Spectrum Health Primary Care Partners
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 15 procedure codes: 59425 at 7.3× median, 90651 at 6.5× median.
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:
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.
These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.
Risk Assessment
Bills $830.47 per claim for 59426 (Antepartum care only, high risk, additional visits) — 6.8× the national median of $122.30.
This is a statistical summary, not an accusation. See our methodology.
Total Paid
$219.6M
$219,576,485
Total Claims
4.2M
Beneficiaries
3.5M
1.2 claims/patient
Avg Cost/Claim
$53
#389 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Spectrum Health Primary Care Partners is a Psychologist, Clinical Child & Adolescent provider based in Grand Rapids, MI. From the 2018–2024 period, this provider received $219.6M in Medicaid payments across 4.2M claims.
Why This Matters
This provider received $219.6M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 27,447 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 (99214 (Office/outpatient visit, est. patient, mod-high complexity)) accounts for 15% of total spending.
$33.1M
503K claims
$65.80
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$33.1M
503K claims · 15.1%
$19.1M
394K claims
$48.52
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$19.1M
394K claims · 8.7%
$8.2M
95K claims
$86.31
$74.09
Office/outpatient visit, high complexity
$8.2M
95K claims · 3.7%
$7.2M
195K claims
$36.81
$23.99
Subsequent hospital care, per day, moderate complexity
$7.2M
195K claims · 3.3%
$6.6M
59K claims
$112.36
$101.24
Critical care, first 30-74 minutes
$6.6M
59K claims · 3.0%
$6.3M
8K claims
$799.64
$470.36
Injection, onabotulinumtoxinA, 1 unit
$6.3M
8K claims · 2.9%
$6.2M
115K claims
$54.19
$35.30
Subsequent hospital care, per day, high complexity
$6.2M
115K claims · 2.8%
$6.2M
73K claims
$84.68
$84.03
Office/outpatient visit, new patient, mod-high complexity
$6.2M
73K claims · 2.8%
$4.4M
2K claims
$2,044.91
$1,482.45
Routine obstetric care, vaginal delivery, including postpartum
$4.4M
2K claims · 2.0%
$4.0M
41K claims
$96.08
$121.58
Office or other outpatient consultation, moderate complexity
$4.0M
41K claims · 1.8%
$3.9M
68K claims
$56.87
$57.85
Office/outpatient visit, new patient, low-mod complexity
$3.9M
68K claims · 1.8%
$3.8M
12K claims
$319.03
$307.98
Subsequent pediatric critical care, per day, age 2-5
$3.8M
12K claims · 1.7%
$3.4M
36K claims
$92.57
$67.32
Initial hospital care, per day, high complexity
$3.4M
36K claims · 1.5%
$3.1M
2K claims · 1.4%
$2.7M
35K claims
$78.04
$75.18
Preventive medicine, established patient, age 1-4
$2.7M
35K claims · 1.2%
$2.6M
32K claims
$82.48
$72.71
Preventive medicine, established patient, age 18-39
$2.6M
32K claims · 1.2%
$2.5M
29K claims · 1.1%
$2.5M
23K claims
$107.93
$111.09
Office/outpatient visit, new patient, high complexity
$2.5M
23K claims · 1.1%
Psychotherapy, 60 minutes
$2.4M
32K claims · 1.1%
$2.4M
2K claims · 1.1%
$2.2M
40K claims
$55.86
$43.85
Hospital discharge day management, more than 30 minutes
$2.2M
40K claims · 1.0%
$2.2M
34K claims
$66.00
$69.35
Preventive medicine, established patient, infant (under 1)
$2.2M
34K claims · 1.0%
Vaginal delivery only
$2.2M
3K claims · 1.0%
$2.0M
34K claims
$59.22
$58.55
Ultrasound, pregnant uterus, follow-up
$2.0M
34K claims · 0.9%
$2.0M
22K claims
$89.06
$76.06
Preventive medicine, established patient, age 40-64
$2.0M
22K claims · 0.9%
$1.9M
24K claims
$78.00
$74.82
Preventive medicine, established patient, age 5-11
$1.9M
24K claims · 0.9%
$1.9M
30K claims
$61.71
$51.25
Initial hospital care, per day, moderate complexity
$1.9M
30K claims · 0.8%
$1.8M
3K claims · 0.8%
$1.8M
2K claims
$948.91
$786.43
Etonogestrel implant system, including implant and supplies
$1.8M
2K claims · 0.8%
$1.7M
2K claims
$830.47
$122.30
Antepartum care only, high risk, additional visits
$1.7M
2K claims · 0.8%
Other Top Providers in Michigan
View all →Guardiantrac. LLC
Community/Behavioral Health
$2.68B
Centria Healthcare LLC
Home Health
$590.6M
Integra Partners LLC
Orthotic Fitter
$422.3M
Community Mental Health Authority of Clinton Eaton Ingham Counties
Clinic/Center Mental Health (Including Community
$368.4M
Macomb Oakland Regional Center Inc.
Community/Behavioral Health
$342.6M