Department of Developmental Services
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $8,538.78 per claim for T2016 (Habilitation, residential, waiver; per diem), which is 25.7× the national median of $331.94.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 2 procedure codes: T2016 at 25.7× median, S5100 at 3.9× median.
Consistent Billing
Monthly billing amounts show almost no natural variation (CV < 0.1).
Monthly billing coefficient of variation: 0.0744 (near-zero variation).
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.
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.
Consistent Billing
Consistent Billing means this provider's monthly billing amounts show almost no natural variation. Real medical practices tend to have some fluctuation in monthly billing, so unnaturally steady billing can indicate automated or fabricated claims.
These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.
Risk Assessment
Bills $8,538.78 per claim for T2016 (Habilitation, residential, waiver; per diem) — 25.7× the national median of $331.94.
Bills $261.97 per claim for S5100 (Day care services, adult, per half day) — 3.9× the national median of $67.58.
Billing above the 90th percentile for 2 procedure codes simultaneously.
This is a statistical summary, not an accusation. See our methodology.
Compared to Case Management Peers
Total spending distribution among 137 providers in this specialty
This provider's total spending of $282.1M is at the 75th percentile among 137 Case Management providers.
Total Paid
$282.1M
$282,079,073
Total Claims
304K
Beneficiaries
105K
2.9 claims/patient
Avg Cost/Claim
$928
#271 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Department of Developmental Services is a Case Management provider based in Worcester, MA. From the 2018–2024 period, this provider received $282.1M in Medicaid payments across 304K claims.
Important Context
- ℹ️This provider appears to operate as a fiscal intermediary or management organization, processing payments on behalf of many individual caregivers. High aggregate billing is expected for this type of entity.
- 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 $282.1M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 35,259 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 10 distinct procedure codes. The top code (T2016 (Habilitation, residential, waiver; per diem)) accounts for 79% of total spending.
$223.3M
26K claims
$8,538.78
$331.94
Habilitation, residential, waiver; per diem
$223.3M
26K claims · 79.2%
$18.1M
69K claims
$261.97
$67.58
Day care services, adult, per half day
$18.1M
69K claims · 6.4%
$15.0M
44K claims
$339.20
$300.13
Community transition, waiver; per service
$15.0M
44K claims · 5.3%
$12.7M
56K claims
$227.44
$96.24
Comprehensive community support services, per 15 min
$12.7M
56K claims · 4.5%
$5.6M
23K claims
$240.58
$150.51
Day habilitation, waiver; per 15 min
$5.6M
23K claims · 2.0%
$3.5M
25K claims
$138.28
$103.94
Supported employment, per 15 min
$3.5M
25K claims · 1.2%
Attendant care services, per 15 min
$1.6M
7K claims · 0.6%
$1.0M
12K claims
$87.69
$88.91
Habilitation, prevocational, waiver; per 15 min
$1.0M
12K claims · 0.4%
$934K
38K claims
$24.64
$21.70
Non-emergency transport; encounter/trip
$934K
38K claims · 0.3%
$292K
4K claims
$81.93
$71.40
Respite care services, per 15 minutes
$292K
4K claims · 0.1%
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