New Vista of the Bluegrass INC
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $128.27 per claim for 97535 (Self-care/home management training, per 15 minutes), which is 7.1× the national median of $18.18.
High Cost Per Claim
Average payment per claim is much higher than peers billing the same procedures.
High Claims Per Patient
Filing an unusually high number of claims per beneficiary compared to peers.
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.
High Cost Per Claim
High Cost Per Claim means each individual claim from this provider costs significantly more than what other providers charge for the same services. This could indicate upcoding (billing for more expensive services than provided) or legitimate specialized care.
High Claims Per Patient
High Claims Per Patient means this provider files an unusually high number of claims per individual patient. This could indicate legitimate intensive treatment or a pattern of billing for services not actually rendered.
These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.
Risk Assessment
Bills $128.27 per claim for 97535 (Self-care/home management training, per 15 minutes) — 7.1× the national median of $18.18.
This is a statistical summary, not an accusation. See our methodology.
Compared to Clinic/Center Mental Health (Including Community Mental Health Center) Peers
Total spending distribution among 28 providers in this specialty
This provider's total spending of $166.4M is at the 50th percentile among 28 Clinic/Center Mental Health (Including Community Mental Health Center) providers.
Total Paid
$166.4M
$166,380,906
Total Claims
1.3M
Beneficiaries
223K
5.7 claims/patient
Avg Cost/Claim
$132
#603 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
New Vista of the Bluegrass INC is a Clinic/Center Mental Health (Including Community Mental Health Center) provider based in Versailles, KY. From the 2018–2024 period, this provider received $166.4M in Medicaid payments across 1.3M claims.
Why This Matters
This provider received $166.4M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 20,797 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 6 distinct procedure codes. The top code (97535 (Self-care/home management training, per 15 minutes)) accounts for 66% of total spending.
$110.3M
860K claims
$128.27
$18.18
Self-care/home management training, per 15 minutes
$110.3M
860K claims · 66.3%
Case management, per month
$23.6M
88K claims · 14.2%
$14.8M
141K claims
$104.38
$107.36
Home care training to home care client, per 15 minutes
$14.8M
141K claims · 8.9%
$8.3M
68K claims
$123.48
$82.47
Personal care services, per 15 min
$8.3M
68K claims · 5.0%
$6.3M
61K claims
$103.49
$108.97
Financial management, self-directed; per month
$6.3M
61K claims · 3.8%
$3.0M
46K claims
$65.83
$71.40
Respite care services, per 15 minutes
$3.0M
46K claims · 1.8%
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