Is CAROLINA OUTREACH, LLC flagged for Medicaid fraud?

CAROLINA OUTREACH, LLC (NPI: 1508171216) has not been flagged by our statistical fraud detection tests. Their billing patterns fall within normal ranges for their specialty.

How much does CAROLINA OUTREACH, LLC bill Medicaid?

CAROLINA OUTREACH, LLC received $0.0B in total Medicaid payments from 2018-2024, based on HHS billing records. They are classified as a Community/Behavioral Health provider. Located in DURHAM, NC.

What is NPI 1508171216?

NPI 1508171216 is the National Provider Identifier for CAROLINA OUTREACH, LLC. They are a Community/Behavioral Health provider based in DURHAM, NC. This NPI is registered with the CMS NPI Registry.

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CAROLINA OUTREACH, LLC

Community/Behavioral Health·DURHAM, NC·NPI: 1508171216Share

Compared to Community/Behavioral Health Peers

Total spending distribution among 218 providers in this specialty

P25MedianP75P90

This provider's total spending of $47.6M is at the 50th percentile among 218 Community/Behavioral Health providers.

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

Total Paid

$47.6M

$47,646,515

Total Claims

253K

Beneficiaries

46K

5.5 claims/patient

Avg Cost/Claim

$189

Monthly Spending Trend

Yearly Spending

2018

$4.0M

-4%

2019

$3.8M

+23%

2020

$4.7M

+56%

2021

$7.3M

+1%

2022

$7.4M

+66%

2023

$12.2M

-33%

2024

$8.3M

Procedure Breakdown

Cost per claim compared to national benchmarks

This provider bills for 22 distinct procedure codes. The top code (H2022 (Community-based wrap-around services, per diem)) accounts for 35% of total spending.

ProcedureTotalYour Cost/ClaimNational Medianvs MedianPercentile

H2022Community-based wrap-around services, per diemSee all providers →

$16.7M

63K claims

$263.03

$336.31

0.8×

Normal range

H2022Normal range

Community-based wrap-around services, per diem

$16.7M

63K claims · 35.0%

Your Cost: $263.03/claim|Median: $336.31

0.8× median

H0040Assertive community treatment, face-to-face, per 15 minutesSee all providers →

$14.3M

65K claims

$219.02

$266.41

0.8×

Normal range

H0040Normal range

Assertive community treatment, face-to-face, per 15 minutes

$14.3M

65K claims · 30.0%

Your Cost: $219.02/claim|Median: $266.41

0.8× median

H2015Comprehensive community support services, per 15 minSee all providers →

$11.8M

77K claims

$152.34

$96.24

1.6×

Normal range

H2015Normal range

Comprehensive community support services, per 15 min

$11.8M

77K claims · 24.7%

Your Cost: $152.34/claim|Median: $96.24

1.6× median

90837Psychotherapy, 60 minutesSee all providers →

$2.4M

28K claims

$84.79

$85.66

1.0×

Normal range

90837Normal range

Psychotherapy, 60 minutes

$2.4M

28K claims · 5.0%

Your Cost: $84.79/claim|Median: $85.66

1.0× median

H0038Self-help/peer services, per 15 minutesSee all providers →

$1.0M

4,229 claims

$243.15

$55.04

4.4×

Top 10%

H0038Top 10%

Self-help/peer services, per 15 minutes

$1.0M

4,229 claims · 2.2%

Your Cost: $243.15/claim|Median: $55.04

4.4× median

99214Office/outpatient visit, est. patient, mod-high complexitySee all providers →

$777K

8,478 claims

$91.68

$53.41

1.7×

Top 25%

99214Top 25%

Office/outpatient visit, est. patient, mod-high complexity

$777K

8,478 claims · 1.6%

Your Cost: $91.68/claim|Median: $53.41

1.7× median

T1023Screening to determine appropriateness of consideration for programSee all providers →

