New Jersey Division of Developmental Disabilities
Day Training Developmentally Disabled Services
Hamilton, New Jersey
NPI: 1073854451
Risk Tier
Critical
Total Paid
$333.9M
$333,873,625
Total Claims
738K
Beneficiaries
145K
Avg Cost/Claim
$452.59
Active billing period: 82 months (2018-01 to 2024-10)
Statistical Fraud Flags (4)
Cost Outlier
Billing over 3× the national median for specific procedure codes.
Bills $3,700.51 per claim for H2016 (Comprehensive community support services, per 15 min), which is 11.5× the national median of $321.53.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 3 procedure codes: H2016 at 11.5× median, T2020 at 3.9× median.
High Cost Per Claim
Average payment per claim is much higher than peers billing the same procedures.
Spending Spike
Experienced a dramatic increase in billing over a short period.
Advanced Detection Signals
CUSUM Change Point
Billing shifted 0.1x in 2019-10 — a statistically significant structural change in billing behavior was detected.
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