Statistical flags indicate unusual patterns — not proof of fraud or wrongdoing. Read our methodology

Vav Operations LLC

Community/Behavioral Health·South Bend, IN·NPI: 1942576905SharePrint Report

Red Flags Explained

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.

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

Change PointBilling shifted 4.5x in 2022-02

These signals use advanced statistical methods including digit distribution analysis, change-point detection, and market concentration metrics. Learn more.

Risk Assessment

Bills $581.59 per claim for 97153 (Adaptive behavior treatment by protocol, per 15 min) — 3.5× the national median of $167.38.

Bills $124.12 per claim for 96152 (Health behavior intervention, individual) — 6.2× the national median of $20.02.

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

P25MedianP75P90

This provider's total spending of $198.7M is at the 75th percentile among 218 Community/Behavioral Health providers.

Active Billing Period:2018-012024-11(78 months)

Total Paid

$198.7M

$198,705,710

Total Claims

482K

Beneficiaries

48K

10.1 claims/patient

Avg Cost/Claim

$412

#462 of 618K providers by total spending(top <0.1%)

🔍 Analysis

Provider Overview

Vav Operations LLC is a Community/Behavioral Health provider based in South Bend, IN. From the 2018–2024 period, this provider received $198.7M in Medicaid payments across 482K claims.

Why This Matters

This provider received $198.7M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 24,838 Medicaid beneficiaries for a full year at average per-enrollee costs.

4759% growthsince first billing year

Monthly Spending Trend

Yearly Spending

2018
$896K
+123%
2019
$2.0M
+476%
2020
$11.5M
+136%
2021
$27.2M
+51%
2022
$41.0M
+77%
2023
$72.5M
-40%
2024
$43.6M

Procedure Breakdown

Cost per claim compared to national benchmarks

This provider bills for 16 distinct procedure codes. The top code (97153 (Adaptive behavior treatment by protocol, per 15 min)) accounts for 90% of total spending.

97153Top 5%

Adaptive behavior treatment by protocol, per 15 min

$179.0M

308K claims · 90.1%

Your Cost: $581.59/claim|Median: $167.38
3.5× median
97155Normal range

Adaptive behavior treatment with protocol modification, per 15 minutes

$16.6M

140K claims · 8.4%

Your Cost: $118.89/claim|Median: $146.45
0.8× median
96152Top 10%

Health behavior intervention, individual

$1.1M

9K claims · 0.6%

Your Cost: $124.12/claim|Median: $20.02
6.2× median
97156Normal range

$777K

10K claims · 0.4%

Your Cost: $77.18/claim|Median: $88.65
0.9× median
97151Normal range

Behavior identification assessment

$682K

5K claims · 0.3%

Your Cost: $143.80/claim|Median: $161.10
0.9× median
92507Normal range

Speech/hearing/language treatment

$220K

5K claims · 0.1%

Your Cost: $47.43/claim|Median: $49.45
1.0× median
97530Top 25%

Therapeutic activities, each 15 min

$131K

2K claims · 0.1%

Your Cost: $63.29/claim|Median: $33.11
1.9× median
97154Normal range

Group adaptive behavior treatment, per 15 min

$80K

3K claims · 0.0%

Your Cost: $26.41/claim|Median: $55.95
0.5× median
90791Top 25%

Psychiatric diagnostic evaluation

$68K

517 claims · 0.0%

Your Cost: $131.02/claim|Median: $99.21
1.3× median
96130Normal range

Psychological testing evaluation by professional, first hour

$12K

329 claims · 0.0%

Your Cost: $35.95/claim|Median: $79.21
0.5× median
96131Normal range

Psychological testing evaluation, each additional hour

$5K

145 claims · 0.0%

Your Cost: $34.65/claim|Median: $133.38
0.3× median
96139Normal range

$4K

140 claims · 0.0%

Your Cost: $28.48/claim|Median: $97.14
0.3× median
96138Normal range

$4K

158 claims · 0.0%

Your Cost: $24.10/claim|Median: $19.87
1.2× median
96136Normal range

Psychological/neuropsychological testing, first 30 min

$1K

89 claims · 0.0%

Your Cost: $15.54/claim|Median: $30.49
0.5× median
96137Normal range

Psychological/neuropsychological testing, each additional 30 min

$1K

88 claims · 0.0%

Your Cost: $14.57/claim|Median: $92.96
0.2× median
96155Normal range

$278

19 claims · 0.0%

Your Cost: $14.65/claim|Median: $34.72
0.4× median