Community Health Center INC
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 4 procedure codes: G2025 at 6.0× median, G0511 at 5.3× median.
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:
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
These signals use advanced statistical methods including digit distribution analysis, change-point detection, and market concentration metrics. Learn more.
Risk Assessment
Bills $93.66 per claim for G2025 — 6.0× the national median of $15.63.
Bills $60.51 per claim for G0511 (RHC/FQHC visit, psychiatric collaborative care model) — 5.3× the national median of $11.35.
Bills $28.77 per claim for G0008 — 11.3× the national median of $2.54.
Billing above the 90th percentile for 3 procedure codes simultaneously.
This is a statistical summary, not an accusation. See our methodology.
Compared to Counselor, Addiction (Substance Use Disorder) Peers
Total spending distribution among 20 providers in this specialty
This provider's total spending of $533.3M is at the 99th percentile among 20 Counselor, Addiction (Substance Use Disorder) providers.
Above 99th percentile for this specialty — higher spending than 19 of 20 peers
Total Paid
$533.3M
$533,305,233
Total Claims
7.3M
Beneficiaries
5.6M
1.3 claims/patient
Avg Cost/Claim
$73
#111 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Community Health Center INC is a Counselor, Addiction (Substance Use Disorder) provider based in Middletown, CT. From the 2018–2024 period, this provider received $533.3M in Medicaid payments across 7.3M claims.
Why This Matters
This provider received $533.3M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 66,663 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 (T1015 (Clinic visit/encounter, all-inclusive)) accounts for 96% of total spending.
$511.8M
3.1M claims
$165.96
$121.16
Clinic visit/encounter, all-inclusive
$511.8M
3.1M claims · 96.0%
$6.7M
1.1M claims
$6.15
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$6.7M
1.1M claims · 1.3%
Psychotherapy, 30 minutes
$4.6M
595K claims · 0.9%
$2.7M
78K claims
$34.90
$21.91
Federally qualified health center visit, mental health
$2.7M
78K claims · 0.5%
$2.1M
23K claims · 0.4%
$1.3M
189K claims
$6.65
$22.44
Telephone E/M by physician, 11-20 minutes
$1.3M
189K claims · 0.2%
Psychotherapy, 45 minutes
$839K
91K claims · 0.2%
$734K
98K claims
$7.50
$12.93
Office/outpatient visit, minimal complexity
$734K
98K claims · 0.1%
Group psychotherapy
$678K
106K claims · 0.1%
$533K
5K claims
$109.65
$45.95
Chronic care management services, FQHC/RHC
$533K
5K claims · 0.1%
$418K
100K claims
$4.17
$25.06
Office/outpatient visit, low complexity
$418K
100K claims · 0.1%
$225K
39K claims
$5.77
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$225K
39K claims · 0.0%
$183K
11K claims · 0.0%
$106K
43K claims · 0.0%
$60K
13K claims
$4.76
$32.55
Telephone E/M by physician, 21-30 min
$60K
13K claims · 0.0%
$49K
3K claims · 0.0%
$45K
11K claims
$3.93
$20.83
Chiropractic manipulative treatment, 3-4 spinal regions
$45K
11K claims · 0.0%
Psychiatric diagnostic evaluation
$43K
11K claims · 0.0%
$28K
124K claims
$0.23
$7.18
Influenza virus vaccine, quadrivalent, preservative-free, IM
$28K
124K claims · 0.0%
$26K
428 claims
$60.51
$11.35
RHC/FQHC visit, psychiatric collaborative care model
$26K
428 claims · 0.0%
$24K
19K claims
$1.28
$57.85
Office/outpatient visit, new patient, low-mod complexity
$24K
19K claims · 0.0%
$22K
53K claims
$0.41
$9.80
Immunization administration, 1 vaccine, percutaneous/ID/SC/IM
$22K
53K claims · 0.0%
$14K
488 claims · 0.0%
$13K
4K claims · 0.0%
$10K
4K claims
$2.41
$76.06
Preventive medicine, established patient, age 40-64
$10K
4K claims · 0.0%
$9K
808 claims · 0.0%
$6K
10K claims · 0.0%
$5K
1K claims
$3.86
$77.33
Family psychotherapy with patient, 50 min
$5K
1K claims · 0.0%
Health/behavior intervention, group
$5K
404 claims · 0.0%
$5K
10K claims
$0.44
$72.71
Preventive medicine, established patient, age 18-39
$5K
10K claims · 0.0%
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