Ma-department of Social Services-rehab
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $2,173.52 per claim for H0018 (Behavioral health; short-term residential, per diem), which is 4.6× the national median of $467.51.
Single-Code
Billing almost exclusively for 1-2 procedure codes despite high total volume.
Bills primarily for code H0018 (1 unique codes).
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.
Single-Code
Single-Code Billing means this provider bills almost exclusively for one or two procedure codes despite high total volume. Legitimate specialists may focus on specific codes, but extreme concentration can indicate a scheme billing repeatedly for the same service.
These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.
Advanced Detection Signals
Additional statistical tests from advanced fraud detection methods
These signals use advanced statistical methods including digit distribution analysis, change-point detection, and market concentration metrics. Learn more.
Risk Assessment
Extreme procedure concentration — 100% of all billing flows through a single code (H0018).
Bills $2,173.52 per claim for H0018 (Behavioral health; short-term residential, per diem) — 4.7× the national median of $467.51.
This is a statistical summary, not an accusation. See our methodology.
Compared to Public Health or Welfare Peers
Total spending distribution among 17 providers in this specialty
This provider's total spending of $490.7M is at the 50th percentile among 17 Public Health or Welfare providers.
Extreme procedure concentration — 100% of $490.7M billed through a single code
Total Paid
$490.7M
$490,725,903
Total Claims
226K
Beneficiaries
106K
2.1 claims/patient
Avg Cost/Claim
$2K
#128 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Ma-department of Social Services-rehab is a Public Health or Welfare provider based in Boston, MA. From the 2018–2024 period, this provider received $490.7M in Medicaid payments across 226K claims.
Important Context
- 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 $490.7M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 61,340 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 1 distinct procedure code. The top code (H0018 (Behavioral health; short-term residential, per diem)) accounts for 100% of total spending.
$490.7M
226K claims
$2,173.52
$467.51
Behavioral health; short-term residential, per diem
$490.7M
226K claims · 100.0%
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