A Physicians Home Care
In Home Supportive Care
Colorado Springs, Colorado
NPI: 1417486531
Risk Tier
Critical
Total Paid
$247.9M
$247,924,558
Total Claims
989K
Beneficiaries
37K
Avg Cost/Claim
$250.68
Active billing period: 84 months (2018-01 to 2024-12)
Statistical Fraud Flags (3)
Cost Outlier
Billing over 3× the national median for specific procedure codes.
Bills $297.05 per claim for H0038 (Self-help/peer services, per 15 minutes), which is 5.4× the national median of $55.04.
High Cost Per Claim
Average payment per claim is much higher than peers billing the same procedures.
High Claims Per Patient
Filing an unusually high number of claims per beneficiary compared to peers.
Advanced Detection Signals
CUSUM Change Point
Billing shifted 3.6x in 2021-11 — a statistically significant structural change in billing behavior was detected.
Suspicious Concentration
Herfindahl-Hirschman Index of 1 across 3 procedure codes — billing is highly concentrated in very few services.
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