Is EDGEWATER RECOVERY CENTER LLC flagged for Medicaid fraud?

EDGEWATER RECOVERY CENTER LLC (NPI: 1619466141) has not been flagged by our statistical fraud detection tests. Their billing patterns fall within normal ranges for their specialty.

How much does EDGEWATER RECOVERY CENTER LLC bill Medicaid?

EDGEWATER RECOVERY CENTER LLC received $0.1B in total Medicaid payments from 2018-2024, based on HHS billing records. They are classified as a Substance Abuse Rehabilitation Facility provider. Located in MOREHEAD, KY.

What is NPI 1619466141?

NPI 1619466141 is the National Provider Identifier for EDGEWATER RECOVERY CENTER LLC. They are a Substance Abuse Rehabilitation Facility provider based in MOREHEAD, KY. This NPI is registered with the CMS NPI Registry.

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EDGEWATER RECOVERY CENTER LLC

Substance Abuse Rehabilitation Facility·MOREHEAD, KY·NPI: 1619466141Share

Compared to Substance Abuse Rehabilitation Facility Peers

Total spending distribution among 20 providers in this specialty

P25MedianP75P90

This provider's total spending of $50.2M is at the 50th percentile among 20 Substance Abuse Rehabilitation Facility providers.

Active Billing Period:2018-10→2024-12(75 months)

Total Paid

$50.2M

$50,216,219

Total Claims

436K

Beneficiaries

46K

9.5 claims/patient

Avg Cost/Claim

$115

Monthly Spending Trend

Yearly Spending

2018

$165K

+1327%

2019

$2.4M

+119%

2020

$5.2M

+74%

2021

$9.0M

+33%

2022

$12.0M

+18%

2023

$14.1M

-47%

2024

$7.5M

Procedure Breakdown

Cost per claim compared to national benchmarks

This provider bills for 22 distinct procedure codes. The top code (H0011 (Alcohol and/or drug services, acute detoxification, per diem)) accounts for 30% of total spending.

ProcedureTotalYour Cost/ClaimNational Medianvs MedianPercentile

H0011Alcohol and/or drug services, acute detoxification, per diemSee all providers →

$15.0M

57K claims

$263.61

$317.54

0.8×

Normal range

H0011Normal range

Alcohol and/or drug services, acute detoxification, per diem

$15.0M

57K claims · 29.8%

Your Cost: $263.61/claim|Median: $317.54

0.8× median

H2034Alcohol and/or drug abuse halfway house services, per hourSee all providers →

$10.7M

45K claims

$239.26

$164.03

1.5×

Normal range

H2034Normal range

Alcohol and/or drug abuse halfway house services, per hour

$10.7M

45K claims · 21.3%

Your Cost: $239.26/claim|Median: $164.03

1.5× median

H0035Mental health partial hospitalization, treatment, per hourSee all providers →

$5.1M

30K claims

$169.25

$148.53

1.1×

Normal range

H0035Normal range

Mental health partial hospitalization, treatment, per hour

$5.1M

30K claims · 10.1%

Your Cost: $169.25/claim|Median: $148.53

1.1× median

H2027Psychoeducational service, per 15 minutesSee all providers →

$4.9M

46K claims

$104.89

$82.72

1.3×

Normal range

H2027Normal range

Psychoeducational service, per 15 minutes

$4.9M

46K claims · 9.7%

Your Cost: $104.89/claim|Median: $82.72

1.3× median

H0015Alcohol and/or drug abuse, intensive outpatient, per hourSee all providers →

