Statistical flags indicate unusual patterns — not proof of fraud or wrongdoing. Read our methodology

Cns Healthcare

Psychiatry & Neurology Psychiatry·Novi, MI·NPI: 1770538068SharePrint Report
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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:

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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

Change PointBilling shifted 3.4x in 2021-09

These signals use advanced statistical methods including digit distribution analysis, change-point detection, and market concentration metrics. Learn more.

Risk Assessment

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Bills $318.45 per claim for S0280 (Medical home program, comprehensive care management) — 6.6× the national median of $48.38.

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Bills $194.89 per claim for 90834 (Psychotherapy, 45 minutes) — 3.1× the national median of $63.65.

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Bills $78.83 per claim for 96372 (Therapeutic injection, subcutaneous/intramuscular) — 8.3× the national median of $9.56.

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Billing in the top 1% nationally for 2 procedure codes: 90791, T1023.

This is a statistical summary, not an accusation. See our methodology.

Active Billing Period:2018-01→2024-12(84 months)

Total Paid

$214.3M

$214,273,046

Total Claims

1.2M

Beneficiaries

726K

1.7 claims/patient

Avg Cost/Claim

$176

#407 of 618K providers by total spending(top <0.1%)

🔍 Analysis

Provider Overview

Cns Healthcare is a Psychiatry & Neurology Psychiatry provider based in Novi, MI. From the 2018–2024 period, this provider received $214.3M in Medicaid payments across 1.2M claims.

Why This Matters

This provider received $214.3M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 26,784 Medicaid beneficiaries for a full year at average per-enrollee costs.

↑ 196% growthsince first billing year

Monthly Spending Trend

Yearly Spending

2018
$16.2M
-21%
2019
$12.8M
-4%
2020
$12.3M
+97%
2021
$24.3M
+110%
2022
$51.0M
-2%
2023
$49.9M
-4%
2024
$47.8M

Procedure Breakdown

Cost per claim compared to national benchmarks

This provider bills for 30 distinct procedure codes. The top code (T1040 (Medicaid certified CCBHC services)) accounts for 41% of total spending.

T1040Top 5%

Medicaid certified CCBHC services

$87.5M

292K claims · 40.8%

Your Cost: $300.14/claim|Median: $130.29
2.3× median
T1017Normal range

Targeted case management, per 15 min

$38.3M

284K claims · 17.9%

Your Cost: $134.73/claim|Median: $69.56
1.9× median
H0039Normal range

Assertive community treatment, per diem

$16.4M

120K claims · 7.6%

Your Cost: $136.94/claim|Median: $132.62
1.0× median
99213Top 5%

Office/outpatient visit, est. patient, low-mod complexity

$9.5M

93K claims · 4.4%

Your Cost: $102.71/claim|Median: $37.81
2.7× median
H2030Top 25%

Mental health clubhouse services, per 15 minutes

$7.9M

65K claims · 3.7%

Your Cost: $121.56/claim|Median: $73.58
1.6× median
H0038Top 25%

Self-help/peer services, per 15 minutes

$6.8M

56K claims · 3.2%

Your Cost: $122.36/claim|Median: $55.04
2.2× median
90837Top 5%

Psychotherapy, 60 minutes

$6.4M

26K claims · 3.0%

Your Cost: $249.26/claim|Median: $85.66
2.9× median
T1002Top 25%

RN services, per 15 minutes

$5.1M

66K claims · 2.4%

Your Cost: $77.24/claim|Median: $37.42
2.1× median
S0280Top 5%

Medical home program, comprehensive care management

$4.2M

13K claims · 2.0%

Your Cost: $318.45/claim|Median: $48.38
6.6× median
H0031Top 10%

Mental health assessment by non-physician

$3.4M

15K claims · 1.6%

Your Cost: $227.98/claim|Median: $96.18
2.4× median
H0032Top 25%

Mental health service plan development

$3.2M

21K claims · 1.5%

Your Cost: $154.42/claim|Median: $80.64
1.9× median
90834Top 5%

Psychotherapy, 45 minutes

$3.2M

16K claims · 1.5%

Your Cost: $194.89/claim|Median: $63.65
3.1× median
96372Top 5%

Therapeutic injection, subcutaneous/intramuscular

$2.7M

34K claims · 1.3%

Your Cost: $78.83/claim|Median: $9.56
8.3× median
S9445Top 25%

$2.7M

42K claims · 1.3%

Your Cost: $64.47/claim|Median: $12.72
5.1× median
H2019Top 5%

Therapeutic behavioral services, per 15 min

$2.7M

6K claims · 1.2%

Your Cost: $435.08/claim|Median: $84.12
5.2× median
90832Top 10%

Psychotherapy, 30 minutes

$2.5M

21K claims · 1.2%

Your Cost: $118.24/claim|Median: $41.28
2.9× median
H2021Top 25%

Community-based wrap-around services, per 15 min

$1.8M

4K claims · 0.8%

Your Cost: $452.34/claim|Median: $169.11
2.7× median
H2023Top 25%

Supported employment, per 15 min

$1.8M

8K claims · 0.8%

Your Cost: $222.84/claim|Median: $103.94
2.1× median
H0036Top 5%

Community psychiatric supportive treatment, per 15 min

$1.8M

5K claims · 0.8%

Your Cost: $333.48/claim|Median: $76.05
4.4× median
90791Top 1%

Psychiatric diagnostic evaluation

$1.6M

4K claims · 0.7%

Your Cost: $352.50/claim|Median: $99.21
3.5× median
90853Top 5%

Group psychotherapy

$1.0M

7K claims · 0.5%

Your Cost: $151.81/claim|Median: $25.02
6.1× median
90792Top 10%

Psychiatric diagnostic evaluation with medical services

$699K

2K claims · 0.3%

Your Cost: $304.29/claim|Median: $108.91
2.8× median
99214Top 5%

Office/outpatient visit, est. patient, mod-high complexity

$674K

4K claims · 0.3%

Your Cost: $158.26/claim|Median: $53.41
3.0× median
H2011Normal range

Crisis intervention service, per 15 minutes

$455K

1K claims · 0.2%

Your Cost: $369.71/claim|Median: $215.80
1.7× median
99212Top 10%

Office/outpatient visit, low complexity

$423K

6K claims · 0.2%

Your Cost: $76.24/claim|Median: $25.06
3.0× median
99205Top 5%

Office/outpatient visit, new patient, high complexity

$417K

2K claims · 0.2%

Your Cost: $264.30/claim|Median: $111.09
2.4× median
S5111Top 25%

Home care training, family member, per session

$370K

2K claims · 0.2%

Your Cost: $200.91/claim|Median: $87.13
2.3× median
T1023Top 1%

Screening to determine appropriateness of consideration for program

$257K

194 claims · 0.1%

Your Cost: $1,325.96/claim|Median: $106.70
12.4× median
T2038Normal range

Community transition, waiver; per service

$202K

353 claims · 0.1%

Your Cost: $573.11/claim|Median: $531.12
1.1× median
99211Top 5%

Office/outpatient visit, minimal complexity

$140K

843 claims · 0.1%

Your Cost: $166.37/claim|Median: $12.93
12.9× median

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