Mount Prospect Academy Inc.
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $6,136.57 per claim for H0019 (Behavioral health; residential, per diem), which is 17.2× the national median of $357.16.
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.
These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.
Total Paid
$76.5M
$76,545,940
Total Claims
16K
Beneficiaries
11K
1.5 claims/patient
Avg Cost/Claim
$5K
🔍 Analysis
Provider Overview
Mount Prospect Academy Inc. is a Residential Treatment Facility Emotionally Disturbed Children provider based in Plymouth, NH. From the 2018–2024 period, this provider received $76.5M in Medicaid payments across 16K claims.
Why This Matters
At $76.5M in Medicaid payments, this provider represents significant public healthcare spending. Understanding where these dollars go helps ensure the program serves those who need it most.
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