The Fogarty Center
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 3 procedure codes: T1999 at 12.5× median, T1002 at 7.2× 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 $443.53 per claim for T2025 (Waiver services, NOS; per 15 min) — 3.6× the national median of $124.39.
Bills $357.75 per claim for T1999 (Miscellaneous therapeutic items and supplies) — 12.5× the national median of $28.63.
Bills $270.60 per claim for T1002 (RN services, per 15 minutes) — 7.2× the national median of $37.42.
Billing in the top 1% nationally for 1 procedure code: T5999.
This is a statistical summary, not an accusation. See our methodology.
Compared to Day Training, Developmentally Disabled Services Peers
Total spending distribution among 56 providers in this specialty
This provider's total spending of $224.3M is at the 90th percentile among 56 Day Training, Developmentally Disabled Services providers.
Above 90th percentile for this specialty — higher spending than 50 of 56 peers
Total Paid
$224.3M
$224,307,102
Total Claims
789K
Beneficiaries
150K
5.3 claims/patient
Avg Cost/Claim
$284
#378 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
The Fogarty Center is a Day Training, Developmentally Disabled Services provider based in Barrington, RI. From the 2018–2024 period, this provider received $224.3M in Medicaid payments across 789K claims.
Why This Matters
This provider received $224.3M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 28,038 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 8 distinct procedure codes. The top code (T2017 (Habilitation, residential, waiver; 15 min)) accounts for 66% of total spending.
$147.2M
534K claims
$276.00
$137.32
Habilitation, residential, waiver; 15 min
$147.2M
534K claims · 65.6%
$50.8M
163K claims
$310.95
$150.51
Day habilitation, waiver; per 15 min
$50.8M
163K claims · 22.6%
Waiver services, NOS; per 15 min
$10.9M
25K claims · 4.9%
Case management, per month
$9.3M
48K claims · 4.2%
$5.6M
18K claims
$303.55
$162.29
Supports brokerage, self-directed; per 15 min
$5.6M
18K claims · 2.5%
$381K
1K claims
$357.75
$28.63
Miscellaneous therapeutic items and supplies
$381K
1K claims · 0.2%
RN services, per 15 minutes
$44K
161 claims · 0.0%
$14K
17 claims
$852.57
$8.13
Transportation service, not otherwise classified
$14K
17 claims · 0.0%
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