Ambercare Home Health Care Corporation
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $353.97 per claim for 99509 (Home visit, assistance w/ ADLs), which is 6.8× the national median of $51.71.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 3 procedure codes: 99509 at 6.8× median, S5110 at 2.9× 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:
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.
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.
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 $353.97 per claim for 99509 (Home visit, assistance w/ ADLs) — 6.8× the national median of $51.71.
Bills $114.22 per claim for G0155 (Services of clinical social worker in home health, per 15 min) — 16.2× the national median of $7.04.
Bills $9.48 per claim for A9270 — 47.4× the national median of $0.20.
Billing above the 90th percentile for 3 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 $518.1M is at the 75th percentile among 322 Home Health providers.
Total Paid
$518.1M
$518,099,159
Total Claims
3.9M
Beneficiaries
440K
8.8 claims/patient
Avg Cost/Claim
$134
#117 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Ambercare Home Health Care Corporation is a Home Health provider based in Albuquerque, NM. From the 2018–2024 period, this provider received $518.1M in Medicaid payments across 3.9M claims.
Why This Matters
This provider received $518.1M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 64,762 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 21 distinct procedure codes. The top code (99509 (Home visit, assistance w/ ADLs)) accounts for 48% of total spending.
Home visit, assistance w/ ADLs
$248.3M
701K claims · 47.9%
$235.0M
2.9M claims
$80.04
$82.47
Personal care services, per 15 min
$235.0M
2.9M claims · 45.4%
$27.1M
146K claims
$185.31
$204.93
Coordination of long-term care services, per hour
$27.1M
146K claims · 5.2%
$3.1M
14K claims
$214.85
$74.36
Home care training, family; per 15 min
$3.1M
14K claims · 0.6%
$2.1M
26K claims
$81.51
$51.67
Skilled nursing services, home health, per visit, RN
$2.1M
26K claims · 0.4%
$1.4M
18K claims
$78.24
$67.94
Physical therapy services, home health, per visit
$1.4M
18K claims · 0.3%
$458K
5K claims
$86.24
$68.93
Occupational therapy services, home health, per visit
$458K
5K claims · 0.1%
$307K
4K claims
$83.92
$82.34
Attendant care services, per 15 min
$307K
4K claims · 0.1%
$178K
2K claims
$81.09
$101.43
Services of SLP in home health, per 15 min
$178K
2K claims · 0.0%
$98K
72 claims
$1,366.06
$531.12
Community transition, waiver; per service
$98K
72 claims · 0.0%
$63K
871 claims
$71.80
$45.50
Skilled nursing services, home health, per visit, LPN
$63K
871 claims · 0.0%
$27K
234 claims
$114.22
$7.04
Services of clinical social worker in home health, per 15 min
$27K
234 claims · 0.0%
$9K
215 claims
$40.35
$39.42
Home health aide services, per visit
$9K
215 claims · 0.0%
$6K
66 claims · 0.0%
$3K
378 claims · 0.0%
$2K
88 claims · 0.0%
$2K
91 claims · 0.0%
$1K
114 claims · 0.0%
$876
103 claims · 0.0%
Gauze, non-impregnated, sterile
$791
191 claims · 0.0%
$715
100 claims · 0.0%
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