Commonwealth of Mass-dds
Case Management
Somerville, Massachusetts
NPI: 1851422661
Risk Tier
Critical
Total Paid
$298.4M
$298,421,390
Total Claims
334K
Beneficiaries
76K
Avg Cost/Claim
$892.79
Active billing period: 70 months (2018-01 to 2024-10)
Statistical Fraud Flags (3)
Cost Outlier
Billing over 3× the national median for specific procedure codes.
Bills $8,693.19 per claim for T2016 (Habilitation, residential, waiver; per diem), which is 26.2× the national median of $331.94.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 3 procedure codes: T2016 at 26.2× median, S5100 at 4.9× median.
Consistent Billing
Monthly billing amounts show almost no natural variation (CV < 0.1).
Monthly billing coefficient of variation: 0.0828 (near-zero variation).
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