Statistical flags indicate unusual patterns — not proof of fraud or wrongdoing. Read our methodology

Alamo Consumer Direct, LLC

Supports Brokerage·Austin, TX·NPI: 1336467166SharePrint Report
View on Risk Watchlist →

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:

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Billing Swing

Billing Swing means this provider's total billing changed dramatically from one year to the next — increasing or decreasing by more than 200% with over $1M in absolute change. This could indicate a change in practice scope, a billing scheme ramping up, or legitimate growth.

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

Change PointBilling shifted 14.5x in 2020-10

These signals use advanced statistical methods including digit distribution analysis, change-point detection, and market concentration metrics. Learn more.

Compared to Supports Brokerage Peers

Total spending distribution among 14 providers in this specialty

P25MedianP75P90

This provider's total spending of $158.8M is at the 25th percentile among 14 Supports Brokerage providers.

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

Total Paid

$158.8M

$158,757,504

Total Claims

2.6M

Beneficiaries

186K

13.8 claims/patient

Avg Cost/Claim

$62

#660 of 618K providers by total spending(top 0.1%)

🔍 Analysis

Provider Overview

Alamo Consumer Direct, LLC is a Supports Brokerage provider based in Austin, TX. From the 2018–2024 period, this provider received $158.8M in Medicaid payments across 2.6M claims.

Important Context

  • ℹ️This provider is a known fiscal management organization for self-directed care programs. They manage billing on behalf of thousands of individual caregivers, so aggregate billing is high by design. However, the self-directed care category has been identified as fraud-prone by regulators.

Why This Matters

This provider received $158.8M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 19,844 Medicaid beneficiaries for a full year at average per-enrollee costs.

↑ 1714% growthsince first billing year

Monthly Spending Trend

Yearly Spending

2018
$2.0M
+29%
2019
$2.6M
+217%
2020
$8.1M
+325%
2021
$34.6M
+9%
2022
$37.9M
-2%
2023
$37.2M
-3%
2024
$36.3M

Procedure Breakdown

Cost per claim compared to national benchmarks

This provider bills for 29 distinct procedure codes. The top code (S5125 (Attendant care services, per 15 min)) accounts for 24% of total spending.

S5125Normal range

Attendant care services, per 15 min

$37.8M

538K claims · 23.8%

Your Cost: $70.15/claim|Median: $82.34
0.8× median
T2016Normal range

Habilitation, residential, waiver; per diem

$32.9M

641K claims · 20.7%

Your Cost: $51.27/claim|Median: $331.94
0.1× median
T1019Normal range

Personal care services, per 15 min

$32.3M

442K claims · 20.3%

Your Cost: $73.00/claim|Median: $82.47
0.9× median
T2040Normal range

Financial management, self-directed; per month

$9.5M

291K claims · 6.0%

Your Cost: $32.80/claim|Median: $108.97
0.3× median
T2017Normal range

Habilitation, residential, waiver; 15 min

$8.3M

92K claims · 5.3%

Your Cost: $90.56/claim|Median: $137.32
0.7× median
M0355Normal range

$7.5M

51K claims · 4.7%

Your Cost: $146.58/claim|Median: $196.65
0.8× median
T1005Normal range

Respite care services, per 15 minutes

$7.4M

96K claims · 4.7%

Your Cost: $77.68/claim|Median: $71.40
1.1× median
H2015Normal range

Comprehensive community support services, per 15 min

$6.0M

72K claims · 3.8%

Your Cost: $82.92/claim|Median: $96.24
0.9× median
M0361Normal range

$5.4M

41K claims · 3.4%

Your Cost: $130.27/claim|Median: $151.88
0.9× median
S9125Normal range

Respite care, in the home, per diem

$3.4M

105K claims · 2.2%

Your Cost: $32.47/claim|Median: $187.28
0.2× median
G0749Normal range

$1.9M

29K claims · 1.2%

Your Cost: $65.39/claim|Median: $219.77
0.3× median
M0209Normal range

$1.3M

7K claims · 0.8%

Your Cost: $181.55/claim|Median: $189.12
1.0× median
M0111Normal range

$1.2M

7K claims · 0.8%

Your Cost: $181.37/claim|Median: $189.91
1.0× median
M0241Normal range

$1.2M

13K claims · 0.8%

Your Cost: $96.15/claim|Median: $113.44
0.8× median
M0373Normal range

$592K

20K claims · 0.4%

Your Cost: $29.93/claim|Median: $53.80
0.6× median
G0226Normal range

$583K

3K claims · 0.4%

Your Cost: $204.14/claim|Median: $204.14
1.0× median
M0420Normal range

$343K

14K claims · 0.2%

Your Cost: $25.38/claim|Median: $49.34
0.5× median
M0145Normal range

$287K

3K claims · 0.2%

Your Cost: $94.03/claim|Median: $96.21
1.0× median
G0227Normal range

$206K

2K claims · 0.1%

Your Cost: $110.58/claim|Median: $110.80
1.0× median
G6063Normal range

$159K

27K claims · 0.1%

Your Cost: $5.87/claim|Median: $36.83
0.2× median
H2038Normal range

$123K

4K claims · 0.1%

Your Cost: $33.18/claim|Median: $67.30
0.5× median
G6064Normal range

$82K

29K claims · 0.1%

Your Cost: $2.83/claim|Median: $86.23
0.0× median
M0202Normal range

$50K

173 claims · 0.0%

Your Cost: $288.76/claim|Median: $288.76
1.0× median
T2020Top 25%

Day habilitation, waiver; per diem

$46K

226 claims · 0.0%

Your Cost: $202.77/claim|Median: $87.34
2.3× median
M0539Normal range

$29K

13K claims · 0.0%

Your Cost: $2.20/claim|Median: $7.60
0.3× median
M0538Normal range

$16K

14K claims · 0.0%

Your Cost: $1.14/claim|Median: $21.57
0.1× median
M0541Normal range

$15K

8K claims · 0.0%

Your Cost: $1.96/claim|Median: $7.08
0.3× median
S5151Normal range

Unskilled respite care, per diem

$9K

33 claims · 0.0%

Your Cost: $265.51/claim|Median: $249.18
1.1× median
M0540Normal range

$8K

8K claims · 0.0%

Your Cost: $0.99/claim|Median: $0.99
1.0× median

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