Legacy Community Health Services, INC
Billing Swing
Experienced over 200% change in year-over-year billing with >$1M absolute change.
Billing changed from $4.3M (2019) to $19.3M (2020) — a 349% swing with $15.0M absolute change.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 5 procedure codes: T1015 at 2.1× median, 99391 at 1.4× 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:
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.
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.
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
Billing above the 90th percentile for 4 procedure codes simultaneously.
This is a statistical summary, not an accusation. See our methodology.
Compared to Pediatrics Peers
Total spending distribution among 14 providers in this specialty
This provider's total spending of $406.5M is at the 99th percentile among 14 Pediatrics providers.
Above 99th percentile for this specialty — higher spending than 13 of 14 peers
Total Paid
$406.5M
$406,511,581
Total Claims
4.9M
Beneficiaries
4.0M
1.2 claims/patient
Avg Cost/Claim
$84
#156 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Legacy Community Health Services, INC is a Pediatrics provider based in Houston, TX. From the 2018–2024 period, this provider received $406.5M in Medicaid payments across 4.9M claims.
Why This Matters
This provider received $406.5M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 50,813 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 (T1015 (Clinic visit/encounter, all-inclusive)) accounts for 83% of total spending.
$336.7M
1.3M claims
$257.65
$121.16
Clinic visit/encounter, all-inclusive
$336.7M
1.3M claims · 82.8%
$20.8M
515K claims
$40.35
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$20.8M
515K claims · 5.1%
$9.1M
92K claims
$99.57
$69.35
Preventive medicine, established patient, infant (under 1)
$9.1M
92K claims · 2.2%
$6.4M
30K claims
$214.87
$73.46
Preventive visit, new patient, infant (<1 yr)
$6.4M
30K claims · 1.6%
$6.3M
114K claims
$54.82
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$6.3M
114K claims · 1.5%
Psychotherapy, 45 minutes
$5.8M
121K claims · 1.4%
$3.9M
75K claims
$52.25
$75.18
Preventive medicine, established patient, age 1-4
$3.9M
75K claims · 1.0%
$3.3M
86K claims
$38.77
$25.06
Office/outpatient visit, low complexity
$3.3M
86K claims · 0.8%
Psychotherapy, 30 minutes
$2.8M
74K claims · 0.7%
$2.2M
10K claims
$230.77
$101.33
Unspecified diagnostic procedure, by report
$2.2M
10K claims · 0.6%
$1.9M
37K claims
$51.22
$74.82
Preventive medicine, established patient, age 5-11
$1.9M
37K claims · 0.5%
$1.1M
21K claims
$55.21
$80.15
Preventive medicine, established patient, age 12-17
$1.1M
21K claims · 0.3%
$571K
18K claims
$32.17
$57.85
Office/outpatient visit, new patient, low-mod complexity
$571K
18K claims · 0.1%
$536K
10K claims
$54.51
$99.21
Psychiatric diagnostic evaluation
$536K
10K claims · 0.1%
$533K
4K claims
$137.16
$137.85
Other specified case management service, per 15 minutes
$533K
4K claims · 0.1%
$528K
940 claims
$561.72
$786.43
Etonogestrel implant system, including implant and supplies
$528K
940 claims · 0.1%
Group psychotherapy
$499K
12K claims · 0.1%
$448K
5K claims
$88.53
$72.71
Preventive medicine, established patient, age 18-39
$448K
5K claims · 0.1%
$385K
11K claims
$36.21
$84.03
Office/outpatient visit, new patient, mod-high complexity
$385K
11K claims · 0.1%
$379K
7K claims
$55.13
$108.91
Psychiatric diagnostic evaluation with medical services
$379K
7K claims · 0.1%
$376K
4K claims
$88.14
$81.92
Preventive visit, new patient, late childhood (5-11 yr)
$376K
4K claims · 0.1%
$280K
3K claims
$102.58
$79.89
Preventive visit, new patient, early childhood (1-4 yr)
$280K
3K claims · 0.1%
$263K
4K claims
$74.37
$83.63
Preventive visit, new patient, adolescent (12-17 yr)
$263K
4K claims · 0.1%
$259K
8K claims · 0.1%
$175K
6K claims
$29.86
$40.11
Office/outpatient visit, new patient, low complexity
$175K
6K claims · 0.0%
$129K
1K claims
$118.30
$76.22
Preventive visit, new patient, 18-39 yr
$129K
1K claims · 0.0%
$124K
2K claims
$68.80
$74.09
Office/outpatient visit, high complexity
$124K
2K claims · 0.0%
$99K
3K claims
$37.80
$21.91
Federally qualified health center visit, mental health
$99K
3K claims · 0.0%
$87K
5K claims · 0.0%
$85K
656 claims
$130.22
$76.06
Preventive medicine, established patient, age 40-64
$85K
656 claims · 0.0%
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