Mbi Health Services LLC
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 4 procedure codes: 99212 at 2.4× median, 99509 at 2.7× 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:
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.
Risk Assessment
Bills $991.59 per claim for H0040 (Assertive community treatment, face-to-face, per 15 minutes) — 3.7× the national median of $266.41.
Billing above the 90th percentile for 2 procedure codes simultaneously.
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 $270.1M is at the 75th percentile among 137 Case Management providers.
Total Paid
$270.1M
$270,125,586
Total Claims
2.8M
Beneficiaries
444K
6.2 claims/patient
Avg Cost/Claim
$98
#295 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Mbi Health Services LLC is a Case Management provider based in Washington, DC. From the 2018–2024 period, this provider received $270.1M in Medicaid payments across 2.8M 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.
Why This Matters
This provider received $270.1M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 33,765 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 30 distinct procedure codes. The top code (H0036 (Community psychiatric supportive treatment, per 15 min)) accounts for 51% of total spending.
$137.9M
1.6M claims
$86.00
$76.05
Community psychiatric supportive treatment, per 15 min
$137.9M
1.6M claims · 51.1%
$67.8M
493K claims
$137.51
$82.47
Personal care services, per 15 min
$67.8M
493K claims · 25.1%
$34.4M
291K claims
$117.99
$132.62
Assertive community treatment, per diem
$34.4M
291K claims · 12.7%
$10.1M
122K claims
$82.95
$36.25
Behavioral health prevention education, per session
$10.1M
122K claims · 3.7%
$5.9M
89K claims
$66.57
$56.90
Medication training and management, per 15 min
$5.9M
89K claims · 2.2%
$3.4M
3K claims
$991.59
$266.41
Assertive community treatment, face-to-face, per 15 minutes
$3.4M
3K claims · 1.3%
$1.9M
27K claims
$67.88
$74.63
Behavioral health counseling & therapy, per 15 min
$1.9M
27K claims · 0.7%
$1.7M
17K claims
$98.97
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$1.7M
17K claims · 0.6%
$1.4M
13K claims
$105.31
$51.67
Skilled nursing services, home health, per visit, RN
$1.4M
13K claims · 0.5%
$1.1M
9K claims · 0.4%
Behavioral health screening
$846K
13K claims · 0.3%
$591K
5K claims
$121.23
$99.21
Psychiatric diagnostic evaluation
$591K
5K claims · 0.2%
Psychotherapy, 60 minutes
$541K
6K claims · 0.2%
$508K
4K claims
$129.98
$69.56
Targeted case management, per 15 min
$508K
4K claims · 0.2%
$353K
7K claims
$52.83
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$353K
7K claims · 0.1%
$337K
3K claims
$112.77
$74.09
Office/outpatient visit, high complexity
$337K
3K claims · 0.1%
$291K
5K claims
$58.94
$25.06
Office/outpatient visit, low complexity
$291K
5K claims · 0.1%
$252K
2K claims
$134.43
$227.82
Multisystemic therapy for juveniles, per 15 minutes
$252K
2K claims · 0.1%
$172K
4K claims
$41.88
$57.85
Office/outpatient visit, new patient, low-mod complexity
$172K
4K claims · 0.1%
$131K
934 claims
$140.14
$108.91
Psychiatric diagnostic evaluation with medical services
$131K
934 claims · 0.0%
$84K
10K claims
$8.41
$38.83
Psychotherapy, 30 min, add-on to E/M service
$84K
10K claims · 0.0%
$73K
819 claims
$89.26
$84.03
Office/outpatient visit, new patient, mod-high complexity
$73K
819 claims · 0.0%
$55K
1K claims
$38.54
$40.11
Office/outpatient visit, new patient, low complexity
$55K
1K claims · 0.0%
$54K
803 claims
$67.59
$56.18
Psychotherapy, 45 min, add-on to E/M
$54K
803 claims · 0.0%
$41K
3K claims
$13.24
$100.49
Ongoing support to maintain employment, per 15 min
$41K
3K claims · 0.0%
Home visit, assistance w/ ADLs
$38K
271 claims · 0.0%
$28K
1K claims
$21.27
$39.70
COVID-19 SARS-CoV-2 amplified probe detection
$28K
1K claims · 0.0%
$22K
295 claims
$76.04
$55.04
Self-help/peer services, per 15 minutes
$22K
295 claims · 0.0%
$22K
178 claims
$122.34
$111.09
Office/outpatient visit, new patient, high complexity
$22K
178 claims · 0.0%
Psychotherapy, 45 minutes
$14K
1K claims · 0.0%
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