John F Murphy Homes Inc.
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $966.59 per claim for H2021 (Community-based wrap-around services, per 15 min), which is 5.7× the national median of $169.11.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 2 procedure codes: H2021 at 5.7× median, H2012 at 4.0× median.
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.
These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.
Risk Assessment
Bills $966.59 per claim for H2021 (Community-based wrap-around services, per 15 min) — 5.7× the national median of $169.11.
Bills $554.85 per claim for H2012 (Behavioral health day treatment, per hour) — 4.0× the national median of $137.86.
Billing above the 90th percentile for 2 procedure codes simultaneously.
This is a statistical summary, not an accusation. See our methodology.
Total Paid
$260.0M
$260,024,323
Total Claims
631K
Beneficiaries
70K
9.0 claims/patient
Avg Cost/Claim
$412
#319 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
John F Murphy Homes Inc. is a Nursing Facility/Intermediate Care Facility provider based in Auburn, ME. From the 2018–2024 period, this provider received $260.0M in Medicaid payments across 631K claims.
Why This Matters
This provider received $260.0M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 32,503 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 19 distinct procedure codes. The top code (H2021 (Community-based wrap-around services, per 15 min)) accounts for 42% of total spending.
$108.6M
112K claims
$966.59
$169.11
Community-based wrap-around services, per 15 min
$108.6M
112K claims · 41.8%
$104.6M
176K claims
$592.86
$331.94
Habilitation, residential, waiver; per diem
$104.6M
176K claims · 40.2%
$14.0M
25K claims
$554.85
$137.86
Behavioral health day treatment, per hour
$14.0M
25K claims · 5.4%
Foster care, adult; per diem
$12.7M
38K claims · 4.9%
$9.1M
71K claims
$127.87
$150.51
Day habilitation, waiver; per 15 min
$9.1M
71K claims · 3.5%
$3.1M
57K claims
$53.60
$49.45
Speech/hearing/language treatment
$3.1M
57K claims · 1.2%
$2.6M
53K claims · 1.0%
$1.7M
55K claims
$30.51
$33.11
Therapeutic activities, each 15 min
$1.7M
55K claims · 0.6%
$1.6M
15K claims
$101.87
$103.94
Supported employment, per 15 min
$1.6M
15K claims · 0.6%
$1.0M
4K claims
$235.37
$357.16
Behavioral health; residential, per diem
$1.0M
4K claims · 0.4%
$334K
9K claims
$38.95
$18.18
Self-care/home management training, per 15 minutes
$334K
9K claims · 0.1%
$246K
3K claims
$71.36
$96.18
Mental health assessment by non-physician
$246K
3K claims · 0.1%
$213K
4K claims
$60.30
$137.85
Other specified case management service, per 15 minutes
$213K
4K claims · 0.1%
$111K
7K claims
$14.92
$13.22
Treatment of speech/language disorder, group, 2+ patients
$111K
7K claims · 0.0%
Crisis intervention, per 15 min
$31K
120 claims · 0.0%
$24K
742 claims
$31.82
$24.49
Therapeutic exercises, each 15 min
$24K
742 claims · 0.0%
$7K
214 claims
$32.10
$20.04
Therapeutic procedure, neuromuscular reeducation, per 15 minutes
$7K
214 claims · 0.0%
Gait training
$648
24 claims · 0.0%
$0
138 claims · 0.0%
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