Ohi
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $2,559.71 per claim for T2016 (Habilitation, residential, waiver; per diem), which is 7.7× the national median of $331.94.
Consistent Billing
Monthly billing amounts show almost no natural variation (CV < 0.1).
Monthly billing coefficient of variation: 0.0902 (near-zero variation).
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:
Cost Outlier
Cost Outlier means this provider charges significantly more per claim than other providers billing the same procedure codes. This could indicate upcoding, inflated charges, or specialized services that justify higher costs.
Consistent Billing
Consistent Billing means this provider's monthly billing amounts show almost no natural variation. Real medical practices tend to have some fluctuation in monthly billing, so unnaturally steady billing can indicate automated or fabricated claims.
These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.
Compared to Community Based Residential Treatment Facility Intellectual and/or Developmental Disabilities Peers
Total spending distribution among 19 providers in this specialty
This provider's total spending of $61.9M is at the 25th percentile among 19 Community Based Residential Treatment Facility Intellectual and/or Developmental Disabilities providers.
Total Paid
$61.9M
$61,926,894
Total Claims
24K
Beneficiaries
4,742
5.2 claims/patient
Avg Cost/Claim
$3K
🔍 Analysis
Provider Overview
Ohi is a Community Based Residential Treatment Facility Intellectual and/or Developmental Disabilities provider based in Bangor, ME. From the 2018–2024 period, this provider received $61.9M in Medicaid payments across 24K claims.
Why This Matters
At $61.9M in Medicaid payments, this provider represents significant public healthcare spending. Understanding where these dollars go helps ensure the program serves those who need it most.
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