Is THRESHOLDS INC flagged for Medicaid fraud?

THRESHOLDS INC (NPI: 1154403467) has not been flagged by our statistical fraud detection tests. Their billing patterns fall within normal ranges for their specialty.

How much does THRESHOLDS INC bill Medicaid?

THRESHOLDS INC received $0.0B in total Medicaid payments from 2018-2024, based on HHS billing records. They are classified as a Case Management provider. Located in GRAND RAPIDS, MI.

What is NPI 1154403467?

NPI 1154403467 is the National Provider Identifier for THRESHOLDS INC. They are a Case Management provider based in GRAND RAPIDS, MI. This NPI is registered with the CMS NPI Registry.

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THRESHOLDS INC

Case Management·GRAND RAPIDS, MI·NPI: 1154403467Share

Compared to Case Management Peers

Total spending distribution among 137 providers in this specialty

P25MedianP75P90

This provider's total spending of $44.3M is at the 25th percentile among 137 Case Management providers.

Active Billing Period:2018-01→2024-11(83 months)

Total Paid

$44.3M

$44,303,087

Total Claims

304K

Beneficiaries

38K

8.0 claims/patient

Avg Cost/Claim

$146

Monthly Spending Trend

Yearly Spending

2018

$8.3M

-19%

2019

$6.7M

-12%

2020

$5.9M

-3%

2021

$5.7M

-4%

2022

$5.5M

+11%

2023

$6.1M

-0%

2024

$6.1M

Procedure Breakdown

Cost per claim compared to national benchmarks

This provider bills for 9 distinct procedure codes. The top code (H2016 (Comprehensive community support services, per 15 min)) accounts for 68% of total spending.

ProcedureTotalYour Cost/ClaimNational Medianvs MedianPercentile

H2016Comprehensive community support services, per 15 minSee all providers →

$30.1M

125K claims

$241.17

$321.53

0.8×

Normal range

H2016Normal range

Comprehensive community support services, per 15 min

$30.1M

125K claims · 67.9%

Your Cost: $241.17/claim|Median: $321.53

0.8× median

T1020Personal care services, per diemSee all providers →

$7.1M

125K claims

$56.90

$296.27

0.2×

Normal range

T1020Normal range

Personal care services, per diem

$7.1M

125K claims · 16.0%

Your Cost: $56.90/claim|Median: $296.27

0.2× median

T1016Case management, each 15 minSee all providers →

$2.5M

14K claims

$182.20

$49.62

3.7×

Top 25%

T1016Top 25%

Case management, each 15 min

$2.5M

14K claims · 5.7%

Your Cost: $182.20/claim|Median: $49.62

3.7× median

H2015Comprehensive community support services, per 15 minSee all providers →

$1.9M

20K claims

$94.11

$96.24

1.0×

Normal range

H2015Normal range

Comprehensive community support services, per 15 min

$1.9M

20K claims · 4.2%

Your Cost: $94.11/claim|Median: $96.24

1.0× median

T2022Case management, per monthSee all providers →

$1.5M

6,263 claims

$242.51

$202.77

1.2×

Normal range

T2022Normal range

Case management, per month

$1.5M

6,263 claims · 3.4%

Your Cost: $242.51/claim|Median: $202.77

1.2× median

T1005Respite care services, per 15 minutesSee all providers →

$838K

11K claims

$74.57

$71.40

1.0×

Normal range

T1005Normal range

Respite care services, per 15 minutes

$838K

11K claims · 1.9%

Your Cost: $74.57/claim|Median: $71.40

1.0× median

T1017Targeted case management, per 15 minSee all providers →

$293K

2,488 claims

$117.87

$69.56

1.7×

Normal range

T1017Normal range

Targeted case management, per 15 min

$293K

2,488 claims · 0.7%

Your Cost: $117.87/claim|Median: $69.56

1.7× median

T2011 See all providers →

$45K

42 claims

$1,067.20

$122.73

8.7×

Top 1%

T2011Top 1%

$45K

42 claims · 0.1%

Your Cost: $1,067.20/claim|Median: $122.73

8.7× median

S5161Emergency response system, per monthSee all providers →

$9K

12 claims

$740.25

$29.97

24.7×

Top 1%

S5161Top 1%

Emergency response system, per month

$9K

12 claims · 0.0%

Your Cost: $740.25/claim|Median: $29.97

24.7× median

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