Community Healthcare Network INC
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $261.77 per claim for G9005 (Coordinated care fee, risk-adjusted, ESRD), which is 5.6× the national median of $47.08.
Billing Swing
Experienced over 200% change in year-over-year billing with >$1M absolute change.
Billing changed from $5.7M (2019) to $24.7M (2020) — a 332% swing with $19.0M absolute change.
Single-Code
Billing almost exclusively for 1-2 procedure codes despite high total volume.
Bills primarily for code G9005 (2 unique codes).
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.
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.
Single-Code
Single-Code Billing means this provider bills almost exclusively for one or two procedure codes despite high total volume. Legitimate specialists may focus on specific codes, but extreme concentration can indicate a scheme billing repeatedly for the same service.
These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.
Compared to Case Management Peers
Total spending distribution among 137 providers in this specialty
This provider's total spending of $75.8M is at the 25th percentile among 137 Case Management providers.
Total Paid
$75.8M
$75,785,041
Total Claims
290K
Beneficiaries
290K
1.0 claims/patient
Avg Cost/Claim
$261
🔍 Analysis
Provider Overview
Community Healthcare Network INC is a Case Management provider based in New York, NY. From the 2018–2024 period, this provider received $75.8M in Medicaid payments across 290K 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
At $75.8M in Medicaid payments, this provider represents significant public healthcare spending. Understanding where these dollars go helps ensure the program serves those who need it most.
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