$4.8M

43K claims

$112.26

$129.75

0.9×

Normal range

H0015Normal range

Alcohol and/or drug abuse, intensive outpatient, per hour

$4.8M

43K claims · 9.7%

Your Cost: $112.26/claim|Median: $129.75

0.9× median

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

$4.6M

181K claims

$25.53

$55.04

0.5×

Normal range

H0038Normal range

Self-help/peer services, per 15 minutes

$4.6M

181K claims · 9.2%

Your Cost: $25.53/claim|Median: $55.04

0.5× median

H0018Behavioral health; short-term residential, per diemSee all providers →

$2.4M

13K claims

$187.66

$467.51

0.4×

Normal range

H0018Normal range

Behavioral health; short-term residential, per diem

$2.4M

13K claims · 4.7%

Your Cost: $187.66/claim|Median: $467.51

0.4× median

T2023Community transition, waiver; per serviceSee all providers →

$2.0M

6,069 claims

$321.61

$300.13

1.1×

Normal range

T2023Normal range

Community transition, waiver; per service

$2.0M

6,069 claims · 3.9%

Your Cost: $321.61/claim|Median: $300.13

1.1× median

90853Group psychotherapySee all providers →

$330K

4,252 claims

$77.61

$25.02

3.1×

Top 10%

90853Top 10%

Group psychotherapy

$330K

4,252 claims · 0.7%

Your Cost: $77.61/claim|Median: $25.02

3.1× median

T1007Alcohol/drug services, treatment plan reviewSee all providers →

$217K

3,832 claims

$56.71

$64.10

0.9×

Normal range

T1007Normal range

Alcohol/drug services, treatment plan review

$217K

3,832 claims · 0.4%

Your Cost: $56.71/claim|Median: $64.10

0.9× median

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

$78K

2,034 claims

$38.46

$37.81

1.0×

Normal range

99213Normal range

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

$78K

2,034 claims · 0.2%

Your Cost: $38.46/claim|Median: $37.81

1.0× median

H0001Alcohol and/or drug assessmentSee all providers →

$40K

738 claims

$54.43

$94.22

0.6×

Normal range

H0001Normal range

Alcohol and/or drug assessment

$40K

738 claims · 0.1%

Your Cost: $54.43/claim|Median: $94.22

0.6× median

90832Psychotherapy, 30 minutesSee all providers →

$40K

1,059 claims

$37.49

$41.28

0.9×

Normal range

90832Normal range

Psychotherapy, 30 minutes

$40K

1,059 claims · 0.1%

Your Cost: $37.49/claim|Median: $41.28

0.9× median

90834Psychotherapy, 45 minutesSee all providers →

$31K

701 claims

$43.83

$63.65

0.7×

Normal range

90834Normal range

Psychotherapy, 45 minutes

$31K

701 claims · 0.1%

Your Cost: $43.83/claim|Median: $63.65

0.7× median

90837Psychotherapy, 60 minutesSee all providers →

$26K

346 claims

$74.48

$85.66

0.9×

Normal range

90837Normal range

Psychotherapy, 60 minutes

$26K

346 claims · 0.1%

Your Cost: $74.48/claim|Median: $85.66

0.9× median

90791Psychiatric diagnostic evaluationSee all providers →

$15K

164 claims

$92.98

$99.21

0.9×

Normal range

90791Normal range

Psychiatric diagnostic evaluation

$15K

164 claims · 0.0%

Your Cost: $92.98/claim|Median: $99.21

0.9× median

96372Therapeutic injection, subcutaneous/intramuscularSee all providers →

$5K

655 claims

$7.41

$9.56

0.8×

Normal range

96372Normal range

Therapeutic injection, subcutaneous/intramuscular

$5K

655 claims · 0.0%

Your Cost: $7.41/claim|Median: $9.56

0.8× median

80305 See all providers →

$2K

397 claims

$5.11

$7.44

0.7×

Normal range

80305Normal range

$2K

397 claims · 0.0%

Your Cost: $5.11/claim|Median: $7.44

0.7× median

S9446 See all providers →

$1K

686 claims

$1.96

$13.66

0.1×

Normal range

S9446Normal range

$1K

686 claims · 0.0%

Your Cost: $1.96/claim|Median: $13.66

0.1× median

99203Office/outpatient visit, new patient, low-mod complexitySee all providers →

$1K

18 claims

$59.70

$57.85

1.0×

Normal range

99203Normal range

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

$1K

18 claims · 0.0%

Your Cost: $59.70/claim|Median: $57.85

1.0× median

H0002Behavioral health screeningSee all providers →

$455

17 claims

$26.77

$38.77

0.7×

Normal range

H0002Normal range

Behavioral health screening

$455

17 claims · 0.0%

Your Cost: $26.77/claim|Median: $38.77

0.7× median

99408 See all providers →

$76

13 claims

$5.81

$9.32

0.6×

Normal range

99408Normal range

$76

13 claims · 0.0%

Your Cost: $5.81/claim|Median: $9.32

0.6× median

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