Is KENTUCKY RIVER COMMUNITY CARE, INC flagged for Medicaid fraud?

KENTUCKY RIVER COMMUNITY CARE, INC (NPI: 1316061658) has not been flagged by our statistical fraud detection tests. Their billing patterns fall within normal ranges for their specialty.

How much does KENTUCKY RIVER COMMUNITY CARE, INC bill Medicaid?

KENTUCKY RIVER COMMUNITY CARE, INC received $0.1B in total Medicaid payments from 2018-2024, based on HHS billing records. They are classified as a Specialist provider. Located in HAZARD, KY.

What is NPI 1316061658?

NPI 1316061658 is the National Provider Identifier for KENTUCKY RIVER COMMUNITY CARE, INC. They are a Specialist provider based in HAZARD, KY. This NPI is registered with the CMS NPI Registry.

⚖️ Compare 🖨️ Print Report

KENTUCKY RIVER COMMUNITY CARE, INC

Specialist·HAZARD, KY·NPI: 1316061658Share

Active Billing Period:2018-01→2024-12(84 months)

Total Paid

$109.2M

$109,240,145

Total Claims

875K

Beneficiaries

94K

9.3 claims/patient

Avg Cost/Claim

$125

Monthly Spending Trend

Yearly Spending

2018

$10.2M

+26%

2019

$12.8M

+9%

2020

$14.0M

+16%

2021

$16.2M

+5%

2022

$17.0M

+9%

2023

$18.5M

+10%

2024

$20.5M

Procedure Breakdown

Cost per claim compared to national benchmarks

This provider bills for 13 distinct procedure codes. The top code (T1019 (Personal care services, per 15 min)) accounts for 35% of total spending.

ProcedureTotalYour Cost/ClaimNational Medianvs MedianPercentile

T1019Personal care services, per 15 minSee all providers →

$38.1M

304K claims

$125.24

$82.47

1.5×

Normal range

T1019Normal range

Personal care services, per 15 min

$38.1M

304K claims · 34.9%

Your Cost: $125.24/claim|Median: $82.47

1.5× median

T2016Habilitation, residential, waiver; per diemSee all providers →

$31.1M

129K claims

$240.61

$331.94

0.7×

Normal range

T2016Normal range

Habilitation, residential, waiver; per diem

$31.1M

129K claims · 28.5%

Your Cost: $240.61/claim|Median: $331.94

0.7× median

97535Self-care/home management training, per 15 minutesSee all providers →

$19.9M

218K claims

$91.23

$18.18

5.0×

Top 10%

97535Top 10%

Self-care/home management training, per 15 minutes

$19.9M

218K claims · 18.2%

Your Cost: $91.23/claim|Median: $18.18

5.0× median

T2022Case management, per monthSee all providers →

$5.3M

24K claims

$220.90

$202.77

1.1×

Normal range

T2022Normal range

Case management, per month

$5.3M

24K claims · 4.9%

Your Cost: $220.90/claim|Median: $202.77

1.1× median

T2021Day habilitation, waiver; per 15 minSee all providers →

$5.0M

67K claims

$75.03

$150.51

0.5×

Normal range

T2021Normal range

Day habilitation, waiver; per 15 min

$5.0M

67K claims · 4.6%

Your Cost: $75.03/claim|Median: $150.51

0.5× median

S5108Home care training to home care client, per 15 minutesSee all providers →

$4.4M

49K claims

$88.81

$107.36

0.8×

Normal range

S5108Normal range

Home care training to home care client, per 15 minutes

$4.4M

49K claims · 4.0%

Your Cost: $88.81/claim|Median: $107.36

0.8× median

T1005Respite care services, per 15 minutesSee all providers →

$2.9M

51K claims

$57.43

$71.40

0.8×

Normal range

T1005Normal range

Respite care services, per 15 minutes

$2.9M

51K claims · 2.7%

Your Cost: $57.43/claim|Median: $71.40

0.8× median

T2040Financial management, self-directed; per monthSee all providers →

$2.2M

26K claims

$86.13

$108.97

0.8×

Normal range

T2040Normal range

Financial management, self-directed; per month

$2.2M

26K claims · 2.1%

Your Cost: $86.13/claim|Median: $108.97

0.8× median

S5130Homemaker service, NOS; per 15 minSee all providers →

$273K

6,007 claims

$45.42

$48.76

0.9×

Normal range

S5130Normal range

Homemaker service, NOS; per 15 min

$273K

6,007 claims · 0.2%

Your Cost: $45.42/claim|Median: $48.76

0.9× median

90832Psychotherapy, 30 minutesSee all providers →

$3K

99 claims

$34.50

$41.28

0.8×

Normal range

90832Normal range

Psychotherapy, 30 minutes

$3K

99 claims · 0.0%

Your Cost: $34.50/claim|Median: $41.28

0.8× median

90834Psychotherapy, 45 minutesSee all providers →

$2K

27 claims

$60.62

$63.65

1.0×

Normal range

90834Normal range

Psychotherapy, 45 minutes

$2K

27 claims · 0.0%

Your Cost: $60.62/claim|Median: $63.65

1.0× median

90837Psychotherapy, 60 minutesSee all providers →

$1K

16 claims

$83.02

$85.66

1.0×

Normal range

90837Normal range

Psychotherapy, 60 minutes

$1K

16 claims · 0.0%

Your Cost: $83.02/claim|Median: $85.66

1.0× median

90887Interpretation/explanation of resultsSee all providers →

$1K

15 claims

$75.90

$47.55

1.6×

Top 25%

90887Top 25%

Interpretation/explanation of results

$1K

15 claims · 0.0%

Your Cost: $75.90/claim|Median: $47.55

1.6× median

Other Top Providers in Kentucky

View all →

University of Kentucky

General Acute Care Hospital

$716.4M

Norton Hospitals INC

General Acute Care Hospital

$419.6M

Seven Counties Services Inc.

Clinic/Center Developmental Disabilities

$375.8M

Cumberland River Behavioral Health INC

Community/Behavioral Health

$349.2M

Addiction Recovery Care LLC

Community Based Residential Treatment Facility, Me

$309.0M

Similar Providers

Other top providers in Specialist

Department of Health and Senior Services

Trenton, NJ

$1.07B

← All providers All providers in Kentucky →How we detect fraud →