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

Consumer Directed Services in Texas Inc.

Supports Brokerage·San Antonio, TX·NPI: 1801027404SharePrint Report
View on Risk Watchlist →

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.

Risk Assessment

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Bills $1,496.48 per claim for M0355 — 7.6× the national median of $196.65.

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Bills $854.12 per claim for M0361 — 5.6× the national median of $151.88.

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Bills $636.13 per claim for T1013 (Sign language or oral interpretive services, per 15 minutes) — 36.0× the national median of $17.67.

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Billing in the top 1% nationally for 10 procedure codes: M0355, M0361, T1013.

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

Compared to Supports Brokerage Peers

Total spending distribution among 14 providers in this specialty

P25MedianP75P90

This provider's total spending of $624.8M is at the 75th percentile among 14 Supports Brokerage providers.

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

Total Paid

$624.8M

$624,768,225

Total Claims

3.4M

Beneficiaries

599K

5.7 claims/patient

Avg Cost/Claim

$183

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

🔍 Analysis

Provider Overview

Consumer Directed Services in Texas Inc. is a Supports Brokerage provider based in San Antonio, TX. From the 2018–2024 period, this provider received $624.8M in Medicaid payments across 3.4M 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 $624.8M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 78,096 Medicaid beneficiaries for a full year at average per-enrollee costs.

↑ 173% growthsince first billing year

Monthly Spending Trend

Yearly Spending

2018
$42.7M
+1%
2019
$42.9M
+33%
2020
$57.1M
+102%
2021
$115.1M
+12%
2022
$129.0M
-6%
2023
$121.4M
-4%
2024
$116.5M

Procedure Breakdown

Cost per claim compared to national benchmarks

This provider bills for 30 distinct procedure codes. The top code (T2016 (Habilitation, residential, waiver; per diem)) accounts for 49% of total spending.

T2016Normal range

Habilitation, residential, waiver; per diem

$305.7M

459K claims · 48.9%

Your Cost: $665.36/claim|Median: $331.94
2.0× median
T1019Normal range

Personal care services, per 15 min

$128.3M

1.7M claims · 20.5%

Your Cost: $77.29/claim|Median: $82.47
0.9× median
H2015Normal range

Comprehensive community support services, per 15 min

$33.1M

368K claims · 5.3%

Your Cost: $90.10/claim|Median: $96.24
0.9× median
T1005Normal range

Respite care services, per 15 minutes

$33.1M

367K claims · 5.3%

Your Cost: $89.99/claim|Median: $71.40
1.3× median
M0355Top 1%

$25.6M

17K claims · 4.1%

Your Cost: $1,496.48/claim|Median: $196.65
7.6× median
T2040Normal range

Financial management, self-directed; per month

$21.8M

142K claims · 3.5%

Your Cost: $154.06/claim|Median: $108.97
1.4× median
S9125Normal range

Respite care, in the home, per diem

$20.7M

157K claims · 3.3%

Your Cost: $132.23/claim|Median: $187.28
0.7× median
G0226Normal range

$14.5M

71K claims · 2.3%

Your Cost: $204.42/claim|Median: $204.14
1.0× median
G0749Top 10%

$13.9M

29K claims · 2.2%

Your Cost: $488.56/claim|Median: $219.77
2.2× median
M0361Top 1%

$6.8M

8K claims · 1.1%

Your Cost: $854.12/claim|Median: $151.88
5.6× median
T1013Top 1%

Sign language or oral interpretive services, per 15 minutes

$5.3M

8K claims · 0.8%

Your Cost: $636.13/claim|Median: $17.67
36.0× median
M0111Normal range

$2.9M

15K claims · 0.5%

Your Cost: $188.69/claim|Median: $189.91
1.0× median
M0373Top 1%

$2.2M

9K claims · 0.4%

Your Cost: $242.10/claim|Median: $53.80
4.5× median
M0241Top 1%

$1.7M

5K claims · 0.3%

Your Cost: $368.35/claim|Median: $113.44
3.3× median
M0209Normal range

$1.6M

8K claims · 0.2%

Your Cost: $186.52/claim|Median: $189.12
1.0× median
G0227Top 25%

$1.5M

14K claims · 0.2%

Your Cost: $111.63/claim|Median: $110.80
1.0× median
G6063Normal range

$1.1M

36K claims · 0.2%

Your Cost: $29.66/claim|Median: $36.83
0.8× median
G0228Normal range

$1.1M

5K claims · 0.2%

Your Cost: $218.94/claim|Median: $218.94
1.0× median
M0145Top 1%

$989K

4K claims · 0.2%

Your Cost: $241.21/claim|Median: $96.21
2.5× median
M0420Top 1%

$567K

4K claims · 0.1%

Your Cost: $161.20/claim|Median: $49.34
3.3× median
S5151Top 5%

Unskilled respite care, per diem

$510K

508 claims · 0.1%

Your Cost: $1,003.69/claim|Median: $249.18
4.0× median
T1003Top 5%

LPN/LVN services, per 15 minutes

$492K

524 claims · 0.1%

Your Cost: $939.22/claim|Median: $24.24
38.8× median
T2001Normal range

Non-emergency transportation, patient attendant or aide

$460K

7K claims · 0.1%

Your Cost: $63.75/claim|Median: $19.61
3.3× median
G6064Normal range

$215K

2K claims · 0.0%

Your Cost: $120.04/claim|Median: $86.23
1.4× median
H2038Top 25%

$131K

462 claims · 0.0%

Your Cost: $283.27/claim|Median: $67.30
4.2× median
G0718Top 1%

$113K

251 claims · 0.0%

Your Cost: $451.46/claim|Median: $451.46
1.0× median
M0539Top 1%

$100K

7K claims · 0.0%

Your Cost: $15.08/claim|Median: $7.60
2.0× median
M0202Top 1%

$87K

245 claims · 0.0%

Your Cost: $353.19/claim|Median: $288.76
1.2× median
T2020Top 10%

Day habilitation, waiver; per diem

$65K

180 claims · 0.0%

Your Cost: $361.02/claim|Median: $87.34
4.1× median
M0359Normal range

$47K

302 claims · 0.0%

Your Cost: $154.79/claim|Median: $154.79
1.0× median

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