Kaiser Foundation Health Plan INC
Explosive Growth
Billing increased over 500% year-over-year — far beyond normal growth patterns.
Billing grew 12913% from 2022 to 2023.
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
▼
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.
Compared to Health Maintenance Organization Peers
Total spending distribution among 10 providers in this specialty
This provider's total spending of $12.8M is at the below 25th percentile among 10 Health Maintenance Organization providers.
Total Paid
$12.8M
$12,770,956
Total Claims
314K
Beneficiaries
253K
1.2 claims/patient
Avg Cost/Claim
$41
🔍 Analysis
Provider Overview
Kaiser Foundation Health Plan INC is a Health Maintenance Organization provider based in Oakland, CA. From the 2018–2024 period, this provider received $12.8M in Medicaid payments across 314K claims.
Why This Matters
At $12.8M in Medicaid payments, this provider represents significant public healthcare spending. Understanding where these dollars go helps ensure the program serves those who need it most.
Other Top Providers in California
View all →Los Angeles County Department of Mental Health
Clinic/Center, Mental Health (Including Community
$6.78B
County of Santa Clara
Community/Behavioral Health
$1.73B
County of Riverside
Community/Behavioral Health
$1.40B
City & County of San Francisco
Community/Behavioral Health
$1.34B
Los Angeles County Department of Public Health
Public Health or Welfare
$1.13B
Similar Providers
Other top providers in Health Maintenance Organization