Act Home Health Services INC
High Claims Per Patient
Filing an unusually high number of claims per beneficiary compared to peers.
Spending Spike
Experienced a dramatic increase in billing over a short period.
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:
High Claims Per Patient
High Claims Per Patient means this provider files an unusually high number of claims per individual patient. This could indicate legitimate intensive treatment or a pattern of billing for services not actually rendered.
Spending Spike
Spending Spike means this provider experienced a dramatic, sudden increase in billing over a short period. Legitimate causes include new contracts or expanded services, but this pattern also appears in billing fraud ramp-ups.
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 $2,221.90 per claim for T2025 (Waiver services, NOS; per 15 min) — 17.9× the national median of $124.39.
Bills $516.54 per claim for S9123 (Nursing care, in the home, by RN, per 15 minutes) — 4.1× the national median of $124.86.
Bills $640.28 per claim for T1003 (LPN/LVN services, per 15 minutes) — 26.4× the national median of $24.24.
Billing above the 90th percentile for 4 procedure codes simultaneously.
This is a statistical summary, not an accusation. See our methodology.
Compared to Home Health Peers
Total spending distribution among 322 providers in this specialty
This provider's total spending of $126.0M is at the 25th percentile among 322 Home Health providers.
Total Paid
$126.0M
$125,953,527
Total Claims
174K
Beneficiaries
9K
19.9 claims/patient
Avg Cost/Claim
$724
#933 of 618K providers by total spending(top 0.2%)
🔍 Analysis
Provider Overview
Act Home Health Services INC is a Home Health provider based in Philadelphia, PA. From the 2018–2024 period, this provider received $126.0M in Medicaid payments across 174K claims.
Why This Matters
This provider received $126.0M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 15,744 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 6 distinct procedure codes. The top code (S9124 (Nursing care, in the home; per hour)) accounts for 38% of total spending.
$48.0M
81K claims
$595.36
$400.25
Nursing care, in the home; per hour
$48.0M
81K claims · 38.1%
Waiver services, NOS; per 15 min
$31.5M
14K claims · 25.0%
$14.3M
28K claims
$516.54
$124.86
Nursing care, in the home, by RN, per 15 minutes
$14.3M
28K claims · 11.4%
LPN/LVN services, per 15 minutes
$13.5M
21K claims · 10.7%
$11.5M
18K claims
$653.43
$402.76
Private duty/independent nursing service(s)
$11.5M
18K claims · 9.1%
RN services, per 15 minutes
$7.1M
13K claims · 5.7%
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