Department of Intellectual and Developmental Disabilities, State of Tn
Public Health or Welfare
Nashville, Tennessee
NPI: 1356709976
Risk Tier
Critical
Total Paid
$1.45B
$1,452,536,495
Total Claims
5.3M
Beneficiaries
390K
Avg Cost/Claim
$274.74
Active billing period: 78 months (2018-01 to 2024-06)
Statistical Fraud Flags (5)
Cost Outlier
Billing over 3× the national median for specific procedure codes.
Bills $597.06 per claim for T2025 (Waiver services, NOS; per 15 min), which is 4.8× the national median of $124.39.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 12 procedure codes: T2012 at 1.3× median, D4341 at 6.7× median.
Consistent Billing
Monthly billing amounts show almost no natural variation (CV < 0.1).
Monthly billing coefficient of variation: 0.0631 (near-zero variation).
Unusually High Spending
This provider's total payments are significantly above the median for their specialty.
High Cost Per Claim
Average payment per claim is much higher than peers billing the same procedures.
Disclaimer: Statistical flags indicate unusual billing patterns — they are not proof of fraud or wrongdoing. Some entities (government agencies, home care programs, hospitals) may legitimately bill at higher rates due to patient acuity, overhead costs, or specialized services. This report is generated from public HHS data and statistical analysis only. No clinical or investigative review has been performed.
Generated by OpenMedicaid | openmedicaid.org | Data: HHS 2018-2024