Keystone Continuum LLC
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $11,881.29 per claim for T2016 (Habilitation, residential, waiver; per diem), which is 35.8× the national median of $331.94.
Billing Swing
Experienced over 200% change in year-over-year billing with >$1M absolute change.
Billing changed from $5.4M (2019) to $28.2M (2020) — a 425% swing with $22.8M absolute change.
High Cost Per Claim
Average payment per claim is much higher than peers billing the same procedures.
Spending Spike
Experienced a dramatic increase in billing over a short period.
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.
Billing Swing
Billing Swing means this provider's total billing changed dramatically from one year to the next — increasing or decreasing by more than 200% with over $1M in absolute change. This could indicate a change in practice scope, a billing scheme ramping up, or legitimate growth.
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.
Spending Spike
Spending Spike means this provider experienced a dramatic, sudden increase in billing over a short period. Legitimate causes include new contracts or expanded services, but this pattern also appears in billing fraud ramp-ups.
These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.
Risk Assessment
Bills $11,881.29 per claim for T2016 (Habilitation, residential, waiver; per diem) — 35.8× the national median of $331.94.
Bills $1,925.29 per claim for H2020 (Day habilitation, waiver, per 15 minutes) — 13.4× the national median of $144.05.
Bills $3,405.91 per claim for H0019 (Behavioral health; residential, per diem) — 9.5× the national median of $357.16.
Billing in the top 1% nationally for 1 procedure code: T2016.
This is a statistical summary, not an accusation. See our methodology.
Total Paid
$123.7M
$123,728,018
Total Claims
15K
Beneficiaries
15K
1.0 claims/patient
Avg Cost/Claim
$8K
#962 of 618K providers by total spending(top 0.2%)
🔍 Analysis
Provider Overview
Keystone Continuum LLC is a Psychiatric Residential Treatment Facility provider based in Mountain City, TN. From the 2018–2024 period, this provider received $123.7M in Medicaid payments across 15K claims.
Why This Matters
This provider received $123.7M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 15,466 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 (T2016 (Habilitation, residential, waiver; per diem)) accounts for 87% of total spending.
$107.4M
9K claims
$11,881.29
$331.94
Habilitation, residential, waiver; per diem
$107.4M
9K claims · 86.8%
$7.5M
4K claims
$1,925.29
$144.05
Day habilitation, waiver, per 15 minutes
$7.5M
4K claims · 6.1%
$4.6M
1K claims
$3,405.91
$357.16
Behavioral health; residential, per diem
$4.6M
1K claims · 3.7%
$3.8M
401 claims
$9,545.89
$1,437.23
Behavioral health; long-term residential, per diem
$3.8M
401 claims · 3.1%
$302K
529 claims
$570.35
$216.31
Foster care, therapeutic, child, per diem
$302K
529 claims · 0.2%
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