Department of Developmental Services
Case Management
Southbridge, Massachusetts
NPI: 1750504064
Risk Tier
Critical
Total Paid
$1.35B
$1,349,935,088
Total Claims
1.7M
Beneficiaries
224K
Avg Cost/Claim
$812.05
Active billing period: 82 months (2018-01 to 2024-10)
Statistical Fraud Flags (5)
Cost Outlier
Billing over 3× the national median for specific procedure codes.
Bills $15,363.35 per claim for T2016 (Habilitation, residential, waiver; per diem), which is 46.3× the national median of $331.94.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 5 procedure codes: T2016 at 46.3× median, S5125 at 4.0× median.
Unusually High Spending
This provider's total payments are significantly above the median for their specialty.
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.
Disclaimer: Statistical flags indicate unusual billing patterns — they are not proof of fraud or wrongdoing. Some entities (government agencies, home care programs, hospitals) may legitimately bill at higher rates due to patient acuity, overhead costs, or specialized services. This report is generated from public HHS data and statistical analysis only. No clinical or investigative review has been performed.
Generated by OpenMedicaid | openmedicaid.org | Data: HHS 2018-2024