Upper Mattaponi Indian Tribe
Billing Swing
Experienced over 200% change in year-over-year billing with >$1M absolute change.
Billing changed from $1.0M (2022) to $17.4M (2023) — a 1632% swing with $16.4M absolute change.
New Entrant
Started billing recently but already receiving millions in Medicaid payments.
First appeared in 2022-01 and has already billed $75.6M, averaging $2.6M/month across 29 months.
Explosive Growth
Billing increased over 500% year-over-year — far beyond normal growth patterns.
Billing grew 1632% from 2022 to 2023.
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:
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.
New Entrant
New Entrant means this provider began billing Medicaid recently but is already receiving millions of dollars in payments. While some new providers legitimately grow fast (e.g., large group practices), this pattern is also common in fraud schemes that set up shell companies to bill aggressively before shutting down.
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.
Risk Assessment
Bills $1,422.57 per claim for S5121 (Attendant care services, in-home, per 15 min) — 12.8× the national median of $111.06.
Bills $812.49 per claim for Q5009 (Hospice/home health aide, per 15 min) — 5.9× the national median of $138.75.
Bills $667.10 per claim for 99213 (Office/outpatient visit, est. patient, low-mod complexity) — 17.6× the national median of $37.81.
Billing in the top 1% nationally for 9 procedure codes: Q5009, 99213, 80053.
This is a statistical summary, not an accusation. See our methodology.
Compared to Family Medicine Peers
Total spending distribution among 19 providers in this specialty
This provider's total spending of $75.6M is at the 75th percentile among 19 Family Medicine providers.
Total Paid
$75.6M
$75,608,666
Total Claims
0
Beneficiaries
0
Avg Cost/Claim
$0
🔍 Analysis
Provider Overview
Upper Mattaponi Indian Tribe is a Family Medicine provider based in Aylett, VA. From the 2018–2024 period, this provider received $0 in Medicaid payments across 0 claims.
Procedure Breakdown
Cost per claim compared to national benchmarks
This provider bills for 10 distinct procedure codes. The top code (S5121 (Attendant care services, in-home, per 15 min)) accounts for 64% of total spending.
$48.2M
34K claims
$1,422.57
$111.06
Attendant care services, in-home, per 15 min
$48.2M
34K claims · 63.7%
$24.4M
30K claims
$812.49
$138.75
Hospice/home health aide, per 15 min
$24.4M
30K claims · 32.3%
$899K
1,347 claims
$667.10
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$899K
1,347 claims · 1.2%
Comprehensive metabolic panel
$448K
658 claims · 0.6%
$442K
648 claims
$681.64
$4.71
Complete blood count (CBC) with differential, automated
$442K
648 claims · 0.6%
$420K
611 claims
$687.69
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$420K
611 claims · 0.6%
Lipid panel
$297K
439 claims · 0.4%
Hemoglobin A1c (glycated hemoglobin)
$171K
253 claims · 0.2%
$104K
144 claims
$719.00
$74.09
Office/outpatient visit, high complexity
$104K
144 claims · 0.1%
Thyroid stimulating hormone (TSH)
$68K
105 claims · 0.1%
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