La Frontera Center Inc.
Billing Swing
Experienced over 200% change in year-over-year billing with >$1M absolute change.
Billing changed from $5.7M (2018) to $23.0M (2019) — a 304% swing with $17.3M absolute change.
High Claims Per Patient
Filing an unusually high number of claims per beneficiary compared to peers.
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:
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.
High Claims Per Patient
High Claims Per Patient means this provider files an unusually high number of claims per individual patient. This could indicate legitimate intensive treatment or a pattern of billing for services not actually rendered.
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.
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 $108.95 per claim for 99233 (Subsequent hospital care, per day, high complexity) — 3.1× the national median of $35.30.
Bills $73.13 per claim for 99232 (Subsequent hospital care, per day, moderate complexity) — 3.0× the national median of $23.99.
Billing above the 90th percentile for 4 procedure codes simultaneously.
This is a statistical summary, not an accusation. See our methodology.
Compared to Clinic/Center Mental Health (Including Community Mental Health Center) Peers
Total spending distribution among 28 providers in this specialty
This provider's total spending of $136.2M is at the 25th percentile among 28 Clinic/Center Mental Health (Including Community Mental Health Center) providers.
Total Paid
$136.2M
$136,186,368
Total Claims
3.1M
Beneficiaries
1.1M
2.9 claims/patient
Avg Cost/Claim
$44
#828 of 618K providers by total spending(top 0.1%)
🔍 Analysis
Provider Overview
La Frontera Center Inc. is a Clinic/Center Mental Health (Including Community Mental Health Center) provider based in Tucson, AZ. From the 2018–2024 period, this provider received $136.2M in Medicaid payments across 3.1M claims.
Why This Matters
This provider received $136.2M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 17,023 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 (T1016 (Case management, each 15 min)) accounts for 26% of total spending.
Case management, each 15 min
$35.9M
1.0M claims · 26.3%
$32.8M
137K claims
$239.25
$467.51
Behavioral health; short-term residential, per diem
$32.8M
137K claims · 24.1%
$21.1M
364K claims
$57.95
$74.63
Behavioral health counseling & therapy, per 15 min
$21.1M
364K claims · 15.5%
$10.9M
77K claims
$140.94
$96.18
Mental health assessment by non-physician
$10.9M
77K claims · 8.0%
$8.2M
90K claims
$91.01
$84.12
Therapeutic behavioral services, per 15 min
$8.2M
90K claims · 6.0%
$4.6M
423K claims
$10.84
$62.69
Comprehensive medication services, per 15 min
$4.6M
423K claims · 3.4%
$4.3M
62K claims
$68.58
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$4.3M
62K claims · 3.1%
$3.6M
75K claims
$48.46
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$3.6M
75K claims · 2.7%
$2.7M
17K claims
$159.18
$129.75
Alcohol and/or drug abuse, intensive outpatient, per hour
$2.7M
17K claims · 2.0%
$2.7M
19K claims
$142.26
$108.91
Psychiatric diagnostic evaluation with medical services
$2.7M
19K claims · 2.0%
$1.7M
44K claims
$37.87
$82.72
Psychoeducational service, per 15 minutes
$1.7M
44K claims · 1.2%
$1.6M
567K claims
$2.88
$18.95
Alcohol/drug services; methadone administration
$1.6M
567K claims · 1.2%
Psychotherapy, 60 minutes
$1.0M
10K claims · 0.8%
LPN/LVN services, per 15 minutes
$829K
35K claims · 0.6%
$674K
6K claims
$108.95
$35.30
Subsequent hospital care, per day, high complexity
$674K
6K claims · 0.5%
$526K
25K claims
$21.39
$55.04
Self-help/peer services, per 15 minutes
$526K
25K claims · 0.4%
$519K
7K claims
$73.13
$23.99
Subsequent hospital care, per day, moderate complexity
$519K
7K claims · 0.4%
$440K
23K claims
$19.12
$74.36
Home care training, family; per 15 min
$440K
23K claims · 0.3%
$281K
16K claims
$17.42
$83.88
Skills training & development, per 15 min
$281K
16K claims · 0.2%
RN services, per 15 minutes
$241K
8K claims · 0.2%
$232K
10K claims
$22.12
$53.97
Behavioral health outreach service, per 15 minutes
$232K
10K claims · 0.2%
Alcohol and/or drug assessment
$200K
7K claims · 0.1%
$165K
1K claims
$112.48
$74.09
Office/outpatient visit, high complexity
$165K
1K claims · 0.1%
$141K
10K claims
$13.47
$21.33
Non-invasive prenatal screening, fetal chromosomal abnormalities
$141K
10K claims · 0.1%
Psychotherapy, 30 minutes
$113K
2K claims · 0.1%
Psychotherapy, 45 minutes
$105K
1K claims · 0.1%
Non-emergency mini-bus transport
$64K
10K claims · 0.0%
$60K
4K claims
$15.19
$31.37
Oral medication administration, direct observation
$60K
4K claims · 0.0%
$56K
1K claims
$42.25
$16.77
Subsequent hospital care, per day, low complexity
$56K
1K claims · 0.0%
$55K
832 claims
$66.43
$37.22
Hospital discharge day management, 30 minutes or less
$55K
832 claims · 0.0%
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