Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 2 procedure codes: 99199 at 44.1× median, T1001 at 3.6× median.
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:
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.
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 $237.80 per claim for 99199 (Unlisted special service, procedure, or report) — 44.1× the national median of $5.39.
Bills $176.99 per claim for T1001 (Nursing assessment/evaluation, per visit) — 3.6× the national median of $49.05.
Billing above the 90th percentile for 2 procedure codes simultaneously.
This is a statistical summary, not an accusation. See our methodology.
Compared to Home Health Peers
Total spending distribution among 322 providers in this specialty
This provider's total spending of $1.11B is at the 90th percentile among 322 Home Health providers.
Above 90th percentile for this specialty — higher spending than 289 of 322 peers
Total Paid
$1.11B
$1,107,509,967
Total Claims
6.9M
Beneficiaries
328K
21.1 claims/patient
Avg Cost/Claim
$160
#23 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Nae Edison LLC is a Home Health provider based in Brooklyn, NY. From the 2018–2024 period, this provider received $1.1B in Medicaid payments across 6.9M claims.
Why This Matters
This provider received $1.1B in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 138,438 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 10 distinct procedure codes. The top code (T1019 (Personal care services, per 15 min)) accounts for 89% of total spending.
$990.8M
6.5M claims
$151.38
$82.47
Personal care services, per 15 min
$990.8M
6.5M claims · 89.5%
$113.5M
341K claims
$332.93
$296.27
Personal care services, per diem
$113.5M
341K claims · 10.2%
$740K
3,447 claims · 0.1%
$737K
5,530 claims
$133.23
$85.62
Nursing care, in the home, by RN, per diem
$737K
5,530 claims · 0.1%
$631K
13K claims
$47.90
$124.86
Nursing care, in the home, by RN, per 15 minutes
$631K
13K claims · 0.1%
$374K
1,574 claims
$237.80
$5.39
Unlisted special service, procedure, or report
$374K
1,574 claims · 0.0%
$324K
2,500 claims
$129.45
$82.34
Attendant care services, per 15 min
$324K
2,500 claims · 0.0%
$230K
1,318 claims
$174.52
$259.38
Supported employment, waiver, per diem
$230K
1,318 claims · 0.0%
$104K
1,290 claims
$80.65
$59.83
Skilled services by RN in home health, per 15 min
$104K
1,290 claims · 0.0%
$61K
344 claims
$176.99
$49.05
Nursing assessment/evaluation, per visit
$61K
344 claims · 0.0%
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