Commonwealth of Massachusetts-dmh
Single-Code
Billing almost exclusively for 1-2 procedure codes despite high total volume.
Bills primarily for code H2018 (2 unique codes).
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:
Single-Code
Single-Code Billing means this provider bills almost exclusively for one or two procedure codes despite high total volume. Legitimate specialists may focus on specific codes, but extreme concentration can indicate a scheme billing repeatedly for the same service.
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
Extreme procedure concentration — 93% of all billing flows through just 2 codes (H2018, H0019).
This is a statistical summary, not an accusation. See our methodology.
Compared to Community/Behavioral Health Peers
Total spending distribution among 218 providers in this specialty
This provider's total spending of $208.0M is at the 75th percentile among 218 Community/Behavioral Health providers.
Extreme procedure concentration — 93% of $208.0M billed through just 2 codes
Total Paid
$208.0M
$208,022,188
Total Claims
545K
Beneficiaries
98K
5.5 claims/patient
Avg Cost/Claim
$382
#427 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Commonwealth of Massachusetts-dmh is a Community/Behavioral Health provider based in Brockton, MA. From the 2018–2024 period, this provider received $208.0M in Medicaid payments across 545K claims.
Why This Matters
This provider received $208.0M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 26,002 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 2 distinct procedure codes. The top code (H2018 (Psychosocial rehabilitation services, per diem)) accounts for 93% of total spending.
$193.1M
528K claims
$365.55
$392.63
Psychosocial rehabilitation services, per diem
$193.1M
528K claims · 92.8%
$14.9M
17K claims
$892.53
$357.16
Behavioral health; residential, per diem
$14.9M
17K claims · 7.2%
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