County of Orange
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $2,945.38 per claim for S9484 (Crisis intervention mental health services, per hour), which is 11.8× the national median of $249.51.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 39 procedure codes: S9484 at 11.8× median, 90837 at 4.2× median.
Unusually High Spending
This provider's total payments are significantly above the median for their specialty.
High Cost Per Claim
Average payment per claim is much higher than peers billing the same procedures.
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.
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.
Unusually High Spending
Unusually High Spending means this provider's total Medicaid payments are significantly above the median for their specialty. This doesn't necessarily indicate fraud — high volume practices and those serving complex populations may legitimately bill more.
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.
These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.
Risk Assessment
Bills $2,945.38 per claim for S9484 (Crisis intervention mental health services, per hour) — 11.8× the national median of $249.51.
Bills $1,561.99 per claim for H0018 (Behavioral health; short-term residential, per diem) — 3.3× the national median of $467.51.
Bills $360.88 per claim for 90837 (Psychotherapy, 60 minutes) — 4.2× the national median of $85.66.
Billing in the top 1% nationally for 8 procedure codes: 90837, 99215, 99213.
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 $806.7M is at the 99th percentile among 28 Clinic/Center Mental Health (Including Community Mental Health Center) providers.
Above 99th percentile for this specialty — higher spending than 27 of 28 peers
Total Paid
$806.7M
$806,659,263
Total Claims
4.9M
Beneficiaries
1.6M
3.2 claims/patient
Avg Cost/Claim
$163
#51 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
County of Orange is a Clinic/Center Mental Health (Including Community Mental Health Center) provider based in Santa Ana, CA. From the 2018–2024 period, this provider received $806.7M in Medicaid payments across 4.9M claims.
Important Context
- ℹ️This is a government entity that may serve as a fiscal agent for large populations. Government providers often bill at high volumes due to the scale of public programs they administer.
Why This Matters
This provider received $806.7M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 100,832 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 (H2015 (Comprehensive community support services, per 15 min)) accounts for 37% of total spending.
$296.2M
1.5M claims
$192.14
$96.24
Comprehensive community support services, per 15 min
$296.2M
1.5M claims · 36.7%
$94.5M
574K claims
$164.51
$62.69
Comprehensive medication services, per 15 min
$94.5M
574K claims · 11.7%
$79.3M
27K claims
$2,945.38
$249.51
Crisis intervention mental health services, per hour
$79.3M
27K claims · 9.8%
$55.1M
406K claims
$135.66
$69.56
Targeted case management, per 15 min
$55.1M
406K claims · 6.8%
$33.9M
226K claims
$149.85
$357.16
Behavioral health; residential, per diem
$33.9M
226K claims · 4.2%
$33.4M
21K claims
$1,561.99
$467.51
Behavioral health; short-term residential, per diem
$33.4M
21K claims · 4.1%
$33.3M
1.2M claims
$28.43
$18.95
Alcohol/drug services; methadone administration
$33.3M
1.2M claims · 4.1%
$22.9M
195K claims
$117.12
$74.63
Behavioral health counseling & therapy, per 15 min
$22.9M
195K claims · 2.8%
$22.2M
111K claims
$200.11
$91.63
Psychosocial rehabilitation services, per 15 min
$22.2M
111K claims · 2.8%
Psychotherapy, 60 minutes
$22.2M
61K claims · 2.7%
$14.7M
22K claims
$659.40
$215.80
Crisis intervention service, per 15 minutes
$14.7M
22K claims · 1.8%
$11.9M
71K claims
$166.83
$96.18
Mental health assessment by non-physician
$11.9M
71K claims · 1.5%
Psychotherapy, 45 minutes
$11.7M
44K claims · 1.5%
$8.1M
9K claims
$867.68
$74.09
Office/outpatient visit, high complexity
$8.1M
9K claims · 1.0%
$7.5M
123K claims
$60.49
$47.35
Alcohol and/or drug services, group counseling
$7.5M
123K claims · 0.9%
$6.7M
14K claims
$485.80
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$6.7M
14K claims · 0.8%
$6.2M
48K claims
$129.87
$23.99
Subsequent hospital care, per day, moderate complexity
$6.2M
48K claims · 0.8%
$5.6M
30K claims · 0.7%
$5.0M
17K claims
$289.29
$84.12
Therapeutic behavioral services, per 15 min
$5.0M
17K claims · 0.6%
$4.6M
15K claims
$302.40
$77.33
Family psychotherapy with patient, 50 min
$4.6M
15K claims · 0.6%
$4.4M
8K claims
$549.71
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$4.4M
8K claims · 0.5%
$4.3M
70K claims
$60.72
$43.10
Alcohol and/or drug services, case management
$4.3M
70K claims · 0.5%
$2.8M
14K claims
$200.40
$56.90
Medication training and management, per 15 min
$2.8M
14K claims · 0.3%
$2.7M
6K claims · 0.3%
Psychotherapy, 30 minutes
$2.6M
15K claims · 0.3%
$2.4M
12K claims
$198.45
$35.30
Subsequent hospital care, per day, high complexity
$2.4M
12K claims · 0.3%
$2.1M
13K claims
$163.15
$80.64
Mental health service plan development
$2.1M
13K claims · 0.3%
$1.5M
5K claims
$303.17
$25.06
Office/outpatient visit, low complexity
$1.5M
5K claims · 0.2%
$1.4M
4K claims
$335.49
$67.32
Initial hospital care, per day, high complexity
$1.4M
4K claims · 0.2%
$974K
13K claims
$74.61
$129.75
Alcohol and/or drug abuse, intensive outpatient, per hour
$974K
13K claims · 0.1%
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$6.78B
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$1.73B
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$1.40B
City & County of San Francisco
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$1.34B
Los Angeles County Department of Public Health
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