Mainstream Living Inc.
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $1,988.35 per claim for H2016 (Comprehensive community support services, per 15 min), which is 6.2× the national median of $321.53.
High Cost Per Claim
Average payment per claim is much higher than peers billing the same procedures.
Spending Spike
Experienced a dramatic increase in billing over a short period.
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.
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.
Spending Spike
Spending Spike means this provider experienced a dramatic, sudden increase in billing over a short period. Legitimate causes include new contracts or expanded services, but this pattern also appears in billing fraud ramp-ups.
These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.
Risk Assessment
Bills $1,988.35 per claim for H2016 (Comprehensive community support services, per 15 min) — 6.2× the national median of $321.53.
Bills $3,950.14 per claim for S5136 (Companion care, adult, per 15 minutes) — 13.1× the national median of $302.34.
This is a statistical summary, not an accusation. See our methodology.
Compared to Social Worker Peers
Total spending distribution among 10 providers in this specialty
This provider's total spending of $134.3M is at the 75th percentile among 10 Social Worker providers.
Total Paid
$134.3M
$134,327,009
Total Claims
137K
Beneficiaries
34K
4.1 claims/patient
Avg Cost/Claim
$978
#845 of 618K providers by total spending(top 0.1%)
🔍 Analysis
Provider Overview
Mainstream Living Inc. is a Social Worker provider based in Ames, IA. From the 2018–2024 period, this provider received $134.3M in Medicaid payments across 137K claims.
Why This Matters
This provider received $134.3M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 16,790 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 7 distinct procedure codes. The top code (H2016 (Comprehensive community support services, per 15 min)) accounts for 69% of total spending.
$92.2M
46K claims
$1,988.35
$321.53
Comprehensive community support services, per 15 min
$92.2M
46K claims · 68.6%
$32.1M
8K claims
$3,950.14
$302.34
Companion care, adult, per 15 minutes
$32.1M
8K claims · 23.9%
Day habilitation, waiver; per diem
$5.2M
33K claims · 3.9%
$3.0M
23K claims
$132.24
$96.24
Comprehensive community support services, per 15 min
$3.0M
23K claims · 2.3%
$968K
19K claims
$51.69
$103.94
Supported employment, per 15 min
$968K
19K claims · 0.7%
$647K
2K claims
$259.33
$225.50
Community psychiatric supportive treatment program, per diem
$647K
2K claims · 0.5%
$195K
6K claims
$33.94
$150.51
Day habilitation, waiver; per 15 min
$195K
6K claims · 0.1%
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