Commonwealth of Massachusetts
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $8,022.74 per claim for T2016 (Habilitation, residential, waiver; per diem), which is 24.2× the national median of $331.94.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 3 procedure codes: T2016 at 24.2× median, S5100 at 4.0× median.
Consistent Billing
Monthly billing amounts show almost no natural variation (CV < 0.1).
Monthly billing coefficient of variation: 0.0669 (near-zero variation).
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.
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.
Consistent Billing
Consistent Billing means this provider's monthly billing amounts show almost no natural variation. Real medical practices tend to have some fluctuation in monthly billing, so unnaturally steady billing can indicate automated or fabricated claims.
These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.
Risk Assessment
Bills $8,022.74 per claim for T2016 (Habilitation, residential, waiver; per diem) — 24.2× the national median of $331.94.
Bills $271.94 per claim for S5100 (Day care services, adult, per half day) — 4.0× the national median of $67.58.
Bills $454.02 per claim for S5125 (Attendant care services, per 15 min) — 5.5× the national median of $82.34.
Billing above the 90th percentile for 3 procedure codes simultaneously.
This is a statistical summary, not an accusation. See our methodology.
Compared to Case Management Peers
Total spending distribution among 137 providers in this specialty
This provider's total spending of $444.0M is at the 90th percentile among 137 Case Management providers.
Above 90th percentile for this specialty — higher spending than 123 of 137 peers
Total Paid
$444.0M
$443,959,620
Total Claims
584K
Beneficiaries
164K
3.6 claims/patient
Avg Cost/Claim
$760
#139 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Commonwealth of Massachusetts is a Case Management provider based in Haverhill, MA. From the 2018–2024 period, this provider received $444.0M in Medicaid payments across 584K claims.
Important Context
- ℹ️This provider appears to operate as a fiscal intermediary or management organization, processing payments on behalf of many individual caregivers. High aggregate billing is expected for this type of entity.
Why This Matters
This provider received $444.0M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 55,494 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 (T2016 (Habilitation, residential, waiver; per diem)) accounts for 75% of total spending.
$333.1M
42K claims
$8,022.74
$331.94
Habilitation, residential, waiver; per diem
$333.1M
42K claims · 75.0%
$52.4M
193K claims
$271.94
$67.58
Day care services, adult, per half day
$52.4M
193K claims · 11.8%
$19.2M
57K claims
$338.83
$300.13
Community transition, waiver; per service
$19.2M
57K claims · 4.3%
$13.5M
62K claims
$218.98
$96.24
Comprehensive community support services, per 15 min
$13.5M
62K claims · 3.0%
Attendant care services, per 15 min
$9.3M
20K claims · 2.1%
$4.8M
32K claims
$148.46
$103.94
Supported employment, per 15 min
$4.8M
32K claims · 1.1%
$4.1M
39K claims
$105.83
$88.91
Habilitation, prevocational, waiver; per 15 min
$4.1M
39K claims · 0.9%
$4.1M
21K claims
$195.04
$150.51
Day habilitation, waiver; per 15 min
$4.1M
21K claims · 0.9%
$3.4M
118K claims
$28.78
$21.70
Non-emergency transport; encounter/trip
$3.4M
118K claims · 0.8%
$52K
968 claims
$54.20
$55.04
Self-help/peer services, per 15 minutes
$52K
968 claims · 0.0%
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