$218K

939 claims

$232.32

$106.70

2.2×

Top 25%

T1023Top 25%

Screening to determine appropriateness of consideration for program

$218K

939 claims · 0.5%

Your Cost: $232.32/claim|Median: $106.70

2.2× median

T2016Habilitation, residential, waiver; per diemSee all providers →

$216K

527 claims

$409.85

$331.94

1.2×

Normal range

T2016Normal range

Habilitation, residential, waiver; per diem

$216K

527 claims · 0.5%

Your Cost: $409.85/claim|Median: $331.94

1.2× median

80307Drug test, presumptive, by chemistry analyzersSee all providers →

$179K

2,814 claims

$63.44

$35.43

1.8×

Top 10%

80307Top 10%

Drug test, presumptive, by chemistry analyzers

$179K

2,814 claims · 0.4%

Your Cost: $63.44/claim|Median: $35.43

1.8× median

90847Family psychotherapy with patient, 50 minSee all providers →

$40K

530 claims

$75.05

$77.33

1.0×

Normal range

90847Normal range

Family psychotherapy with patient, 50 min

$40K

530 claims · 0.1%

Your Cost: $75.05/claim|Median: $77.33

1.0× median

90834Psychotherapy, 45 minutesSee all providers →

$24K

427 claims

$56.79

$63.65

0.9×

Normal range

90834Normal range

Psychotherapy, 45 minutes

$24K

427 claims · 0.1%

Your Cost: $56.79/claim|Median: $63.65

0.9× median

99213Office/outpatient visit, est. patient, low-mod complexitySee all providers →

$22K

302 claims

$73.57

$37.81

1.9×

Top 10%

99213Top 10%

Office/outpatient visit, est. patient, low-mod complexity

$22K

302 claims · 0.0%

Your Cost: $73.57/claim|Median: $37.81

1.9× median

90791Psychiatric diagnostic evaluationSee all providers →

$16K

141 claims

$112.01

$99.21

1.1×

Normal range

90791Normal range

Psychiatric diagnostic evaluation

$16K

141 claims · 0.0%

Your Cost: $112.01/claim|Median: $99.21

1.1× median

99204Office/outpatient visit, new patient, mod-high complexitySee all providers →

$10K

72 claims

$135.91

$84.03

1.6×

Top 25%

99204Top 25%

Office/outpatient visit, new patient, mod-high complexity

$10K

72 claims · 0.0%

Your Cost: $135.91/claim|Median: $84.03

1.6× median

99215Office/outpatient visit, high complexitySee all providers →

$3K

33 claims

$92.71

$74.09

1.3×

Normal range

99215Normal range

Office/outpatient visit, high complexity

$3K

33 claims · 0.0%

Your Cost: $92.71/claim|Median: $74.09

1.3× median

90853Group psychotherapySee all providers →

$3K

77 claims

$35.76

$25.02

1.4×

Normal range

90853Normal range

Group psychotherapy

$3K

77 claims · 0.0%

Your Cost: $35.76/claim|Median: $25.02

1.4× median

90832Psychotherapy, 30 minutesSee all providers →

$2K

45 claims

$43.01

$41.28

1.0×

Normal range

90832Normal range

Psychotherapy, 30 minutes

$2K

45 claims · 0.0%

Your Cost: $43.01/claim|Median: $41.28

1.0× median

98968 See all providers →

$2K

54 claims

$27.90

$28.39

1.0×

Normal range

98968Normal range

$2K

54 claims · 0.0%

Your Cost: $27.90/claim|Median: $28.39

1.0× median

99406 See all providers →

$602

54 claims

$11.15

$6.53

1.7×

Top 25%

99406Top 25%

$602

54 claims · 0.0%

Your Cost: $11.15/claim|Median: $6.53

1.7× median

98966 See all providers →

$137

13 claims

$10.51

$6.84

1.5×

Normal range

98966Normal range

$137

13 claims · 0.0%

Your Cost: $10.51/claim|Median: $6.84

1.5× median

H2015HT See all providers →

29 claims

$0.00

$173.43

—

Normal range

H2015HTNormal range

29 claims · 0.0%

Your Cost: $0.00/claim|Median: $173.43

T1017Targeted case management, per 15 minSee all providers →

74 claims

$0.00

$69.56

—

Normal range

T1017Normal range

Targeted case management, per 15 min

74 claims · 0.0%

Your Cost: $0.00/claim|Median: $69.56

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