Keystone Continuum LLC
Psychiatric Residential Treatment Facility
Mountain City, Tennessee
NPI: 1750304044
Risk Tier
Critical
Total Paid
$123.7M
$123,728,018
Total Claims
15K
Beneficiaries
15K
Avg Cost/Claim
$8,116.51
Active billing period: 61 months (2019-10 to 2024-10)
Statistical Fraud Flags (4)
Cost Outlier
Billing over 3× the national median for specific procedure codes.
Bills $11,881.29 per claim for T2016 (Habilitation, residential, waiver; per diem), which is 35.8× the national median of $331.94.
Billing Swing
Experienced over 200% change in year-over-year billing with >$1M absolute change.
Billing changed from $5.4M (2019) to $28.2M (2020) — a 425% swing with $22.8M absolute change.
High Cost Per Claim
Average payment per claim is much higher than peers billing the same procedures.
Spending Spike
Experienced a dramatic increase in billing over a short period.
Disclaimer: Statistical flags indicate unusual billing patterns — they are not proof of fraud or wrongdoing. Some entities (government agencies, home care programs, hospitals) may legitimately bill at higher rates due to patient acuity, overhead costs, or specialized services. This report is generated from public HHS data and statistical analysis only. No clinical or investigative review has been performed.
Generated by OpenMedicaid | openmedicaid.org | Data: HHS 2018-2024