Is ABILITY FIRST, LLC flagged for Medicaid fraud?

ABILITY FIRST, LLC (NPI: 1477685139) has not been flagged by our statistical fraud detection tests. Their billing patterns fall within normal ranges for their specialty.

How much does ABILITY FIRST, LLC bill Medicaid?

ABILITY FIRST, LLC received $0.0B in total Medicaid payments from 2018-2024, based on HHS billing records. They are classified as a Exclusive Provider Organization provider. Located in ALBUQUERQUE, NM.

What is NPI 1477685139?

NPI 1477685139 is the National Provider Identifier for ABILITY FIRST, LLC. They are a Exclusive Provider Organization provider based in ALBUQUERQUE, NM. This NPI is registered with the CMS NPI Registry.

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ABILITY FIRST, LLC

Exclusive Provider Organization·ALBUQUERQUE, NM·NPI: 1477685139Share

Active Billing Period:2018-01→2024-12(84 months)

Total Paid

$48.9M

$48,942,766

Total Claims

211K

Beneficiaries

10K

20.4 claims/patient

Avg Cost/Claim

$232

Monthly Spending Trend

Yearly Spending

2018

$2.9M

+11%

2019

$3.2M

+69%

2020

$5.4M

+28%

2021

$6.9M

+31%

2022

$9.0M

+35%

2023

$12.2M

-23%

2024

$9.4M

Procedure Breakdown

Cost per claim compared to national benchmarks

This provider bills for 7 distinct procedure codes. The top code (T2016 (Habilitation, residential, waiver; per diem)) accounts for 54% of total spending.

ProcedureTotalYour Cost/ClaimNational Medianvs MedianPercentile

T2016Habilitation, residential, waiver; per diemSee all providers →

$26.6M

84K claims

$315.64

$331.94

1.0×

Normal range

T2016Normal range

Habilitation, residential, waiver; per diem

$26.6M

84K claims · 54.3%

Your Cost: $315.64/claim|Median: $331.94

1.0× median

T2033Residential care, NOS; per diemSee all providers →

$14.7M

83K claims

$176.65

$1,051.57

0.2×

Normal range

T2033Normal range

Residential care, NOS; per diem

$14.7M

83K claims · 30.0%

Your Cost: $176.65/claim|Median: $1,051.57

0.2× median

H2021Community-based wrap-around services, per 15 minSee all providers →

$6.5M

33K claims

$197.47

$169.11

1.2×

Normal range

H2021Normal range

Community-based wrap-around services, per 15 min

$6.5M

33K claims · 13.4%

Your Cost: $197.47/claim|Median: $169.11

1.2× median

T2021Day habilitation, waiver; per 15 minSee all providers →

$793K

8,974 claims

$88.39

$150.51

0.6×

Normal range

T2021Normal range

Day habilitation, waiver; per 15 min

$793K

8,974 claims · 1.6%

Your Cost: $88.39/claim|Median: $150.51

0.6× median

T1002RN services, per 15 minutesSee all providers →

$147K

1,246 claims

$118.09

$37.42

3.2×

Top 25%

T1002Top 25%

RN services, per 15 minutes

$147K

1,246 claims · 0.3%

Your Cost: $118.09/claim|Median: $37.42

3.2× median

T2025Waiver services, NOS; per 15 minSee all providers →

$143K

149 claims

$960.75

$124.39

7.7×

Top 5%

T2025Top 5%

Waiver services, NOS; per 15 min

$143K

149 claims · 0.3%

Your Cost: $960.75/claim|Median: $124.39

7.7× median

T1005Respite care services, per 15 minutesSee all providers →

$39K

277 claims

$139.96

$71.40

2.0×

Top 25%

T1005Top 25%

Respite care services, per 15 minutes

$39K

277 claims · 0.1%

Your Cost: $139.96/claim|Median: $71.40

2.0× median

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