South Dakota Achieve
High Cost Per Claim
Average payment per claim is much higher than peers billing the same procedures.
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 Cost Per Claim
High Cost Per Claim means each individual claim from this provider costs significantly more than what other providers charge for the same services. This could indicate upcoding (billing for more expensive services than provided) or legitimate specialized care.
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.
Risk Assessment
Bills $298.13 per claim for T2020 (Day habilitation, waiver; per diem) — 3.4× the national median of $87.34.
Bills $416.94 per claim for S0281 — 4.5× the national median of $92.97.
This is a statistical summary, not an accusation. See our methodology.
Compared to Clinic/Center Developmental Disabilities Peers
Total spending distribution among 10 providers in this specialty
This provider's total spending of $166.9M is at the 50th percentile among 10 Clinic/Center Developmental Disabilities providers.
Total Paid
$166.9M
$166,942,970
Total Claims
419K
Beneficiaries
185K
2.3 claims/patient
Avg Cost/Claim
$398
#599 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
South Dakota Achieve is a Clinic/Center Developmental Disabilities provider based in Sioux Falls, SD. From the 2018–2024 period, this provider received $166.9M in Medicaid payments across 419K claims.
Why This Matters
This provider received $166.9M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 20,867 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 9 distinct procedure codes. The top code (T2016 (Habilitation, residential, waiver; per diem)) accounts for 68% of total spending.
$113.4M
122K claims
$926.90
$331.94
Habilitation, residential, waiver; per diem
$113.4M
122K claims · 67.9%
Day habilitation, waiver; per diem
$31.3M
105K claims · 18.8%
$10.7M
26K claims · 6.4%
$7.3M
57K claims
$129.25
$124.39
Waiver services, NOS; per 15 min
$7.3M
57K claims · 4.4%
$1.3M
8K claims
$157.21
$137.32
Habilitation, residential, waiver; 15 min
$1.3M
8K claims · 0.8%
$1.3M
27K claims
$47.42
$79.30
Specialized supply, NOS; per unit
$1.3M
27K claims · 0.8%
$1.1M
24K claims
$44.24
$74.75
Habilitation, prevocational, waiver, per hour
$1.1M
24K claims · 0.6%
$363K
47K claims · 0.2%
$104K
2K claims
$44.58
$88.91
Habilitation, prevocational, waiver; per 15 min
$104K
2K claims · 0.1%
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