Mosaic
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $1,426.42 per claim for H2016 (Comprehensive community support services, per 15 min), which is 4.4× the national median of $321.53.
Single-Code
Billing almost exclusively for 1-2 procedure codes despite high total volume.
Bills primarily for code S5136 (2 unique codes).
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.
Single-Code
Single-Code Billing means this provider bills almost exclusively for one or two procedure codes despite high total volume. Legitimate specialists may focus on specific codes, but extreme concentration can indicate a scheme billing repeatedly for the same service.
These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.
Risk Assessment
Extreme procedure concentration — 86% of all billing flows through just 2 codes (H2016, S5136).
Bills $1,426.42 per claim for H2016 (Comprehensive community support services, per 15 min) — 4.4× the national median of $321.53.
Bills $1,439.82 per claim for S5136 (Companion care, adult, per 15 minutes) — 4.8× the national median of $302.34.
This is a statistical summary, not an accusation. See our methodology.
Compared to Community Based Residential Treatment Facility Intellectual and/or Developmental Disabilities Peers
Total spending distribution among 19 providers in this specialty
This provider's total spending of $177.4M is at the 75th percentile among 19 Community Based Residential Treatment Facility Intellectual and/or Developmental Disabilities providers.
Extreme procedure concentration — 86% of $177.4M billed through just 2 codes
Total Paid
$177.4M
$177,402,111
Total Claims
124K
Beneficiaries
16K
8.0 claims/patient
Avg Cost/Claim
$1K
#543 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Mosaic is a Community Based Residential Treatment Facility Intellectual and/or Developmental Disabilities provider based in Urbandale, IA. From the 2018–2024 period, this provider received $177.4M in Medicaid payments across 124K claims.
Why This Matters
This provider received $177.4M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 22,175 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 2 distinct procedure codes. The top code (H2016 (Comprehensive community support services, per 15 min)) accounts for 86% of total spending.
$151.9M
106K claims
$1,426.42
$321.53
Comprehensive community support services, per 15 min
$151.9M
106K claims · 85.6%
$25.5M
18K claims
$1,439.82
$302.34
Companion care, adult, per 15 minutes
$25.5M
18K claims · 14.4%
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