Is A PLUS FAMILY CARE LLC flagged for Medicaid fraud?

A PLUS FAMILY CARE LLC (NPI: 1861439754) has not been flagged by our statistical fraud detection tests. Their billing patterns fall within normal ranges for their specialty.

How much does A PLUS FAMILY CARE LLC bill Medicaid?

A PLUS FAMILY CARE LLC received $0.1B in total Medicaid payments from 2018-2024, based on HHS billing records. They are classified as a Home Health provider. Located in SAN ANTONIO, TX.

What is NPI 1861439754?

NPI 1861439754 is the National Provider Identifier for A PLUS FAMILY CARE LLC. They are a Home Health provider based in SAN ANTONIO, TX. This NPI is registered with the CMS NPI Registry.

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A PLUS FAMILY CARE LLC

Home Health·SAN ANTONIO, TX·NPI: 1861439754Share

Compared to Home Health Peers

Total spending distribution among 322 providers in this specialty

P25MedianP75P90

This provider's total spending of $73.1M is at the 25th percentile among 322 Home Health providers.

Active Billing Period:2018-01→2024-12(84 months)

Total Paid

$73.1M

$73,121,794

Total Claims

1.3M

Beneficiaries

63K

20.2 claims/patient

Avg Cost/Claim

$57

Monthly Spending Trend

Yearly Spending

2018

$3.3M

+6%

2019

$3.5M

+85%

2020

$6.4M

+172%

2021

$17.4M

-9%

2022

$15.8M

-10%

2023

$14.3M

-12%

2024

$12.6M

Procedure Breakdown

Cost per claim compared to national benchmarks

This provider bills for 13 distinct procedure codes. The top code (S5125 (Attendant care services, per 15 min)) accounts for 85% of total spending.

ProcedureTotalYour Cost/ClaimNational Medianvs MedianPercentile

S5125Attendant care services, per 15 minSee all providers →

$62.4M

1.1M claims

$56.36

$82.34

0.7×

Normal range

S5125Normal range

Attendant care services, per 15 min

$62.4M

1.1M claims · 85.4%

Your Cost: $56.36/claim|Median: $82.34

0.7× median

T1019Personal care services, per 15 minSee all providers →

$2.8M

62K claims

$45.30

$82.47

0.5×

Normal range

T1019Normal range

Personal care services, per 15 min

$2.8M

62K claims · 3.8%

Your Cost: $45.30/claim|Median: $82.47

0.5× median

T1005Respite care services, per 15 minutesSee all providers →

$1.9M

40K claims

$48.01

$71.40

0.7×

Normal range

T1005Normal range

Respite care services, per 15 minutes

$1.9M

40K claims · 2.6%

Your Cost: $48.01/claim|Median: $71.40

0.7× median

97110Therapeutic exercises, each 15 minSee all providers →

$1.6M

16K claims

$97.52

$24.49

4.0×

Top 5%

97110Top 5%

Therapeutic exercises, each 15 min

$1.6M

16K claims · 2.2%

Your Cost: $97.52/claim|Median: $24.49

4.0× median

97530Therapeutic activities, each 15 minSee all providers →

$1.5M

17K claims

$91.15

$33.11

2.8×

Top 10%

97530Top 10%

Therapeutic activities, each 15 min

$1.5M

17K claims · 2.1%

Your Cost: $91.15/claim|Median: $33.11

2.8× median

92507Speech/hearing/language treatmentSee all providers →

$1.5M

17K claims

$88.13

$49.45

1.8×

Top 10%

92507Top 10%

Speech/hearing/language treatment

$1.5M

17K claims · 2.1%

Your Cost: $88.13/claim|Median: $49.45

1.8× median

92526Treatment of swallowing dysfunction and/or oral functionSee all providers →

$621K

5,242 claims

$118.49

$49.74

2.4×

Top 10%

92526Top 10%

Treatment of swallowing dysfunction and/or oral function

$621K

5,242 claims · 0.8%

Your Cost: $118.49/claim|Median: $49.74

2.4× median

H2015Comprehensive community support services, per 15 minSee all providers →

$591K

8,481 claims

$69.73

$96.24

0.7×

Normal range

H2015Normal range

Comprehensive community support services, per 15 min

$591K

8,481 claims · 0.8%

Your Cost: $69.73/claim|Median: $96.24

0.7× median

S9152Speech therapy, re-evaluationSee all providers →

$65K

452 claims

$143.66

$92.99

1.5×

Top 5%

S9152Top 5%

Speech therapy, re-evaluation

$65K

452 claims · 0.1%

Your Cost: $143.66/claim|Median: $92.99

1.5× median

97168OT re-evaluationSee all providers →

$28K

276 claims

$100.86

$50.43

2.0×

Top 25%

97168Top 25%

OT re-evaluation

$28K

276 claims · 0.0%

Your Cost: $100.86/claim|Median: $50.43

2.0× median

92523Evaluation of speech sound production with language comprehensionSee all providers →

$11K

77 claims

$144.00

$110.87

1.3×

Normal range

92523Normal range

Evaluation of speech sound production with language comprehension

$11K

77 claims · 0.0%

Your Cost: $144.00/claim|Median: $110.87

1.3× median

97164PT re-evaluationSee all providers →

$8K

84 claims

$100.20

$32.66

3.1×

Top 5%

97164Top 5%

PT re-evaluation

$8K

84 claims · 0.0%

Your Cost: $100.20/claim|Median: $32.66

3.1× median

97167OT evaluation, high complexitySee all providers →

$8K

71 claims

$109.15

$70.96

1.5×

Normal range

97167Normal range

OT evaluation, high complexity

$8K

71 claims · 0.0%

Your Cost: $109.15/claim|Median: $70.96

1.5× median

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