Tennessee Department of Children's Services
Public Health or Welfare
Nashville, Tennessee
NPI: 1124494059
Risk Tier
Critical
Total Paid
$781.0M
$780,976,224
Total Claims
911K
Beneficiaries
878K
Avg Cost/Claim
$857.43
Active billing period: 65 months (2019-07 to 2024-11)
Statistical Fraud Flags (5)
Billing Swing
Experienced over 200% change in year-over-year billing with >$1M absolute change.
Billing changed from $18.5M (2019) to $160.6M (2020) — a 769% swing with $142.2M absolute change.
Explosive Growth
Billing increased over 500% year-over-year — far beyond normal growth patterns.
Billing grew 769% from 2019 to 2020.
Single-Code
Billing almost exclusively for 1-2 procedure codes despite high total volume.
Bills primarily for code T2023 (1 unique codes).
Unusually High Spending
This provider's total payments are significantly above the median for their specialty.
Spending Spike
Experienced a dramatic increase in billing over a short period.
Advanced Detection Signals
CUSUM Change Point
Billing shifted 4.6x in 2019-12 — a statistically significant structural change in billing behavior was detected.
Suspicious Concentration
Herfindahl-Hirschman Index of 1 across 1 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