Alabama Department of Mental Health and Mental Retardation
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $3,837.56 per claim for T2016 (Habilitation, residential, waiver; per diem), which is 11.6× the national median of $331.94.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 4 procedure codes: H2021 at 6.9× median, T2019 at 5.4× median.
Unusually High Spending
This provider's total payments are significantly above the median for their specialty.
High Cost Per Claim
Average payment per claim is much higher than peers billing the same procedures.
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
▼
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.
Unusually High Spending
Unusually High Spending means this provider's total Medicaid payments are significantly above the median for their specialty. This doesn't necessarily indicate fraud — high volume practices and those serving complex populations may legitimately bill more.
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.
These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.
Risk Assessment
Bills $3,837.56 per claim for T2016 (Habilitation, residential, waiver; per diem) — 11.6× the national median of $331.94.
Bills $1,169.35 per claim for H2021 (Community-based wrap-around services, per 15 min) — 6.9× the national median of $169.11.
Bills $340.68 per claim for T2015 (Habilitation, prevocational, waiver, per diem) — 3.9× the national median of $88.27.
Billing above the 90th percentile for 4 procedure codes simultaneously.
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 $2.25B is at the 99th percentile among 218 Community/Behavioral Health providers.
Above 99th percentile for this specialty — higher spending than 215 of 218 peers
Total Paid
$2.25B
$2,254,946,212
Total Claims
2.0M
Beneficiaries
595K
3.3 claims/patient
Avg Cost/Claim
$1K
#8 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Alabama Department of Mental Health and Mental Retardation is a Community/Behavioral Health provider based in Montgomery, AL. From the 2018–2024 period, this provider received $2.3B in Medicaid payments across 2.0M claims.
Important Context
- ℹ️This is a government entity that may serve as a fiscal agent for large populations. Government providers often bill at high volumes due to the scale of public programs they administer.
Why This Matters
This provider received $2.3B in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 281,868 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 21 distinct procedure codes. The top code (T2016 (Habilitation, residential, waiver; per diem)) accounts for 81% of total spending.
$1.83B
478K claims
$3,837.56
$331.94
Habilitation, residential, waiver; per diem
$1.83B
478K claims · 81.3%
$204.6M
494K claims
$414.16
$150.51
Day habilitation, waiver; per 15 min
$204.6M
494K claims · 9.1%
$141.4M
681K claims
$207.54
$82.47
Personal care services, per 15 min
$141.4M
681K claims · 6.3%
$32.8M
28K claims
$1,169.35
$169.11
Community-based wrap-around services, per 15 min
$32.8M
28K claims · 1.5%
$11.0M
71K claims
$153.56
$79.30
Specialized supply, NOS; per unit
$11.0M
71K claims · 0.5%
Companion care, adult, per diem
$7.7M
70K claims · 0.3%
$6.3M
46K claims
$135.76
$84.12
Therapeutic behavioral services, per 15 min
$6.3M
46K claims · 0.3%
$6.1M
18K claims
$340.68
$88.27
Habilitation, prevocational, waiver, per diem
$6.1M
18K claims · 0.3%
$6.1M
13K claims
$482.22
$88.91
Habilitation, prevocational, waiver; per 15 min
$6.1M
13K claims · 0.3%
$3.6M
19K claims
$194.32
$19.61
Non-emergency transportation, patient attendant or aide
$3.6M
19K claims · 0.2%
Waiver services, NOS; per 15 min
$867K
846 claims · 0.0%
Speech/hearing/language treatment
$374K
6K claims · 0.0%
$311K
8K claims
$36.80
$18.18
Self-care/home management training, per 15 minutes
$311K
8K claims · 0.0%
$264K
2K claims
$119.21
$84.46
Unskilled respite care, per 15 min
$264K
2K claims · 0.0%
$254K
6K claims
$40.96
$24.49
Therapeutic exercises, each 15 min
$254K
6K claims · 0.0%
$219K
919 claims
$237.80
$141.34
Specialized transportation, waiver, per mile, extra
$219K
919 claims · 0.0%
$106K
2K claims
$54.32
$400.25
Nursing care, in the home; per hour
$106K
2K claims · 0.0%
$69K
2K claims
$35.85
$21.33
Non-invasive prenatal screening, fetal chromosomal abnormalities
$69K
2K claims · 0.0%
$21K
3K claims
$7.65
$83.88
Skills training & development, per 15 min
$21K
3K claims · 0.0%
$4K
95 claims
$41.63
$81.30
Assessment of home, physical & family environments
$4K
95 claims · 0.0%
Residential care, NOS; per diem
$478
14 claims · 0.0%
Other Top Providers in Alabama
View all →Alabama Department of Senior Services
Home Health
$631.6M
Alabama Department of Mental Health and Mental Retardation
Community/Behavioral Health
$559.5M
State of Alabama Department of Public Health
Clinical Medical Laboratory
$373.6M
Laboratory Corporation of America Holdings
Clinical Medical Laboratory
$289.1M
Rocky Mountain Holdings, LLC
Ambulance, Air Transport
$285.1M
Similar Providers
Other top providers in Community/Behavioral Health