims · 0.2%
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