Area Agency on Aging 1-b
Billing Swing
Experienced over 200% change in year-over-year billing with >$1M absolute change.
Billing changed from $1.1M (2020) to $23.3M (2021) — a 2022% swing with $22.2M absolute change.
Explosive Growth
Billing increased over 500% year-over-year — far beyond normal growth patterns.
Billing grew 2022% from 2020 to 2021.
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:
Billing Swing
Billing Swing means this provider's total billing changed dramatically from one year to the next — increasing or decreasing by more than 200% with over $1M in absolute change. This could indicate a change in practice scope, a billing scheme ramping up, or legitimate growth.
Explosive Growth
Explosive Growth means this provider's billing increased by more than 500% year-over-year. While rapid expansion can be legitimate, this pattern has been observed in fraud schemes that ramp up billing quickly before detection.
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 $662.10 per claim for T2022 (Case management, per month) — 3.3× the national median of $202.77.
Bills $106.92 per claim for A0130 (Non-emergency wheelchair van transport) — 3.6× the national median of $29.37.
Bills $65.04 per claim for S0209 (Outpatient psychiatric services, partial hospitalization, per hour) — 3.6× the national median of $18.24.
Billing in the top 1% nationally for 1 procedure code: T5999.
This is a statistical summary, not an accusation. See our methodology.
Compared to Case Management Peers
Total spending distribution among 137 providers in this specialty
This provider's total spending of $143.1M is at the 50th percentile among 137 Case Management providers.
Total Paid
$143.1M
$143,076,884
Total Claims
1.6M
Beneficiaries
124K
12.7 claims/patient
Avg Cost/Claim
$91
#767 of 618K providers by total spending(top 0.1%)
🔍 Analysis
Provider Overview
Area Agency on Aging 1-b is a Case Management provider based in Southfield, MI. From the 2018–2024 period, this provider received $143.1M in Medicaid payments across 1.6M claims.
Important Context
- ℹ️This provider appears to operate as a fiscal intermediary or management organization, processing payments on behalf of many individual caregivers. High aggregate billing is expected for this type of entity.
Why This Matters
This provider received $143.1M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 17,884 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 22 distinct procedure codes. The top code (H2015 (Comprehensive community support services, per 15 min)) accounts for 43% of total spending.
$61.9M
696K claims
$88.92
$96.24
Comprehensive community support services, per 15 min
$61.9M
696K claims · 43.3%
$34.9M
337K claims
$103.33
$82.47
Personal care services, per 15 min
$34.9M
337K claims · 24.4%
Case management, per month
$22.9M
35K claims · 16.0%
$8.6M
13K claims
$654.29
$402.76
Private duty/independent nursing service(s)
$8.6M
13K claims · 6.0%
$4.4M
51K claims
$87.28
$321.53
Comprehensive community support services, per 15 min
$4.4M
51K claims · 3.1%
Homemaker service, NOS, per diem
$2.9M
300K claims · 2.0%
$2.5M
21K claims
$116.21
$1,051.57
Residential care, NOS; per diem
$2.5M
21K claims · 1.7%
Non-emergency wheelchair van transport
$943K
9K claims · 0.7%
$641K
30K claims
$21.58
$21.33
Non-invasive prenatal screening, fetal chromosomal abnormalities
$641K
30K claims · 0.4%
$573K
7K claims
$80.59
$111.06
Attendant care services, in-home, per 15 min
$573K
7K claims · 0.4%
$565K
9K claims
$65.04
$18.24
Outpatient psychiatric services, partial hospitalization, per hour
$565K
9K claims · 0.4%
$517K
5K claims
$100.95
$67.58
Day care services, adult, per half day
$517K
5K claims · 0.4%
$466K
7K claims
$63.09
$21.70
Non-emergency transport; encounter/trip
$466K
7K claims · 0.3%
$407K
12K claims
$32.61
$29.97
Emergency response system, per month
$407K
12K claims · 0.3%
$373K
3K claims
$131.53
$124.39
Waiver services, NOS; per 15 min
$373K
3K claims · 0.3%
$209K
59 claims · 0.1%
$154K
36K claims
$4.33
$89.79
Enteral formula, nutritionally complete with fiber, per 100 calories
$154K
36K claims · 0.1%
$43K
840 claims
$50.86
$141.34
Specialized transportation, waiver, per mile, extra
$43K
840 claims · 0.0%
LPN/LVN services, per 15 minutes
$20K
972 claims · 0.0%
$16K
81 claims
$200.00
$259.38
Supported employment, waiver, per diem
$16K
81 claims · 0.0%
$10K
48 claims · 0.0%
$5K
241 claims · 0.0%
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