Is COMMUNITY PROGRAMS INC. flagged for Medicaid fraud?

COMMUNITY PROGRAMS INC. (NPI: 1003247362) has not been flagged by our statistical fraud detection tests. Their billing patterns fall within normal ranges for their specialty.

How much does COMMUNITY PROGRAMS INC. bill Medicaid?

COMMUNITY PROGRAMS INC. received $0.0B in total Medicaid payments from 2018-2024, based on HHS billing records. They are classified as a Substance Abuse Rehabilitation Facility provider. Located in WATERFORD, MI.

What is NPI 1003247362?

NPI 1003247362 is the National Provider Identifier for COMMUNITY PROGRAMS INC.. They are a Substance Abuse Rehabilitation Facility provider based in WATERFORD, MI. This NPI is registered with the CMS NPI Registry.

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COMMUNITY PROGRAMS INC.

Substance Abuse Rehabilitation Facility·WATERFORD, MI·NPI: 1003247362Share

Compared to Substance Abuse Rehabilitation Facility Peers

Total spending distribution among 20 providers in this specialty

P25MedianP75P90

This provider's total spending of $26.5M is at the 50th percentile among 20 Substance Abuse Rehabilitation Facility providers.

Active Billing Period:2018-01→2024-11(83 months)

Total Paid

$26.5M

$26,540,583

Total Claims

46K

Beneficiaries

33K

1.4 claims/patient

Avg Cost/Claim

$577

Monthly Spending Trend

Yearly Spending

2018

$413K

+249%

2019

$1.4M

+145%

2020

$3.5M

+18%

2021

$4.2M

+3%

2022

$4.3M

+17%

2023

$5.0M

+51%

2024

$7.6M

Procedure Breakdown

Cost per claim compared to national benchmarks

This provider bills for 13 distinct procedure codes. The top code (H0018 (Behavioral health; short-term residential, per diem)) accounts for 48% of total spending.

ProcedureTotalYour Cost/ClaimNational Medianvs MedianPercentile

H0018Behavioral health; short-term residential, per diemSee all providers →

$12.6M

10K claims

$1,246.96

$467.51

2.7×

Normal range

H0018Normal range

Behavioral health; short-term residential, per diem

$12.6M

10K claims · 47.5%

Your Cost: $1,246.96/claim|Median: $467.51

2.7× median

H0019Behavioral health; residential, per diemSee all providers →

$6.1M

3,577 claims

$1,712.81

$357.16

4.8×

Top 25%

H0019Top 25%

Behavioral health; residential, per diem

$6.1M

3,577 claims · 23.1%

Your Cost: $1,712.81/claim|Median: $357.16

4.8× median

H0010Alcohol and/or drug services, sub-acute detoxification, per diemSee all providers →

$4.5M

4,120 claims

$1,095.91

$369.55

3.0×

Top 25%

H0010Top 25%

Alcohol and/or drug services, sub-acute detoxification, per diem

$4.5M

4,120 claims · 17.0%

Your Cost: $1,095.91/claim|Median: $369.55

3.0× median

S9976 See all providers →

$2.5M

15K claims

$174.14

$64.43

2.7×

Top 25%

S9976Top 25%

$2.5M

15K claims · 9.5%

Your Cost: $174.14/claim|Median: $64.43

2.7× median

H0001Alcohol and/or drug assessmentSee all providers →

$231K

1,420 claims

$162.99

$94.22

1.7×

Top 25%

H0001Top 25%

Alcohol and/or drug assessment

$231K

1,420 claims · 0.9%

Your Cost: $162.99/claim|Median: $94.22

1.7× median

90834Psychotherapy, 45 minutesSee all providers →

$203K

2,605 claims

$77.95

$63.65

1.2×

Normal range

90834Normal range

Psychotherapy, 45 minutes

$203K

2,605 claims · 0.8%

Your Cost: $77.95/claim|Median: $63.65

1.2× median

90853Group psychotherapySee all providers →

$160K

4,807 claims

$33.34

$25.02

1.3×

Normal range

90853Normal range

Group psychotherapy

$160K

4,807 claims · 0.6%

Your Cost: $33.34/claim|Median: $25.02

1.3× median

99214Office/outpatient visit, est. patient, mod-high complexitySee all providers →

$73K

1,329 claims

$54.93

$53.41

1.0×

Normal range

99214Normal range

Office/outpatient visit, est. patient, mod-high complexity

$73K

1,329 claims · 0.3%

Your Cost: $54.93/claim|Median: $53.41

1.0× median

H0002Behavioral health screeningSee all providers →

$47K

1,042 claims

$45.36

$38.77

1.2×

Normal range

H0002Normal range

Behavioral health screening

$47K

1,042 claims · 0.2%

Your Cost: $45.36/claim|Median: $38.77

1.2× median

H2027Psychoeducational service, per 15 minutesSee all providers →

$20K

795 claims

$24.80

$82.72

0.3×

Normal range

H2027Normal range

Psychoeducational service, per 15 minutes

$20K

795 claims · 0.1%

Your Cost: $24.80/claim|Median: $82.72

0.3× median

H0003 See all providers →

$16K

1,567 claims

$10.00

$13.38

0.7×

Normal range

H0003Normal range

$16K

1,567 claims · 0.1%

Your Cost: $10.00/claim|Median: $13.38

0.7× median

90837Psychotherapy, 60 minutesSee all providers →

$4K

59 claims

$74.85

$85.66

0.9×

Normal range

90837Normal range

Psychotherapy, 60 minutes

$4K

59 claims · 0.0%

Your Cost: $74.85/claim|Median: $85.66

0.9× median

A0110Non-emergency taxi transportSee all providers →

$410

13 claims

$31.53

$9.27

3.4×

Top 10%

A0110Top 10%

Non-emergency taxi transport

$410

13 claims · 0.0%

Your Cost: $31.53/claim|Median: $9.27

3.4× median

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$342.6M

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