Cumberland River Behavioral Health INC
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $130.98 per claim for 97535 (Self-care/home management training, per 15 minutes), which is 7.2× the national median of $18.18.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 2 procedure codes: 97535 at 7.2× median, H2019 at 2.6× median.
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.
Rate Outlier
Rate Outlier means this provider charges above the 90th percentile for multiple different procedure codes simultaneously. While one high-cost code could reflect specialization, consistently high rates across many codes may indicate systematic overbilling.
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 $130.98 per claim for 97535 (Self-care/home management training, per 15 minutes) — 7.2× the national median of $18.18.
Billing above the 90th percentile for 2 procedure codes simultaneously.
This is a statistical summary, not an accusation. See our methodology.
Compared to Community/Behavioral Health Peers
Total spending distribution among 218 providers in this specialty
This provider's total spending of $349.2M is at the 90th percentile among 218 Community/Behavioral Health providers.
Above 90th percentile for this specialty — higher spending than 196 of 218 peers
Total Paid
$349.2M
$349,237,896
Total Claims
2.7M
Beneficiaries
689K
4.0 claims/patient
Avg Cost/Claim
$127
#198 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Cumberland River Behavioral Health INC is a Community/Behavioral Health provider based in Corbin, KY. From the 2018–2024 period, this provider received $349.2M in Medicaid payments across 2.7M claims.
Why This Matters
This provider received $349.2M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 43,654 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 30 distinct procedure codes. The top code (97535 (Self-care/home management training, per 15 minutes)) accounts for 34% of total spending.
$120.3M
918K claims
$130.98
$18.18
Self-care/home management training, per 15 minutes
$120.3M
918K claims · 34.4%
Personal care services, per 15 min
$80.8M
438K claims · 23.1%
$23.5M
194K claims
$121.16
$107.36
Home care training to home care client, per 15 minutes
$23.5M
194K claims · 6.7%
$22.6M
137K claims
$164.65
$331.94
Habilitation, residential, waiver; per diem
$22.6M
137K claims · 6.5%
Case management, per month
$20.0M
74K claims · 5.7%
Psychotherapy, 60 minutes
$19.4M
240K claims · 5.5%
$10.4M
62K claims
$167.02
$144.05
Day habilitation, waiver, per 15 minutes
$10.4M
62K claims · 3.0%
$9.6M
35K claims
$272.92
$300.13
Community transition, waiver; per service
$9.6M
35K claims · 2.7%
$8.0M
77K claims
$104.60
$108.97
Financial management, self-directed; per month
$8.0M
77K claims · 2.3%
Interpretation/explanation of results
$7.3M
92K claims · 2.1%
$5.6M
26K claims
$217.77
$84.12
Therapeutic behavioral services, per 15 min
$5.6M
26K claims · 1.6%
$5.1M
81K claims
$63.32
$150.51
Day habilitation, waiver; per 15 min
$5.1M
81K claims · 1.5%
Psychotherapy, 45 minutes
$2.8M
48K claims · 0.8%
Psychotherapy, 30 minutes
$2.6M
63K claims · 0.7%
$2.0M
55K claims
$35.88
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$2.0M
55K claims · 0.6%
$1.1M
35K claims
$31.49
$55.04
Self-help/peer services, per 15 minutes
$1.1M
35K claims · 0.3%
$1.0M
5K claims
$200.19
$501.33
Crisis intervention mental health services, per diem
$1.0M
5K claims · 0.3%
$1.0M
17K claims
$61.56
$96.24
Comprehensive community support services, per 15 min
$1.0M
17K claims · 0.3%
$736K
10K claims
$71.97
$392.63
Psychosocial rehabilitation services, per diem
$736K
10K claims · 0.2%
Group psychotherapy
$734K
49K claims · 0.2%
$711K
15K claims
$47.68
$71.40
Respite care services, per 15 minutes
$711K
15K claims · 0.2%
$570K
10K claims
$55.83
$164.03
Alcohol and/or drug abuse halfway house services, per hour
$570K
10K claims · 0.2%
$490K
5K claims
$102.02
$215.80
Crisis intervention service, per 15 minutes
$490K
5K claims · 0.1%
$426K
795 claims
$536.15
$266.41
Assertive community treatment, face-to-face, per 15 minutes
$426K
795 claims · 0.1%
$419K
9K claims
$45.17
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$419K
9K claims · 0.1%
$376K
5K claims
$77.96
$80.64
Mental health service plan development
$376K
5K claims · 0.1%
$335K
6K claims
$55.03
$317.54
Alcohol and/or drug services, acute detoxification, per diem
$335K
6K claims · 0.1%
$312K
2K claims
$135.26
$108.91
Psychiatric diagnostic evaluation with medical services
$312K
2K claims · 0.1%
$182K
2K claims
$89.00
$169.11
Community-based wrap-around services, per 15 min
$182K
2K claims · 0.1%
$157K
3K claims
$55.13
$129.75
Alcohol and/or drug abuse, intensive outpatient, per hour
$157K
3K claims · 0.0%
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