Department of Intellectual and Developmental Disabilities, State of Tn
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 20 procedure codes: D4341 at 6.8× median, S9470 at 6.3× median.
Consistent Billing
Monthly billing amounts show almost no natural variation (CV < 0.1).
Monthly billing coefficient of variation: 0.0777 (near-zero variation).
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:
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.
Consistent Billing
Consistent Billing means this provider's monthly billing amounts show almost no natural variation. Real medical practices tend to have some fluctuation in monthly billing, so unnaturally steady billing can indicate automated or fabricated claims.
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.
Risk Assessment
Bills $433.30 per claim for T2025 (Waiver services, NOS; per 15 min) — 3.5× the national median of $124.39.
Bills $142.48 per claim for T1003 (LPN/LVN services, per 15 minutes) — 5.9× the national median of $24.24.
Bills $476.87 per claim for D4341 (Periodontal scaling, per quadrant) — 6.8× the national median of $70.00.
Billing in the top 1% nationally for 3 procedure codes: D4341, D0460, D4210.
This is a statistical summary, not an accusation. See our methodology.
Compared to Public Health or Welfare Peers
Total spending distribution among 17 providers in this specialty
This provider's total spending of $2.60B is at the 99th percentile among 17 Public Health or Welfare providers.
Above 99th percentile for this specialty — higher spending than 16 of 17 peers
Total Paid
$2.60B
$2,596,064,455
Total Claims
16.3M
Beneficiaries
1.2M
13.9 claims/patient
Avg Cost/Claim
$159
#7 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Department of Intellectual and Developmental Disabilities, State of Tn is a Public Health or Welfare provider based in Nashville, TN. From the 2018–2024 period, this provider received $2.6B in Medicaid payments across 16.3M claims.
Important Context
- ℹ️This is a government entity that may serve as a fiscal agent for large populations. Government providers often bill at high volumes due to the scale of public programs they administer.
Why This Matters
This provider received $2.6B in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 324,508 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 30 distinct procedure codes. The top code (T2033 (Residential care, NOS; per diem)) accounts for 59% of total spending.
$1.53B
6.1M claims
$250.02
$1,051.57
Residential care, NOS; per diem
$1.53B
6.1M claims · 59.0%
$194.8M
2.9M claims
$67.38
$150.51
Day habilitation, waiver; per 15 min
$194.8M
2.9M claims · 7.5%
$167.2M
991K claims
$168.78
$331.94
Habilitation, residential, waiver; per diem
$167.2M
991K claims · 6.4%
$158.6M
1.2M claims
$137.11
$82.47
Personal care services, per 15 min
$158.6M
1.2M claims · 6.1%
$144.1M
1.8M claims
$79.48
$87.34
Day habilitation, waiver; per diem
$144.1M
1.8M claims · 5.6%
$135.2M
765K claims
$176.76
$177.54
Habilitation, educational; per 15 min
$135.2M
765K claims · 5.2%
$86.1M
1.0M claims
$82.20
$100.49
Ongoing support to maintain employment, per 15 min
$86.1M
1.0M claims · 3.3%
Case management, per month
$78.5M
334K claims · 3.0%
Waiver services, NOS; per 15 min
$27.8M
64K claims · 1.1%
$16.8M
262K claims
$64.19
$88.91
Habilitation, prevocational, waiver; per 15 min
$16.8M
262K claims · 0.6%
$14.7M
103K claims
$142.48
$24.24
LPN/LVN services, per 15 minutes
$14.7M
103K claims · 0.6%
$6.0M
64K claims
$92.29
$101.43
Services of SLP in home health, per 15 min
$6.0M
64K claims · 0.2%
$5.7M
48K claims
$117.93
$215.80
Crisis intervention service, per 15 minutes
$5.7M
48K claims · 0.2%
Periodontal scaling, per quadrant
$5.4M
11K claims · 0.2%
$3.6M
40K claims
$90.79
$67.94
Physical therapy services, home health, per visit
$3.6M
40K claims · 0.1%
$3.4M
478K claims
$7.04
$19.35
Non-emergency transport; per trip
$3.4M
478K claims · 0.1%
$3.0M
30K claims
$102.23
$68.93
Occupational therapy services, home health, per visit
$3.0M
30K claims · 0.1%
$2.6M
14K claims
$180.52
$853.15
Waiver services, not otherwise specified
$2.6M
14K claims · 0.1%
Nutritional counseling
$2.3M
22K claims · 0.1%
$1.7M
4K claims
$427.17
$141.34
Specialized transportation, waiver, per mile, extra
$1.7M
4K claims · 0.1%
$1.5M
6K claims · 0.1%
$542K
7K claims · 0.0%
$516K
2K claims
$210.60
$187.28
Respite care, in the home, per diem
$516K
2K claims · 0.0%
$508K
5K claims · 0.0%
$349K
5K claims
$66.39
$26.24
Inhalation of nitrous oxide/analgesia, anxiolysis
$349K
5K claims · 0.0%
$290K
7K claims · 0.0%
$278K
786 claims
$354.29
$119.19
Respite care services, not in the home, per diem
$278K
786 claims · 0.0%
$212K
2K claims · 0.0%
$209K
309 claims · 0.0%
$198K
8K claims
$24.50
$24.34
Periodic oral evaluation, established patient
$198K
8K claims · 0.0%
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