Community Alternatives Virginia Inc.
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $8,330.64 per claim for T2033 (Residential care, NOS; per diem), which is 7.9× the national median of $1,051.57.
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:
Cost Outlier
Cost Outlier means this provider charges significantly more per claim than other providers billing the same procedure codes. This could indicate upcoding, inflated charges, or specialized services that justify higher costs.
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
Bills $8,330.64 per claim for T2033 (Residential care, NOS; per diem) — 7.9× the national median of $1,051.57.
Bills $3,839.20 per claim for H2014 (Skills training & development, per 15 min) — 45.8× the national median of $83.88.
Bills $1,236.18 per claim for 97150 (Therapeutic procedure, group (2+ patients)) — 102.0× the national median of $12.12.
Billing in the top 1% nationally for 2 procedure codes: H2014, 97150.
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 $172.7M is at the 75th percentile among 218 Community/Behavioral Health providers.
Total Paid
$172.7M
$172,726,466
Total Claims
23K
Beneficiaries
22K
1.1 claims/patient
Avg Cost/Claim
$8K
#565 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Community Alternatives Virginia Inc. is a Community/Behavioral Health provider based in Forest, VA. From the 2018–2024 period, this provider received $172.7M in Medicaid payments across 23K claims.
Why This Matters
This provider received $172.7M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 21,590 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 3 distinct procedure codes. The top code (T2033 (Residential care, NOS; per diem)) accounts for 96% of total spending.
$166.5M
20K claims
$8,330.64
$1,051.57
Residential care, NOS; per diem
$166.5M
20K claims · 96.4%
$3.8M
1K claims
$3,839.20
$83.88
Skills training & development, per 15 min
$3.8M
1K claims · 2.2%
$2.4M
2K claims
$1,236.18
$12.12
Therapeutic procedure, group (2+ patients)
$2.4M
2K claims · 1.4%
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