Is UTOPIA HOME CARE INC flagged for Medicaid fraud?

UTOPIA HOME CARE INC (NPI: 1164460820) has not been flagged by our statistical fraud detection tests. Their billing patterns fall within normal ranges for their specialty.

How much does UTOPIA HOME CARE INC bill Medicaid?

UTOPIA HOME CARE INC received $0.1B in total Medicaid payments from 2018-2024, based on HHS billing records. They are classified as a Home Health provider. Located in EAST HAVEN, CT.

What is NPI 1164460820?

NPI 1164460820 is the National Provider Identifier for UTOPIA HOME CARE INC. They are a Home Health provider based in EAST HAVEN, CT. This NPI is registered with the CMS NPI Registry.

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UTOPIA HOME CARE INC

Home Health·EAST HAVEN, CT·NPI: 1164460820Share

Compared to Home Health Peers

Total spending distribution among 322 providers in this specialty

P25MedianP75P90

This provider's total spending of $81.3M is at the 25th percentile among 322 Home Health providers.

Active Billing Period:2018-01→2024-12(84 months)

Total Paid

$81.3M

$81,312,572

Total Claims

2.1M

Beneficiaries

144K

14.5 claims/patient

Avg Cost/Claim

$39

Monthly Spending Trend

Yearly Spending

2018

$14.3M

+24%

2019

$17.7M

-41%

2020

$10.5M

-1%

2021

$10.4M

-5%

2022

$9.9M

+1%

2023

$10.0M

-15%

2024

$8.5M

Procedure Breakdown

Cost per claim compared to national benchmarks

This provider bills for 14 distinct procedure codes. The top code (T1004 (Services of a qualified nursing aide, per 15 minutes)) accounts for 32% of total spending.

ProcedureTotalYour Cost/ClaimNational Medianvs MedianPercentile

T1004Services of a qualified nursing aide, per 15 minutesSee all providers →

$25.9M

808K claims

$32.07

$50.30

0.6×

Normal range

T1004Normal range

Services of a qualified nursing aide, per 15 minutes

$25.9M

808K claims · 31.9%

Your Cost: $32.07/claim|Median: $50.30

0.6× median

T1502Administration of oral, intramuscular, or subcutaneous medicationSee all providers →

$24.4M

743K claims

$32.79

$7.86

4.2×

Top 25%

T1502Top 25%

Administration of oral, intramuscular, or subcutaneous medication

$24.4M

743K claims · 30.0%

Your Cost: $32.79/claim|Median: $7.86

4.2× median

S9123Nursing care, in the home, by RN, per 15 minutesSee all providers →

$13.4M

278K claims

$48.10

$124.86

0.4×

Normal range

S9123Normal range

Nursing care, in the home, by RN, per 15 minutes

$13.4M

278K claims · 16.5%

Your Cost: $48.10/claim|Median: $124.86

0.4× median

T1019Personal care services, per 15 minSee all providers →

$10.1M

77K claims

$130.56

$82.47

1.6×

Normal range

T1019Normal range

Personal care services, per 15 min

$10.1M

77K claims · 12.4%

Your Cost: $130.56/claim|Median: $82.47

1.6× median

S9124Nursing care, in the home; per hourSee all providers →

$3.1M

65K claims

$47.22

$400.25

0.1×

Normal range

S9124Normal range

Nursing care, in the home; per hour

$3.1M

65K claims · 3.8%

Your Cost: $47.22/claim|Median: $400.25

0.1× median

G0162Skilled services by RN in home health, per 15 minSee all providers →

$2.5M

70K claims

$36.63

$59.83

0.6×

Normal range

G0162Normal range

Skilled services by RN in home health, per 15 min

$2.5M

70K claims · 3.1%

Your Cost: $36.63/claim|Median: $59.83

0.6× median

S5130Homemaker service, NOS; per 15 minSee all providers →

$833K

15K claims

$55.60

$48.76

1.1×

Normal range

S5130Normal range

Homemaker service, NOS; per 15 min

$833K

15K claims · 1.0%

Your Cost: $55.60/claim|Median: $48.76

1.1× median

T1503 See all providers →

$523K

14K claims

$37.06

$48.74

0.8×

Normal range

T1503Normal range

$523K

14K claims · 0.6%

Your Cost: $37.06/claim|Median: $48.74

0.8× median

T1001Nursing assessment/evaluation, per visitSee all providers →

$249K

10K claims

$24.73

$49.05

0.5×

Normal range

T1001Normal range

Nursing assessment/evaluation, per visit

$249K

10K claims · 0.3%

Your Cost: $24.73/claim|Median: $49.05

0.5× median

S5125Attendant care services, per 15 minSee all providers →

$150K

2,472 claims

$60.54

$82.34

0.7×

Normal range

S5125Normal range

Attendant care services, per 15 min

$150K

2,472 claims · 0.2%

Your Cost: $60.54/claim|Median: $82.34

0.7× median

99509Home visit, assistance w/ ADLsSee all providers →

$147K

4,336 claims

$33.96

$51.71

0.7×

Normal range

99509Normal range

Home visit, assistance w/ ADLs

$147K

4,336 claims · 0.2%

Your Cost: $33.96/claim|Median: $51.71

0.7× median

S5135Companion care, adult, per diemSee all providers →

$51K

2,072 claims

$24.63

$52.25

0.5×

Normal range

S5135Normal range

Companion care, adult, per diem

$51K

2,072 claims · 0.1%

Your Cost: $24.63/claim|Median: $52.25

0.5× median

T1030Nursing care, in the home, by RN, per diemSee all providers →

$4K

53 claims

$71.40

$85.62

0.8×

Normal range

T1030Normal range

Nursing care, in the home, by RN, per diem

$4K

53 claims · 0.0%

Your Cost: $71.40/claim|Median: $85.62

0.8× median

G0156Home health aide services, per visitSee all providers →

834 claims

$0.00

$39.42

—

Normal range

G0156Normal range

Home health aide services, per visit

834 claims · 0.0%

Your Cost: $0.00/claim|Median: $39.42

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