County of San Bernardino
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $258.73 per claim for H2010 (Comprehensive medication services, per 15 min), which is 4.1× the national median of $62.69.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 29 procedure codes: 90837 at 4.8× median, H2019 at 3.9× 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.
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 $258.73 per claim for H2010 (Comprehensive medication services, per 15 min) — 4.1× the national median of $62.69.
Bills $999.59 per claim for S9484 (Crisis intervention mental health services, per hour) — 4.0× the national median of $249.51.
Bills $412.51 per claim for 90837 (Psychotherapy, 60 minutes) — 4.8× the national median of $85.66.
Billing in the top 1% nationally for 10 procedure codes: 90837, 99214, 90834.
This is a statistical summary, not an accusation. See our methodology.
Compared to Clinic/Center Rehabilitation Substance Use Disorder Peers
Total spending distribution among 8 providers in this specialty
This provider's total spending of $1.05B is at the 99th percentile among 8 Clinic/Center Rehabilitation Substance Use Disorder providers.
Above 99th percentile for this specialty — higher spending than 7 of 8 peers
Total Paid
$1.05B
$1,053,552,905
Total Claims
6.5M
Beneficiaries
1.7M
3.9 claims/patient
Avg Cost/Claim
$161
#33 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
County of San Bernardino is a Clinic/Center Rehabilitation Substance Use Disorder provider based in San Bernardino, CA. From the 2018–2024 period, this provider received $1.1B in Medicaid payments across 6.5M 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 $1.1B in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 131,694 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 31% of total spending.
$325.1M
1.6M claims
$202.91
$96.24
Comprehensive community support services, per 15 min
$325.1M
1.6M claims · 30.9%
$122.8M
558K claims
$219.92
$91.63
Psychosocial rehabilitation services, per 15 min
$122.8M
558K claims · 11.7%
$90.7M
351K claims
$258.73
$62.69
Comprehensive medication services, per 15 min
$90.7M
351K claims · 8.6%
$58.2M
137K claims
$423.53
$467.51
Behavioral health; short-term residential, per diem
$58.2M
137K claims · 5.5%
$55.9M
328K claims
$170.31
$69.56
Targeted case management, per 15 min
$55.9M
328K claims · 5.3%
$51.8M
289K claims
$179.43
$357.16
Behavioral health; residential, per diem
$51.8M
289K claims · 4.9%
$46.0M
46K claims
$999.59
$249.51
Crisis intervention mental health services, per hour
$46.0M
46K claims · 4.4%
$30.5M
2.0M claims
$15.08
$18.95
Alcohol/drug services; methadone administration
$30.5M
2.0M claims · 2.9%
Psychotherapy, 60 minutes
$29.7M
72K claims · 2.8%
$27.1M
83K claims
$326.42
$84.12
Therapeutic behavioral services, per 15 min
$27.1M
83K claims · 2.6%
$25.3M
255K claims
$99.21
$74.63
Behavioral health counseling & therapy, per 15 min
$25.3M
255K claims · 2.4%
$25.0M
133K claims
$187.51
$80.64
Mental health service plan development
$25.0M
133K claims · 2.4%
$18.7M
49K claims
$382.90
$215.80
Crisis intervention service, per 15 minutes
$18.7M
49K claims · 1.8%
$17.5M
21K claims
$850.65
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$17.5M
21K claims · 1.7%
$16.1M
41K claims
$389.77
$72.96
Prolonged office/outpatient E/M, each additional 15 min
$16.1M
41K claims · 1.5%
Psychotherapy, 45 minutes
$14.5M
47K claims · 1.4%
$13.9M
12K claims
$1,160.76
$74.09
Office/outpatient visit, high complexity
$13.9M
12K claims · 1.3%
$11.3M
9K claims
$1,225.43
$49.05
Nursing assessment/evaluation, per visit
$11.3M
9K claims · 1.1%
$9.0M
39K claims
$228.55
$56.90
Medication training and management, per 15 min
$9.0M
39K claims · 0.9%
$8.5M
178K claims
$47.69
$47.35
Alcohol and/or drug services, group counseling
$8.5M
178K claims · 0.8%
$6.2M
12K claims
$526.60
$96.18
Mental health assessment by non-physician
$6.2M
12K claims · 0.6%
$5.6M
5K claims
$1,041.80
$23.99
Subsequent hospital care, per day, moderate complexity
$5.6M
5K claims · 0.5%
Psychotherapy, 30 minutes
$5.2M
25K claims · 0.5%
$4.4M
7K claims
$611.00
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$4.4M
7K claims · 0.4%
$4.3M
17K claims · 0.4%
$3.7M
6K claims
$605.56
$108.91
Psychiatric diagnostic evaluation with medical services
$3.7M
6K claims · 0.4%
$3.1M
8K claims
$376.12
$25.06
Office/outpatient visit, low complexity
$3.1M
8K claims · 0.3%
$3.0M
46K claims
$64.69
$129.75
Alcohol and/or drug abuse, intensive outpatient, per hour
$3.0M
46K claims · 0.3%
$2.8M
8K claims
$338.58
$77.33
Family psychotherapy with patient, 50 min
$2.8M
8K claims · 0.3%
$2.2M
1K claims
$1,577.48
$51.25
Initial hospital care, per day, moderate complexity
$2.2M
1K claims · 0.2%
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$1.73B
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