Kelsch Associates
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $1,421.37 per claim for H2016 (Comprehensive community support services, per 15 min), which is 4.4× the national median of $321.53.
Single-Code
Billing almost exclusively for 1-2 procedure codes despite high total volume.
Bills primarily for code T2021 (2 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:
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.
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.
Compared to Community Based Residential Treatment Facility Intellectual and/or Developmental Disabilities Peers
Total spending distribution among 19 providers in this specialty
This provider's total spending of $117.4M is at the 50th percentile among 19 Community Based Residential Treatment Facility Intellectual and/or Developmental Disabilities providers.
Total Paid
$117.4M
$117,431,259
Total Claims
97K
Beneficiaries
14K
7.1 claims/patient
Avg Cost/Claim
$1K
🔍 Analysis
Provider Overview
Kelsch Associates is a Community Based Residential Treatment Facility Intellectual and/or Developmental Disabilities provider based in Woodbury Heights, NJ. From the 2018–2024 period, this provider received $117.4M in Medicaid payments across 97K claims.
Why This Matters
This provider received $117.4M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 14,678 Medicaid beneficiaries for a full year at average per-enrollee costs.
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