State of Missouri
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $2,978.25 per claim for H0018 (Behavioral health; short-term residential, per diem), which is 6.4× the national median of $467.51.
High Cost Per Claim
Average payment per claim is much higher than peers billing the same procedures.
Spending Spike
Experienced a dramatic increase in billing over a short period.
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.
High Cost Per Claim
High Cost Per Claim means each individual claim from this provider costs significantly more than what other providers charge for the same services. This could indicate upcoding (billing for more expensive services than provided) or legitimate specialized care.
Spending Spike
Spending Spike means this provider experienced a dramatic, sudden increase in billing over a short period. Legitimate causes include new contracts or expanded services, but this pattern also appears in billing fraud ramp-ups.
These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.
Risk Assessment
Bills $2,978.25 per claim for H0018 (Behavioral health; short-term residential, per diem) — 6.4× the national median of $467.51.
This is a statistical summary, not an accusation. See our methodology.
Total Paid
$160.2M
$160,213,996
Total Claims
257K
Beneficiaries
58K
4.4 claims/patient
Avg Cost/Claim
$622
#649 of 618K providers by total spending(top 0.1%)
🔍 Analysis
Provider Overview
State of Missouri is a Rehabilitation Counselor provider based in Jefferson City, MO. From the 2018–2024 period, this provider received $160.2M in Medicaid payments across 257K claims.
Important Context
- ℹ️This is a government entity that may serve as a fiscal agent for large populations. Government providers often bill at high volumes due to the scale of public programs they administer.
Why This Matters
This provider received $160.2M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 20,026 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 3 distinct procedure codes. The top code (H0018 (Behavioral health; short-term residential, per diem)) accounts for 84% of total spending.
$134.5M
45K claims
$2,978.25
$467.51
Behavioral health; short-term residential, per diem
$134.5M
45K claims · 84.0%
$25.5M
203K claims
$125.83
$321.53
Comprehensive community support services, per 15 min
$25.5M
203K claims · 15.9%
$146K
9K claims
$15.40
$15.37
Telehealth originating site facility fee
$146K
9K claims · 0.1%