Coordinated Behavioral Care INC
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $306.99 per claim for G9005 (Coordinated care fee, risk-adjusted, ESRD), which is 6.5× the national median of $47.08.
Billing Swing
Experienced over 200% change in year-over-year billing with >$1M absolute change.
Billing changed from $1.3M (2018) to $19.7M (2019) — a 1443% swing with $18.4M absolute change.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 3 procedure codes: T2022 at 2.4× median, T1016 at 5.8× median.
Explosive Growth
Billing increased over 500% year-over-year — far beyond normal growth patterns.
Billing grew 1443% from 2018 to 2019.
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.
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.
Explosive Growth
Explosive Growth means this provider's billing increased by more than 500% year-over-year. While rapid expansion can be legitimate, this pattern has been observed in fraud schemes that ramp up billing quickly before detection.
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 $306.99 per claim for G9005 (Coordinated care fee, risk-adjusted, ESRD) — 6.5× the national median of $47.08.
Bills $289.01 per claim for T1016 (Case management, each 15 min) — 5.8× the national median of $49.62.
Bills $185.10 per claim for G0506 (Comprehensive assessment of chronic care management) — 25.0× the national median of $7.41.
Billing above the 90th percentile for 3 procedure codes simultaneously.
This is a statistical summary, not an accusation. See our methodology.
Compared to Case Management Peers
Total spending distribution among 137 providers in this specialty
This provider's total spending of $407.2M is at the 90th percentile among 137 Case Management providers.
Above 90th percentile for this specialty — higher spending than 123 of 137 peers
Total Paid
$407.2M
$407,155,352
Total Claims
1.2M
Beneficiaries
1.2M
1.0 claims/patient
Avg Cost/Claim
$335
#155 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Coordinated Behavioral Care INC is a Case Management provider based in New York, NY. From the 2018–2024 period, this provider received $407.2M in Medicaid payments across 1.2M claims.
Important Context
- ℹ️This provider appears to operate as a fiscal intermediary or management organization, processing payments on behalf of many individual caregivers. High aggregate billing is expected for this type of entity.
Why This Matters
This provider received $407.2M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 50,894 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 7 distinct procedure codes. The top code (G9005 (Coordinated care fee, risk-adjusted, ESRD)) accounts for 71% of total spending.
$288.4M
939K claims
$306.99
$47.08
Coordinated care fee, risk-adjusted, ESRD
$288.4M
939K claims · 70.8%
Case management, per month
$103.2M
214K claims · 25.3%
Case management, each 15 min
$13.6M
47K claims · 3.3%
$1.6M
9K claims
$185.10
$7.41
Comprehensive assessment of chronic care management
$1.6M
9K claims · 0.4%
$333K
4K claims · 0.1%
Behavioral health screening
$11K
119 claims · 0.0%
$0
124 claims · 0.0%
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