Neighborhood Healthcare
Explosive Growth
Billing increased over 500% year-over-year — far beyond normal growth patterns.
Billing grew 527% from 2019 to 2020.
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:
Explosive Growth
Explosive Growth means this provider's billing increased by more than 500% year-over-year. While rapid expansion can be legitimate, this pattern has been observed in fraud schemes that ramp up billing quickly before detection.
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
Billing above the 90th percentile for 5 procedure codes simultaneously.
This is a statistical summary, not an accusation. See our methodology.
Compared to Clinic/Center, Federally Qualified Health Center (FQHC) Peers
Total spending distribution among 16 providers in this specialty
This provider's total spending of $160.4M is at the 75th percentile among 16 Clinic/Center, Federally Qualified Health Center (FQHC) providers.
Total Paid
$160.4M
$160,418,317
Total Claims
932K
Beneficiaries
761K
1.2 claims/patient
Avg Cost/Claim
$172
#646 of 618K providers by total spending(top 0.1%)
🔍 Analysis
Provider Overview
Neighborhood Healthcare is a Clinic/Center, Federally Qualified Health Center (FQHC) provider based in Hemet, CA. From the 2018–2024 period, this provider received $160.4M in Medicaid payments across 932K claims.
Why This Matters
This provider received $160.4M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 20,052 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 92% of total spending.
$146.8M
479K claims
$306.43
$121.16
Clinic visit/encounter, all-inclusive
$146.8M
479K claims · 91.5%
Anesthesia services
$13.0M
32K claims · 8.1%
$344K
31K claims
$11.19
$20.83
Chiropractic manipulative treatment, 3-4 spinal regions
$344K
31K claims · 0.2%
$131K
15K claims · 0.1%
$80K
197K claims
$0.40
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$80K
197K claims · 0.0%
$9K
132 claims
$67.00
$33.85
COVID-19 vaccine admin, Moderna, 2nd dose
$9K
132 claims · 0.0%
$7K
286 claims
$25.19
$21.91
Federally qualified health center visit, mental health
$7K
286 claims · 0.0%
COVID-19 vaccine admin, Pfizer, 2nd dose
$6K
93 claims · 0.0%
$4K
42K claims
$0.10
$25.06
Office/outpatient visit, low complexity
$4K
42K claims · 0.0%
$4K
270 claims · 0.0%
$4K
39K claims
$0.09
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$4K
39K claims · 0.0%
$3K
257 claims
$11.21
$11.35
RHC/FQHC visit, psychiatric collaborative care model
$3K
257 claims · 0.0%
COVID-19 vaccine admin, Pfizer, 1st dose
$1K
18 claims · 0.0%
COVID-19 vaccine admin, Moderna, 1st dose
$1K
17 claims · 0.0%
$500
15 claims · 0.0%
$54
1K claims
$0.04
$80.15
Preventive medicine, established patient, age 12-17
$54
1K claims · 0.0%
$50
29 claims
$1.71
$12.63
Pure tone audiometry, air only, each ear
$50
29 claims · 0.0%
$43
2K claims
$0.02
$74.82
Preventive medicine, established patient, age 5-11
$43
2K claims · 0.0%
Urine pregnancy test
$37
91 claims · 0.0%
$14
340 claims
$0.04
$2.00
Urinalysis, non-automated without microscopy
$14
340 claims · 0.0%
$2
43 claims · 0.0%
$0
34 claims · 0.0%
$0
123 claims
$0.00
$83.63
Preventive visit, new patient, adolescent (12-17 yr)
$0
123 claims · 0.0%
$0
13 claims · 0.0%
$0
17 claims · 0.0%
$0
2K claims
$0.00
$75.18
Preventive medicine, established patient, age 1-4
$0
2K claims · 0.0%
Psychiatric diagnostic evaluation
$0
2K claims · 0.0%
$0
5K claims · 0.0%
$0
4K claims · 0.0%
$0
1K claims · 0.0%
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