Billing Behavior Shifts: When Providers Suddenly Change
CUSUM change point detection identifies the exact month a provider's billing behavior dramatically shifted. A 3x+ increase or decrease in monthly billing suggests a fundamental change — a new fraud scheme, new ownership, or legitimate expansion. We found 7,314 providers with 3x+ shifts; these 170 are the most extreme among top billers.
170
Providers with shifts
113.3x
Highest ratio
2020
Most common year
$47.65B
Total spending
How CUSUM Change Point Detection Works
CUSUM (Cumulative Sum) is a sequential analysis technique that detects shifts in a time series. For each provider, we analyzed their monthly billing over 7 years (2018–2024) and identified the single month where the cumulative deviation from the mean was greatest — the “change point.” We then compared average monthly billing before and after this point.
3–5x
Moderate shift. Could indicate new services, contract changes, or gradual expansion.
5–20x
Major shift. New ownership, merger, or significant operational change likely.
20x+
Extreme shift. Often a near-zero baseline suddenly jumping to millions monthly.
The Most Dramatic Shifts
NPI: 1891799227 · KY · Changed 2022-10
113.3x
increase
$96K
before/month
$10.9M
after/month
$299.0M
total paid
NPI: 1437534559 · TX · Changed 2021-02
80.3x
increase
$64K
before/month
$5.1M
after/month
$243.2M
total paid
NPI: 1093810889 · AZ · Changed 2018-09
70.9x
increase
$25K
before/month
$1.8M
after/month
$136.2M
total paid
NPI: 1821007881 · PA · Changed 2020-08
53.1x
increase
$44K
before/month
$2.3M
after/month
$125.5M
total paid
NPI: 1578554630 · NY · Changed 2019-09
49.1x
increase
$57K
before/month
$2.8M
after/month
$179.8M
total paid
The top provider on this list went from $96K/month to $10.9M/month in 2022-10 — a 113.3x increase. Among these 170 providers, 157 show dramatic increases and 13 show dramatic decreases.
Why 2020 Dominates
47 of 170 providers had their change point in 2020. This aligns with major policy shifts — pandemic-era waivers, telehealth expansions, and new managed care contracts all created legitimate reasons for billing to change. But they also created cover for providers who dramatically increased billing under less scrutiny.
Not all shifts are suspicious. Hospitals expanding services, providers joining larger networks, or states transitioning to managed care can all produce dramatic billing changes. The most concerning cases are those where a small provider suddenly begins billing millions per month with no clear operational explanation — especially when the change is concentrated in a single procedure code.
Important Caveat
Billing shifts have many legitimate causes: mergers and acquisitions, new service lines, state policy changes, pandemic waivers, and changes in patient population. This analysis identifies the statistical fact that billing changed dramatically — determining why requires investigation. The most extreme ratios often involve providers that had near-zero billing before the shift, making even modest post-shift billing appear as a large multiple.
Top 30 Most Dramatic Billing Shifts
| # | Provider | Change Month | Before/Mo | After/Mo | Ratio | Total Paid |
|---|---|---|---|---|---|---|
| 1 | Norton Hospitals, INC KY | 2022-10 | $96K | $10.9M | 113.3x | $299.0M |
| 2 | Daybreak Community Services Texas LLC TX | 2021-02 | $64K | $5.1M | 80.3x | $243.2M |
| 3 | La Frontera Center Inc. AZ | 2018-09 | $25K | $1.8M | 70.9x | $136.2M |
| 4 | Upmc Presbyterian Shadyside PA | 2020-08 | $44K | $2.3M | 53.1x | $125.5M |
| 5 | Suny Health Science Center at Syracuse NY | 2019-09 | $57K | $2.8M | 49.1x | $179.8M |
| 6 | Arthur G James Cancer Hospital and Research Institute OH | 2022-12 | $111K | $5.4M | 48.2x | $140.7M |
| 7 | Excel Copmanion Care INC PA | 2020-10 | $134K | $6.1M | 45.5x | $308.4M |
| 8 | Children's Health System of Texas TX | 2020-10 | $115K | $5.1M | 44.2x | $263.8M |
| 9 | Texas Children's Physician Group TX | 2020-10 | $70K | $3.1M | 44.2x | $160.8M |
| 10 | New York Psychotherapy and Counseling Center NY | 2019-09 | $119K | $4.7M | 39.5x | $304.0M |
| 11 | Chrysalis Center LLC FL | 2018-12 | $59K | $2.1M | 36.1x | $155.3M |
| 12 | Texas Department of State Health TX | 2019-11 | $171K | $6.1M | 35.6x | $381.9M |
| 13 | Apple Homecare Medical Supply LLC TX | 2020-10 | $70K | $2.4M | 33.8x | $123.3M |
| 14 | New York City Health and Hospitals Corporation NY | 2019-09 | $80K | $2.5M | 30.8x | $160.3M |
| 15 | Infinity Diagnostics Laboratory INC NJ | 2022-01 | $244K | $7.4M | 30.5x | $138.0M |
| 16 | Barrio Comprehensive Family Health Care Center, Inc. TX | 2020-11 | $113K | $2.9M | 25.6x | $148.0M |
| 17 | Advance Hi-tech Nursing Inc. TX | 2020-10 | $311K | $7.6M | 24.6x | $399.8M |
| 18 | New York City Health and Hospitals Corporation NY | 2019-09 | $139K | $3.4M | 24.1x | $217.7M |
| 19 | Johns Hopkins All Children's Hospital INC FL | 2018-12 | $89K | $2.1M | 23.5x | $152.8M |
| 20 | Beth Israel Medical Center NY | 2019-09 | $192K | $4.3M | 22.4x | $278.7M |
| 21 | St. Barnabas Hospital NY | 2019-09 | $117K | $2.5M | 21.6x | $163.6M |
| 22 | New York City Health and Hospitals Corporation NY | 2019-09 | $105K | $2.3M | 21.5x | $146.6M |
| 23 | Texas Home Health of America L.p. TX | 2020-10 | $205K | $4.1M | 20.1x | $216.3M |
| 24 | Tradition Choice NY | 2022-07 | $335K | $6.6M | 19.6x | $208.3M |
| 25 | Variety Children's Hospital FL | 2018-11 | $148K | $2.8M | 19.0x | $175.3M |
| 26 | Dallas County Hospital District TX | 2020-11 | $164K | $3.0M | 18.0x | $152.6M |
| 27 | Legacy Community Health Services, INC TX | 2020-10 | $440K | $7.7M | 17.5x | $406.5M |
| 28 | New York City Health and Hospitals Corporation NY | 2019-09 | $105K | $1.8M | 17.4x | $119.3M |
| 29 | Mount Sinai Hospital NY | 2019-09 | $248K | $4.3M | 17.3x | $279.0M |
| 30 | Topcare Medical Group INC TX | 2020-12 | $183K | $3.1M | 17.1x | $160.4M |
Key Takeaways
- ▸7,314 providers across the dataset showed 3x+ billing shifts. These 170 are the most extreme among top billers.
- ▸The highest increase ratio is 113.3x — monthly billing jumping from $96K to $10.9M.
- ▸2020 was the most common year for change points (47 providers), coinciding with pandemic-era policy changes.
- ▸Billing shifts have many legitimate explanations. This flag is most meaningful when combined with other anomaly indicators.
Source: HHS T-MSIS Other Services File (2018–2024) · 227M records