Consumer Direct Care Network Virginia
Billing Swing
Experienced over 200% change in year-over-year billing with >$1M absolute change.
Billing changed from $5.9M (2018) to $150.4M (2019) — a 2439% swing with $144.5M absolute change.
Explosive Growth
Billing increased over 500% year-over-year — far beyond normal growth patterns.
Billing grew 2439% from 2018 to 2019.
Unusually High Spending
This provider's total payments are significantly above the median for their specialty.
Spending Spike
Experienced a dramatic increase in billing over a short period.
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:
Billing Swing
Billing Swing means this provider's total billing changed dramatically from one year to the next — increasing or decreasing by more than 200% with over $1M in absolute change. This could indicate a change in practice scope, a billing scheme ramping up, or legitimate growth.
Explosive Growth
Explosive Growth means this provider's billing increased by more than 500% year-over-year. While rapid expansion can be legitimate, this pattern has been observed in fraud schemes that ramp up billing quickly before detection.
Unusually High Spending
Unusually High Spending means this provider's total Medicaid payments are significantly above the median for their specialty. This doesn't necessarily indicate fraud — high volume practices and those serving complex populations may legitimately bill more.
Spending Spike
Spending Spike means this provider experienced a dramatic, sudden increase in billing over a short period. Legitimate causes include new contracts or expanded services, but this pattern also appears in billing fraud ramp-ups.
These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.
Advanced Detection Signals
Additional statistical tests from advanced fraud detection methods
These signals use advanced statistical methods including digit distribution analysis, change-point detection, and market concentration metrics. Learn more.
Compared to Home Health Peers
Total spending distribution among 322 providers in this specialty
This provider's total spending of $2.11B is at the 99th percentile among 322 Home Health providers.
Above 99th percentile for this specialty — higher spending than 318 of 322 peers
Total Paid
$2.11B
$2,105,798,329
Total Claims
22.2M
Beneficiaries
1.1M
20.7 claims/patient
Avg Cost/Claim
$95
#9 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Consumer Direct Care Network Virginia is a Home Health provider based in Missoula, MT. From the 2018–2024 period, this provider received $2.1B in Medicaid payments across 22.2M claims.
Important Context
- ℹ️This provider is a known fiscal management organization for self-directed care programs. They manage billing on behalf of thousands of individual caregivers, so aggregate billing is high by design. However, the self-directed care category has been identified as fraud-prone by regulators.
Why This Matters
This provider received $2.1B in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 263,224 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 5 distinct procedure codes. The top code (S5126 (Attendant care services, per diem)) accounts for 84% of total spending.
$1.77B
17.9M claims
$98.57
$156.98
Attendant care services, per diem
$1.77B
17.9M claims · 83.9%
$230.5M
3.1M claims
$74.45
$84.46
Unskilled respite care, per 15 min
$230.5M
3.1M claims · 10.9%
$93.9M
1.1M claims
$82.67
$302.34
Companion care, adult, per 15 minutes
$93.9M
1.1M claims · 4.5%
$15.6M
14K claims
$1,107.60
$856.03
Health care common procedure coding system HCPCS lvl II
$15.6M
14K claims · 0.7%
$5K
1K claims
$4.98
$5.39
Unlisted special service, procedure, or report
$5K
1K claims · 0.0%
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