CARES INC: From $1.6M to $112.6M — A 6,886% Billing Explosion
A New York case management provider triggered four independent risk detection flags. Here's everything the data shows.
7
Risk Flags
$1.04B
Total Billing
6,886%
Peak Growth
240K
Beneficiaries
The Timeline
Community Assistance Resources & Extended Services INC (CARES INC) is registered as a Case Management provider in New York, NY (NPI: 1396049987). Their billing trajectory tells a striking story:
Total lifetime billing: $1.04 billion in taxpayer-funded Medicaid payments across 2.8 million claims serving 240,000 beneficiaries.
Four Independent Red Flags
CARES INC triggered 4 independent risk detection flags. Each flag represents a different statistical test:
Cost Outlier
Bills $555.61 per claim for H2015 (comprehensive community support) — 5.8× the national median of $96.24. Also 4.5× median for H2014 and 3.1× for 90847.
Billing Swing
Billing changed by more than 200% year-over-year with over $1M in absolute change — triggered in multiple years as billing surged from $77K to $486M.
Rate Outlier
Billing above the 90th percentile for 9 procedure codes simultaneously. One high-cost code could be specialization — nine suggests systematic overbilling.
Explosive Growth
6,886% year-over-year increase from 2020 to 2021 — far beyond the 500% threshold. This is the single largest percentage jump among major providers.
What Are They Billing For?
CARES INC bills primarily for community-based behavioral health and support services:
These are 15-minute billing increments. At $555.61 per 15-minute session for H2015, this implies a rate of over $2,222/hour — compared to the national median of $385/hour for the same service.
Important Context
This provider may operate as a fiscal intermediary — an organization that processes Medicaid payments on behalf of many individual caregivers. In New York's self-directed care model, these entities can legitimately aggregate high billing volumes.
However, several patterns remain unusual even for fiscal intermediaries: the 6,886% single-year growth rate, the significantly above-median cost per claim across multiple codes, and the sharp billing decline in 2023-2024 after the peak.
These findings are statistical indicators, not proof of fraud. A qualified investigation would need to examine individual claims, verify services were delivered, and assess whether the billing rates reflect legitimate costs.
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