Community Healthcare Network INC
Case Management
New York, New York
NPI: 1952518078
Risk Tier
Critical
Total Paid
$75.8M
$75,785,041
Total Claims
290K
Beneficiaries
290K
Avg Cost/Claim
$261.08
Statistical Fraud Flags (3)
Cost Outlier
Billing over 3× the national median for specific procedure codes.
Bills $261.77 per claim for G9005 (Coordinated care fee, risk-adjusted, ESRD), which is 5.6× the national median of $47.08.
Billing Swing
Experienced over 200% change in year-over-year billing with >$1M absolute change.
Billing changed from $5.7M (2019) to $24.7M (2020) — a 332% swing with $19.0M absolute change.
Single-Code
Billing almost exclusively for 1-2 procedure codes despite high total volume.
Bills primarily for code G9005 (2 unique codes).
Disclaimer: Statistical flags indicate unusual billing patterns — they are not proof of fraud or wrongdoing. Some entities (government agencies, home care programs, hospitals) may legitimately bill at higher rates due to patient acuity, overhead costs, or specialized services. This report is generated from public HHS data and statistical analysis only. No clinical or investigative review has been performed.
Generated by OpenMedicaid | openmedicaid.org | Data: HHS 2018-2024