New Mexico Consumer Direct Personal Care LLC
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $346.55 per claim for 99509 (Home visit, assistance w/ ADLs), which is 6.7× the national median of $51.71.
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 $346.55 per claim for 99509 (Home visit, assistance w/ ADLs) — 6.7× the national median of $51.71.
Bills $26.13 per claim for S9999 — 4.9× the national median of $5.38.
Billing above the 90th percentile for 2 procedure codes simultaneously.
This is a statistical summary, not an accusation. See our methodology.
Compared to Home Health Peers
Total spending distribution among 322 providers in this specialty
This provider's total spending of $149.6M is at the 50th percentile among 322 Home Health providers.
Total Paid
$149.6M
$149,619,585
Total Claims
542K
Beneficiaries
171K
3.2 claims/patient
Avg Cost/Claim
$276
#717 of 618K providers by total spending(top 0.1%)
🔍 Analysis
Provider Overview
New Mexico Consumer Direct Personal Care LLC is a Home Health provider based in Albuquerque, NM. From the 2018–2024 period, this provider received $149.6M in Medicaid payments across 542K 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 $149.6M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 18,702 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 5 distinct procedure codes. The top code (99509 (Home visit, assistance w/ ADLs)) accounts for 85% of total spending.
Home visit, assistance w/ ADLs
$127.5M
368K claims · 85.2%
$17.5M
89K claims
$196.29
$204.93
Coordination of long-term care services, per hour
$17.5M
89K claims · 11.7%
$4.3M
71K claims
$61.53
$82.47
Personal care services, per 15 min
$4.3M
71K claims · 2.9%
$234K
9K claims · 0.2%
Waiver services, NOS; per 15 min
$0
5K claims · 0.0%
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