Communicare INC
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $104.41 per claim for 97535 (Self-care/home management training, per 15 minutes), which is 5.7× the national median of $18.18.
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 $104.41 per claim for 97535 (Self-care/home management training, per 15 minutes) — 5.7× the national median of $18.18.
Bills $133.88 per claim for T1999 (Miscellaneous therapeutic items and supplies) — 4.7× the national median of $28.63.
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 $206.1M is at the 75th percentile among 218 Community/Behavioral Health providers.
Total Paid
$206.1M
$206,109,230
Total Claims
1.8M
Beneficiaries
214K
8.6 claims/patient
Avg Cost/Claim
$112
#433 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Communicare INC is a Community/Behavioral Health provider based in Elizabethtown, KY. From the 2018–2024 period, this provider received $206.1M in Medicaid payments across 1.8M claims.
Why This Matters
This provider received $206.1M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 25,763 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 10 distinct procedure codes. The top code (97535 (Self-care/home management training, per 15 minutes)) accounts for 49% of total spending.
$100.5M
962K claims
$104.41
$18.18
Self-care/home management training, per 15 minutes
$100.5M
962K claims · 48.8%
$31.1M
152K claims
$205.44
$331.94
Habilitation, residential, waiver; per diem
$31.1M
152K claims · 15.1%
$25.3M
225K claims
$112.49
$82.47
Personal care services, per 15 min
$25.3M
225K claims · 12.3%
Case management, per month
$14.5M
53K claims · 7.0%
$12.0M
130K claims
$92.48
$107.36
Home care training to home care client, per 15 minutes
$12.0M
130K claims · 5.8%
$11.0M
173K claims
$63.80
$150.51
Day habilitation, waiver; per 15 min
$11.0M
173K claims · 5.4%
$5.7M
54K claims
$104.58
$108.97
Financial management, self-directed; per month
$5.7M
54K claims · 2.8%
$5.6M
96K claims
$59.12
$71.40
Respite care services, per 15 minutes
$5.6M
96K claims · 2.7%
$271K
3K claims
$88.52
$74.63
Behavioral health counseling & therapy, per 15 min
$271K
3K claims · 0.1%
$74K
554 claims
$133.88
$28.63
Miscellaneous therapeutic items and supplies
$74K
554 claims · 0.0%
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