Southwest Brooklyn Health Home LLC
Case Management
Brooklyn, New York
NPI: 1023354933
Risk Tier
High
Total Paid
$113.0M
$113,013,500
Total Claims
380K
Beneficiaries
380K
Avg Cost/Claim
$297.42
Statistical Fraud Flags (2)
Cost Outlier
Billing over 3× the national median for specific procedure codes.
Bills $300.14 per claim for G9005 (Coordinated care fee, risk-adjusted, ESRD), which is 6.4× the national median of $47.08.
Billing Swing
Experienced over 200% change in year-over-year billing with >$1M absolute change.
Billing changed from $7.2M (2019) to $24.6M (2020) — a 240% swing with $17.3M absolute change.
Advanced Detection Signals
Suspicious Concentration
Herfindahl-Hirschman Index of 1 across 3 procedure codes — billing is highly concentrated in very few services.
Disclaimer: Statistical flags indicate unusual billing patterns — they are not proof of fraud or wrongdoing. Some entities (government agencies, home care programs, hospitals) may legitimately bill at higher rates due to patient acuity, overhead costs, or specialized services. This report is generated from public HHS data and statistical analysis only. No clinical or investigative review has been performed.
Generated by OpenMedicaid | openmedicaid.org | Data: HHS 2018-2024