CRITERION IN-HOME HEALTH SERVICE , LLC
NPI: 1336489145
· SAINT LOUIS, MO 63132
· In Home Supportive Care Agency
· NPI assigned 02/15/2013
Billing Flags
· Automated signals — not evidence of fraud
Single-Code Concentration
99% of spending on code T1019 with only 2 total codes billed. Highly concentrated billing profile.
$5.59M
Total Medicaid Paid
Provider Details
| Authorized Official | BECTON, DONNA (DIRECTOR) |
| NPI Enumeration Date | 02/15/2013 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
446 |
$18K |
| 2019 |
2,269 |
$115K |
| 2020 |
2,088 |
$114K |
| 2021 |
4,065 |
$550K |
| 2022 |
9,902 |
$1.95M |
| 2023 |
7,705 |
$1.78M |
| 2024 |
4,849 |
$1.07M |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1019 |
Personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, icf/mr or imd, part of the individualized plan of treatment (code may not be used to identify services provided by home health aide or certified nurse assistant) |
29,353 |
1,506 |
$5.51M |
| T1001 |
Nursing assessment / evaluation |
1,971 |
594 |
$80K |