Northern Valley Indian Health INC
Clinic/Center
Willows, California
NPI: 1295752384
Risk Tier
Critical
Total Paid
$217.1M
$217,070,731
Total Claims
850K
Beneficiaries
687K
Avg Cost/Claim
$255.29
Active billing period: 84 months (2018-01 to 2024-12)
Statistical Fraud Flags (3)
Cost Outlier
Billing over 3× the national median for specific procedure codes.
Bills $543.37 per claim for T1015 (Clinic visit/encounter, all-inclusive), which is 4.5× the national median of $121.16.
Billing Swing
Experienced over 200% change in year-over-year billing with >$1M absolute change.
Billing changed from $10.3M (2018) to $38.4M (2019) — a 272% swing with $28.1M absolute change.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 11 procedure codes: 00003 at 2.4× median, T1015 at 4.5× median.
Disclaimer: Statistical flags indicate unusual billing patterns — they are not proof of fraud or wrongdoing. Some entities (government agencies, home care programs, hospitals) may legitimately bill at higher rates due to patient acuity, overhead costs, or specialized services. This report is generated from public HHS data and statistical analysis only. No clinical or investigative review has been performed.
Generated by OpenMedicaid | openmedicaid.org | Data: HHS 2018-2024