Gateways Community Services
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $1,239.64 per claim for T2025 (Waiver services, NOS; per 15 min), which is 10.0× the national median of $124.39.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 3 procedure codes: T2025 at 10.0× median, T2002 at 9.3× 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 $1,239.64 per claim for T2025 (Waiver services, NOS; per 15 min) — 10.0× the national median of $124.39.
Bills $180.86 per claim for T2002 (Non-emergency transport; per trip) — 9.3× the national median of $19.35.
Bills $643.27 per claim for H2014 (Skills training & development, per 15 min) — 7.7× the national median of $83.88.
Billing in the top 1% nationally for 1 procedure code: T2002.
This is a statistical summary, not an accusation. See our methodology.
Compared to Early Intervention Provider Agency Peers
Total spending distribution among 14 providers in this specialty
This provider's total spending of $286.0M is at the 90th percentile among 14 Early Intervention Provider Agency providers.
Above 90th percentile for this specialty — higher spending than 12 of 14 peers
Total Paid
$286.0M
$285,983,084
Total Claims
1.2M
Beneficiaries
164K
7.0 claims/patient
Avg Cost/Claim
$249
#264 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Gateways Community Services is a Early Intervention Provider Agency provider based in Nashua, NH. From the 2018–2024 period, this provider received $286.0M in Medicaid payments across 1.2M claims.
Why This Matters
This provider received $286.0M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 35,747 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 (T1020 (Personal care services, per diem)) accounts for 48% of total spending.
$138.2M
380K claims
$363.81
$296.27
Personal care services, per diem
$138.2M
380K claims · 48.3%
Waiver services, NOS; per 15 min
$65.9M
53K claims · 23.0%
$32.1M
164K claims
$195.95
$150.51
Day habilitation, waiver; per 15 min
$32.1M
164K claims · 11.2%
$16.6M
136K claims
$121.80
$103.94
Supported employment, per 15 min
$16.6M
136K claims · 5.8%
Case management, per month
$11.1M
41K claims · 3.9%
Case management, each 15 min
$6.4M
254K claims · 2.2%
$5.0M
19K claims
$258.66
$300.13
Community transition, waiver; per service
$5.0M
19K claims · 1.7%
$3.7M
53K claims
$69.28
$96.24
Comprehensive community support services, per 15 min
$3.7M
53K claims · 1.3%
$3.4M
13K claims
$257.09
$119.08
Evaluation & treatment, integrated specialty team
$3.4M
13K claims · 1.2%
$2.2M
26K claims
$84.71
$82.47
Personal care services, per 15 min
$2.2M
26K claims · 0.8%
Respite care services, per 15 minutes
$1.3M
9K claims · 0.4%
Activity therapy, per 15 minutes
$127K
661 claims · 0.0%
$42K
545 claims
$76.22
$215.80
Crisis intervention service, per 15 minutes
$42K
545 claims · 0.0%
Non-emergency transport; per trip
$38K
211 claims · 0.0%
$33K
824 claims
$40.10
$81.10
Day care services, adult; per 15 min
$33K
824 claims · 0.0%
$9K
92 claims
$93.03
$85.62
Nursing care, in the home, by RN, per diem
$9K
92 claims · 0.0%
$8K
13 claims
$643.27
$83.88
Skills training & development, per 15 min
$8K
13 claims · 0.0%
$6K
55 claims
$108.69
$84.12
Therapeutic behavioral services, per 15 min
$6K
55 claims · 0.0%
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