Northeast Kingdom Human Services INC Ds Waiver
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $7,409.48 per claim for 99199 (Unlisted special service, procedure, or report), which is 1374.7× the national median of $5.39.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 1 procedure codes: 99199 at 1374.7× 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 $7,409.48 per claim for 99199 (Unlisted special service, procedure, or report) — 1374.7× the national median of $5.39.
Billing in the top 1% nationally for 1 procedure code: 99199.
This is a statistical summary, not an accusation. See our methodology.
Compared to Clinic/Center Developmental Disabilities Peers
Total spending distribution among 10 providers in this specialty
This provider's total spending of $204.8M is at the 75th percentile among 10 Clinic/Center Developmental Disabilities providers.
Total Paid
$204.8M
$204,755,692
Total Claims
673K
Beneficiaries
74K
9.1 claims/patient
Avg Cost/Claim
$304
#439 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Northeast Kingdom Human Services INC Ds Waiver is a Clinic/Center Developmental Disabilities provider based in Newport, VT. From the 2018–2024 period, this provider received $204.8M in Medicaid payments across 673K claims.
Why This Matters
This provider received $204.8M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 25,594 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 18 distinct procedure codes. The top code (99199 (Unlisted special service, procedure, or report)) accounts for 70% of total spending.
$144.1M
19K claims
$7,409.48
$5.39
Unlisted special service, procedure, or report
$144.1M
19K claims · 70.4%
$60.6M
63K claims
$965.99
$336.31
Community-based wrap-around services, per diem
$60.6M
63K claims · 29.6%
$0
153 claims
$0.00
$74.09
Office/outpatient visit, high complexity
$0
153 claims · 0.0%
Residential care, NOS; per diem
$0
35K claims · 0.0%
Case management, each 15 min
$0
144K claims · 0.0%
$0
60 claims
$0.00
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$0
60 claims · 0.0%
Psychotherapy, 30 minutes
$0
205 claims · 0.0%
$0
12K claims
$0.00
$137.32
Habilitation, residential, waiver; 15 min
$0
12K claims · 0.0%
Companion care, adult, per diem
$0
16K claims · 0.0%
Day habilitation, waiver; per 15 min
$0
84K claims · 0.0%
Psychotherapy, 45 minutes
$0
37 claims · 0.0%
$0
30K claims
$0.00
$100.49
Ongoing support to maintain employment, per 15 min
$0
30K claims · 0.0%
Unskilled respite care, per 15 min
$0
47K claims · 0.0%
$0
74 claims
$0.00
$215.80
Crisis intervention service, per 15 minutes
$0
74 claims · 0.0%
Unskilled respite care, per diem
$0
20K claims · 0.0%
Foster care, adult; per diem
$0
198K claims · 0.0%
$0
5K claims
$0.00
$331.94
Habilitation, residential, waiver; per diem
$0
5K claims · 0.0%
Supported employment, per 15 min
$0
883 claims · 0.0%
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