OIG EXCLUDED — This provider appears on the federal exclusion list
Compared to Counselor, Addiction (Substance Use Disorder) Peers
Total spending distribution among 20 providers in this specialty
This provider's total spending of $427K is at the 25th percentile among 20 Counselor, Addiction (Substance Use Disorder) providers.
Total Paid
$427K
$426,963
Total Claims
4,829
Beneficiaries
561
8.6 claims/patient
Avg Cost/Claim
$88
🔍 Analysis
Provider Overview
Ethel Bethea is a Counselor, Addiction (Substance Use Disorder) provider based in New Haven, CT. From 2018-11 through 2019-09, this provider received $427K in Medicaid payments across 5K claims serving 561 beneficiaries, billing 2 distinct procedure codes.
Key Findings
- 📊98% of all billing comes from a single procedure code: 90837 (90837). This extreme concentration is unusual and may indicate specialized services or a narrow billing pattern.
- 📊Spending grew 715% from $47K in 2018 to $380K in 2019.
- 📊Saw a 8.1× spike in 2019 ($47K → $380K), a sharp year-over-year increase.
- 📊Billing stopped in 2019-09, suggesting this provider is no longer active in Medicaid. Abrupt cessation of billing can be a risk indicator.
Yearly Spending
Procedure Breakdown
Cost per claim compared to national benchmarks
This provider bills for 2 distinct procedure codes. The top code (90837 (Psychotherapy, 60 minutes)) accounts for 98% of total spending.
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