Bjc Behavioral Health
New Entrant
Started billing recently but already receiving millions in Medicaid payments.
First appeared in 2022-01 and has already billed $155.5M, averaging $4.3M/month across 36 months.
Instant Volume
New provider billing over $1M in their first year of Medicaid participation.
Billed $44.8M in first year (2022).
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:
New Entrant
New Entrant means this provider began billing Medicaid recently but is already receiving millions of dollars in payments. While some new providers legitimately grow fast (e.g., large group practices), this pattern is also common in fraud schemes that set up shell companies to bill aggressively before shutting down.
Instant Volume
Instant Volume means this provider billed over $1 million in their very first year of Medicaid participation. New providers typically ramp up gradually, so immediate high-volume billing can be a red flag.
These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.
Compared to Community/Behavioral Health Peers
Total spending distribution among 218 providers in this specialty
This provider's total spending of $155.5M is at the 75th percentile among 218 Community/Behavioral Health providers.
Total Paid
$155.5M
$155,549,118
Total Claims
1.3M
Beneficiaries
486K
2.7 claims/patient
Avg Cost/Claim
$118
#681 of 618K providers by total spending(top 0.1%)
🔍 Analysis
Provider Overview
Bjc Behavioral Health is a Community/Behavioral Health provider based in Saint Louis, MO. From the 2018–2024 period, this provider received $155.5M in Medicaid payments across 1.3M claims.
Why This Matters
This provider received $155.5M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 19,443 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 24 distinct procedure codes. The top code (T1040 (Medicaid certified CCBHC services)) accounts for 100% of total spending.
Medicaid certified CCBHC services
$155.1M
546K claims · 99.7%
$360K
68K claims
$5.28
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$360K
68K claims · 0.2%
Psychotherapy, 60 minutes
$23K
1K claims · 0.0%
Psychotherapy, 45 minutes
$21K
2K claims · 0.0%
$9K
1K claims
$6.47
$108.91
Psychiatric diagnostic evaluation with medical services
$9K
1K claims · 0.0%
Psychotherapy, 30 minutes
$7K
1K claims · 0.0%
$5K
3K claims
$1.87
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$5K
3K claims · 0.0%
Psychiatric diagnostic evaluation
$2K
362 claims · 0.0%
$2K
17 claims
$96.84
$74.09
Office/outpatient visit, high complexity
$2K
17 claims · 0.0%
$62
893 claims
$0.07
$36.49
Office consultation, straightforward
$62
893 claims · 0.0%
$6
446K claims
$0.00
$76.05
Community psychiatric supportive treatment, per 15 min
$6
446K claims · 0.0%
Group psychotherapy
$0
40 claims · 0.0%
$0
6K claims
$0.00
$47.35
Alcohol and/or drug services, group counseling
$0
6K claims · 0.0%
$0
5K claims
$0.00
$36.25
Behavioral health prevention education, per session
$0
5K claims · 0.0%
$0
40K claims
$0.00
$91.63
Psychosocial rehabilitation services, per 15 min
$0
40K claims · 0.0%
Behavioral health screening
$0
25K claims · 0.0%
Mental health service plan development
$0
13K claims · 0.0%
$0
9K claims
$0.00
$137.86
Behavioral health day treatment, per hour
$0
9K claims · 0.0%
$0
69K claims
$0.00
$225.50
Community psychiatric supportive treatment program, per diem
$0
69K claims · 0.0%
$0
21K claims
$0.00
$74.63
Behavioral health counseling & therapy, per 15 min
$0
21K claims · 0.0%
$0
23K claims
$0.00
$266.41
Assertive community treatment, face-to-face, per 15 minutes
$0
23K claims · 0.0%
$0
27K claims
$0.00
$62.69
Comprehensive medication services, per 15 min
$0
27K claims · 0.0%
Self-help/peer services, per 15 minutes
$0
7K claims · 0.0%
$0
4K claims
$0.00
$84.12
Therapeutic behavioral services, per 15 min
$0
4K claims · 0.0%
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