Northwestern Counseling & Support Services
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $6,259.25 per claim for 99199 (Unlisted special service, procedure, or report), which is 1161.3× the national median of $5.39.
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.
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 $6,259.25 per claim for 99199 (Unlisted special service, procedure, or report) — 1161.3× the national median of $5.39.
Bills $587.70 per claim for H2000 (Comprehensive multidisciplinary evaluation) — 5.1× the national median of $114.71.
Billing in the top 1% nationally for 1 procedure code: 99199.
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 $129.7M is at the 50th percentile among 218 Community/Behavioral Health providers.
Total Paid
$129.7M
$129,734,549
Total Claims
587K
Beneficiaries
53K
11.1 claims/patient
Avg Cost/Claim
$221
#892 of 618K providers by total spending(top 0.1%)
🔍 Analysis
Provider Overview
Northwestern Counseling & Support Services is a Community/Behavioral Health provider based in Saint Albans, VT. From the 2018–2024 period, this provider received $129.7M in Medicaid payments across 587K claims.
Why This Matters
This provider received $129.7M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 16,216 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 19 distinct procedure codes. The top code (99199 (Unlisted special service, procedure, or report)) accounts for 70% of total spending.
$90.9M
15K claims
$6,259.25
$5.39
Unlisted special service, procedure, or report
$90.9M
15K claims · 70.1%
$38.4M
292K claims
$131.55
$336.31
Community-based wrap-around services, per diem
$38.4M
292K claims · 29.6%
Psychotherapy, 45 minutes
$273K
3K claims · 0.2%
$220K
374 claims
$587.70
$114.71
Comprehensive multidisciplinary evaluation
$220K
374 claims · 0.2%
Psychotherapy, 30 minutes
$3K
143 claims · 0.0%
$91
91 claims
$1.00
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$91
91 claims · 0.0%
Unskilled respite care, per 15 min
$0
24K claims · 0.0%
$0
1K claims
$0.00
$215.80
Crisis intervention service, per 15 minutes
$0
1K claims · 0.0%
$0
91 claims
$0.00
$96.24
Comprehensive community support services, per 15 min
$0
91 claims · 0.0%
Supported employment, per 15 min
$0
905 claims · 0.0%
Foster care, adult; per diem
$0
26K claims · 0.0%
Activity therapy, per 15 minutes
$0
402 claims · 0.0%
$0
6K claims
$0.00
$137.32
Habilitation, residential, waiver; 15 min
$0
6K claims · 0.0%
$0
8K claims
$0.00
$331.94
Habilitation, residential, waiver; per diem
$0
8K claims · 0.0%
Unskilled respite care, per diem
$0
13K claims · 0.0%
Case management, each 15 min
$0
99K claims · 0.0%
Waiver services, NOS; per 15 min
$0
1K claims · 0.0%
Day habilitation, waiver; per 15 min
$0
70K claims · 0.0%
$0
27K claims
$0.00
$100.49
Ongoing support to maintain employment, per 15 min
$0
27K claims · 0.0%
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