Consumer Direct for Florida
Billing Swing
Experienced over 200% change in year-over-year billing with >$1M absolute change.
Billing changed from $12.1M (2018) to $48.7M (2019) — a 302% swing with $36.6M absolute change.
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:
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.
Risk Assessment
Bills $434.70 per claim for T1002 (RN services, per 15 minutes) — 11.6× the national median of $37.42.
This is a statistical summary, not an accusation. See our methodology.
Compared to Case Management Peers
Total spending distribution among 137 providers in this specialty
This provider's total spending of $156.5M is at the 50th percentile among 137 Case Management providers.
Total Paid
$156.5M
$156,501,810
Total Claims
3.7M
Beneficiaries
314K
11.8 claims/patient
Avg Cost/Claim
$42
#676 of 618K providers by total spending(top 0.1%)
🔍 Analysis
Provider Overview
Consumer Direct for Florida is a Case Management provider based in Sunrise, FL. From the 2018–2024 period, this provider received $156.5M in Medicaid payments across 3.7M claims.
Important Context
- ℹ️This provider appears to operate as a fiscal intermediary or management organization, processing payments on behalf of many individual caregivers. High aggregate billing is expected for this type of entity.
- 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 $156.5M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 19,562 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 8 distinct procedure codes. The top code (T1019 (Personal care services, per 15 min)) accounts for 61% of total spending.
$95.4M
2.0M claims
$48.37
$82.47
Personal care services, per 15 min
$95.4M
2.0M claims · 60.9%
$32.7M
1.3M claims
$25.64
$48.76
Homemaker service, NOS; per 15 min
$32.7M
1.3M claims · 20.9%
$12.3M
365K claims
$33.80
$52.25
Companion care, adult, per diem
$12.3M
365K claims · 7.9%
$11.4M
71K claims
$160.44
$137.85
Other specified case management service, per 15 minutes
$11.4M
71K claims · 7.3%
$4.0M
26K claims
$154.64
$108.97
Financial management, self-directed; per month
$4.0M
26K claims · 2.5%
$471K
2,292 claims
$205.63
$81.30
Assessment of home, physical & family environments
$471K
2,292 claims · 0.3%
$174K
1,874 claims
$92.67
$106.70
Screening to determine appropriateness of consideration for program
$174K
1,874 claims · 0.1%
RN services, per 15 minutes
$77K
177 claims · 0.0%
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