Ohioguidestone
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 6 procedure codes: 99214 at 2.0× median, T2023 at 2.4× median.
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:
Rate Outlier
Rate Outlier means this provider charges above the 90th percentile for multiple different procedure codes simultaneously. While one high-cost code could reflect specialization, consistently high rates across many codes may indicate systematic overbilling.
These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.
Risk Assessment
Billing above the 90th percentile for 6 procedure codes simultaneously.
This is a statistical summary, not an accusation. See our methodology.
Compared to Community/Behavioral Health Peers
Total spending distribution among 218 providers in this specialty
This provider's total spending of $195.0M is at the 75th percentile among 218 Community/Behavioral Health providers.
Total Paid
$195.0M
$195,022,004
Total Claims
2.2M
Beneficiaries
1.0M
2.2 claims/patient
Avg Cost/Claim
$88
#474 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Ohioguidestone is a Community/Behavioral Health provider based in Berea, OH. From the 2018–2024 period, this provider received $195.0M in Medicaid payments across 2.2M claims.
Why This Matters
This provider received $195.0M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 24,377 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 30 distinct procedure codes. The top code (H2019 (Therapeutic behavioral services, per 15 min)) accounts for 53% of total spending.
$103.6M
1.1M claims
$91.54
$84.12
Therapeutic behavioral services, per 15 min
$103.6M
1.1M claims · 53.1%
Psychotherapy, 60 minutes
$37.5M
403K claims · 19.2%
$10.6M
40K claims
$265.51
$266.41
Assertive community treatment, face-to-face, per 15 minutes
$10.6M
40K claims · 5.4%
$9.3M
88K claims
$105.72
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$9.3M
88K claims · 4.8%
Psychotherapy, 30 minutes
$6.3M
125K claims · 3.2%
$6.2M
41K claims
$149.09
$144.05
Day habilitation, waiver, per 15 minutes
$6.2M
41K claims · 3.2%
Psychotherapy, 45 minutes
$4.9M
77K claims · 2.5%
$3.2M
76K claims
$41.92
$76.05
Community psychiatric supportive treatment, per 15 min
$3.2M
76K claims · 1.6%
$1.9M
28K claims · 1.0%
Case management, per month
$1.8M
9,044 claims · 0.9%
$1.7M
16K claims
$101.88
$99.21
Psychiatric diagnostic evaluation
$1.7M
16K claims · 0.9%
$1.5M
41K claims
$37.71
$91.63
Psychosocial rehabilitation services, per 15 min
$1.5M
41K claims · 0.8%
$1.2M
22K claims
$56.38
$38.83
Psychotherapy, 30 min, add-on to E/M service
$1.2M
22K claims · 0.6%
$1.0M
15K claims
$67.90
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$1.0M
15K claims · 0.5%
$770K
1,060 claims
$726.16
$300.13
Community transition, waiver; per service
$770K
1,060 claims · 0.4%
$634K
8,347 claims
$75.93
$77.33
Family psychotherapy with patient, 50 min
$634K
8,347 claims · 0.3%
$555K
51K claims · 0.3%
$545K
3,430 claims
$158.94
$84.03
Office/outpatient visit, new patient, mod-high complexity
$545K
3,430 claims · 0.3%
$261K
4,338 claims
$60.20
$253.79
Alcohol/drug treatment, per hour
$261K
4,338 claims · 0.1%
$252K
6,561 claims
$38.38
$137.86
Behavioral health day treatment, per hour
$252K
6,561 claims · 0.1%
$215K
1,205 claims
$178.80
$96.24
Comprehensive community support services, per 15 min
$215K
1,205 claims · 0.1%
$195K
954 claims
$204.39
$111.09
Office/outpatient visit, new patient, high complexity
$195K
954 claims · 0.1%
$165K
1,119 claims
$147.63
$74.09
Office/outpatient visit, high complexity
$165K
1,119 claims · 0.1%
$144K
1,816 claims
$79.51
$76.61
Family psychotherapy without patient, 50 min
$144K
1,816 claims · 0.1%
$127K
1,009 claims
$125.85
$83.98
Psychotherapy for crisis, first 60 min
$127K
1,009 claims · 0.1%
$124K
3,288 claims
$37.64
$43.10
Alcohol and/or drug services, case management
$124K
3,288 claims · 0.1%
$81K
673 claims · 0.0%
$62K
554 claims
$111.37
$57.85
Office/outpatient visit, new patient, low-mod complexity
$62K
554 claims · 0.0%
$59K
402 claims
$146.45
$114.71
Comprehensive multidisciplinary evaluation
$59K
402 claims · 0.0%
$53K
1,361 claims
$38.72
$25.06
Office/outpatient visit, low complexity
$53K
1,361 claims · 0.0%
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