State of Oklahoma Dept. of Human Services
Single-Code
Billing almost exclusively for 1-2 procedure codes despite high total volume.
Bills primarily for code G9012 (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:
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 (G9012).
This is a statistical summary, not an accusation. See our methodology.
Compared to Case Management Peers
Total spending distribution among 137 providers in this specialty
This provider's total spending of $187.3M is at the 50th percentile among 137 Case Management providers.
Extreme procedure concentration — 100% of $187.3M billed through a single code
Total Paid
$187.3M
$187,336,349
Total Claims
815K
Beneficiaries
381K
2.1 claims/patient
Avg Cost/Claim
$230
#502 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
State of Oklahoma Dept. of Human Services is a Case Management provider based in Oklahoma City, OK. From the 2018–2024 period, this provider received $187.3M in Medicaid payments across 815K claims.
Important Context
- ℹ️This provider appears to operate as a fiscal intermediary or management organization, processing payments on behalf of many individual caregivers. High aggregate billing is expected for this type of entity.
- 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 $187.3M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 23,417 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 (G9012 (Other specified case management service, per 15 minutes)) accounts for 100% of total spending.
$187.3M
815K claims
$229.91
$137.85
Other specified case management service, per 15 minutes
$187.3M
815K claims · 100.0%
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