Is PRIMARY HEALTH CHOICE, INC. flagged for Medicaid fraud?

PRIMARY HEALTH CHOICE, INC. (NPI: 1851539126) has not been flagged by our statistical fraud detection tests. Their billing patterns fall within normal ranges for their specialty.

How much does PRIMARY HEALTH CHOICE, INC. bill Medicaid?

PRIMARY HEALTH CHOICE, INC. received $0.1B in total Medicaid payments from 2018-2024, based on HHS billing records. They are classified as a Community/Behavioral Health provider. Located in LUMBERTON, NC.

What is NPI 1851539126?

NPI 1851539126 is the National Provider Identifier for PRIMARY HEALTH CHOICE, INC.. They are a Community/Behavioral Health provider based in LUMBERTON, NC. This NPI is registered with the CMS NPI Registry.

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PRIMARY HEALTH CHOICE, INC.

Community/Behavioral Health·LUMBERTON, NC·NPI: 1851539126Share

Compared to Community/Behavioral Health Peers

Total spending distribution among 218 providers in this specialty

P25MedianP75P90

This provider's total spending of $93.1M is at the 50th percentile among 218 Community/Behavioral Health providers.

Active Billing Period:2018-01→2024-11(83 months)

Total Paid

$93.1M

$93,139,990

Total Claims

575K

Beneficiaries

29K

19.9 claims/patient

Avg Cost/Claim

$162

Monthly Spending Trend

Yearly Spending

2018

$11.2M

-5%

2019

$10.7M

+2%

2020

$10.9M

+3%

2021

$11.2M

+32%

2022

$14.8M

+8%

2023

$15.9M

+15%

2024

$18.4M

Procedure Breakdown

Cost per claim compared to national benchmarks

This provider bills for 13 distinct procedure codes. The top code (T2013 (Habilitation, residential, waiver, per hour)) accounts for 70% of total spending.

ProcedureTotalYour Cost/ClaimNational Medianvs MedianPercentile

T2013Habilitation, residential, waiver, per hourSee all providers →

$65.5M

379K claims

$172.54

$158.23

1.1×

Normal range

T2013Normal range

Habilitation, residential, waiver, per hour

$65.5M

379K claims · 70.3%

Your Cost: $172.54/claim|Median: $158.23

1.1× median

T2012Habilitation, educational; per 15 minSee all providers →

$21.0M

120K claims

$175.14

$177.54

1.0×

Normal range

T2012Normal range

Habilitation, educational; per 15 min

$21.0M

120K claims · 22.6%

Your Cost: $175.14/claim|Median: $177.54

1.0× median

S5150Unskilled respite care, per 15 minSee all providers →

$4.9M

66K claims

$74.31

$84.46

0.9×

Normal range

S5150Normal range

Unskilled respite care, per 15 min

$4.9M

66K claims · 5.2%

Your Cost: $74.31/claim|Median: $84.46

0.9× median

S5125Attendant care services, per 15 minSee all providers →

$638K

3,700 claims

$172.50

$82.34

2.1×

Top 25%

S5125Top 25%

Attendant care services, per 15 min

$638K

3,700 claims · 0.7%

Your Cost: $172.50/claim|Median: $82.34

2.1× median

99509Home visit, assistance w/ ADLsSee all providers →

$514K

3,031 claims

$169.63

$51.71

3.3×

Top 10%

99509Top 10%

Home visit, assistance w/ ADLs

$514K

3,031 claims · 0.6%

Your Cost: $169.63/claim|Median: $51.71

3.3× median

H2022Community-based wrap-around services, per diemSee all providers →

$365K

1,297 claims

$281.21

$336.31

0.8×

Normal range

H2022Normal range

Community-based wrap-around services, per diem

$365K

1,297 claims · 0.4%

Your Cost: $281.21/claim|Median: $336.31

0.8× median

H2015Comprehensive community support services, per 15 minSee all providers →

$142K

922 claims

$154.32

$96.24

1.6×

Normal range

H2015Normal range

Comprehensive community support services, per 15 min

$142K

922 claims · 0.2%

Your Cost: $154.32/claim|Median: $96.24

1.6× median

T1019Personal care services, per 15 minSee all providers →

$48K

280 claims

$170.36

$82.47

2.1×

Top 25%

T1019Top 25%

Personal care services, per 15 min

$48K

280 claims · 0.1%

Your Cost: $170.36/claim|Median: $82.47

2.1× median

T1017Targeted case management, per 15 minSee all providers →

$37K

109 claims

$343.97

$69.56

4.9×

Top 5%

T1017Top 5%

Targeted case management, per 15 min

$37K

109 claims · 0.0%

Your Cost: $343.97/claim|Median: $69.56

4.9× median

90837Psychotherapy, 60 minutesSee all providers →

$10K

154 claims

$66.13

$85.66

0.8×

Normal range

90837Normal range

Psychotherapy, 60 minutes

$10K

154 claims · 0.0%

Your Cost: $66.13/claim|Median: $85.66

0.8× median

H0045Respite care services, not in the home, per diemSee all providers →

$7K

69 claims

$101.93

$119.19

0.9×

Normal range

H0045Normal range

Respite care services, not in the home, per diem

$7K

69 claims · 0.0%

Your Cost: $101.93/claim|Median: $119.19

0.9× median

T1004Services of a qualified nursing aide, per 15 minutesSee all providers →

$4K

16 claims

$220.90

$50.30

4.4×

Top 5%

T1004Top 5%

Services of a qualified nursing aide, per 15 minutes

$4K

16 claims · 0.0%

Your Cost: $220.90/claim|Median: $50.30

4.4× median

Q3014Telehealth originating site facility feeSee all providers →

$3K

148 claims

$19.05

$15.37

1.2×

Normal range

Q3014Normal range

Telehealth originating site facility fee

$3K

148 claims · 0.0%

Your Cost: $19.05/claim|Median: $15.37

1.2× median

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