Granite Bay Care INC
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $1,262.44 per claim for T2016 (Habilitation, residential, waiver; per diem), which is 3.8× the national median of $331.94.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 2 procedure codes: G9012 at 2.3× median, H0004 at 2.8× 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:
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.
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 $1,262.44 per claim for T2016 (Habilitation, residential, waiver; per diem) — 3.8× the national median of $331.94.
Billing above the 90th percentile for 2 procedure codes simultaneously.
This is a statistical summary, not an accusation. See our methodology.
Compared to Residential Treatment Facility Intellectual and/or Developmental Disabilities Peers
Total spending distribution among 8 providers in this specialty
This provider's total spending of $281.7M is at the 75th percentile among 8 Residential Treatment Facility Intellectual and/or Developmental Disabilities providers.
Total Paid
$281.7M
$281,653,043
Total Claims
226K
Beneficiaries
16K
14.2 claims/patient
Avg Cost/Claim
$1K
#272 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Granite Bay Care INC is a Residential Treatment Facility Intellectual and/or Developmental Disabilities provider based in Portland, ME. From the 2018–2024 period, this provider received $281.7M in Medicaid payments across 226K claims.
Why This Matters
This provider received $281.7M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 35,206 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 4 distinct procedure codes. The top code (T2016 (Habilitation, residential, waiver; per diem)) accounts for 100% of total spending.
$280.5M
222K claims
$1,262.44
$331.94
Habilitation, residential, waiver; per diem
$280.5M
222K claims · 99.6%
$950K
3K claims
$311.02
$137.85
Other specified case management service, per 15 minutes
$950K
3K claims · 0.3%
$151K
714 claims
$211.86
$74.63
Behavioral health counseling & therapy, per 15 min
$151K
714 claims · 0.1%
$7K
132 claims · 0.0%
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