County of Santa Clara
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $417.87 per claim for T1015 (Clinic visit/encounter, all-inclusive), which is 3.4× the national median of $121.16.
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.
These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.
Risk Assessment
Bills $417.87 per claim for T1015 (Clinic visit/encounter, all-inclusive) — 3.5× the national median of $121.16.
Bills $152.20 per claim for G0467 (Federally qualified health center visit, mental health) — 7.0× the national median of $21.91.
Billing above the 90th percentile for 3 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 24 providers in this specialty
This provider's total spending of $132.4M is at the 50th percentile among 24 Clinic/Center Federally Qualified Health Center (FQHC) providers.
Total Paid
$132.4M
$132,370,238
Total Claims
1.4M
Beneficiaries
1.1M
1.3 claims/patient
Avg Cost/Claim
$94
#867 of 618K providers by total spending(top 0.1%)
🔍 Analysis
Provider Overview
County of Santa Clara is a Clinic/Center Federally Qualified Health Center (FQHC) provider based in San Jose, CA. From the 2018–2024 period, this provider received $132.4M in Medicaid payments across 1.4M 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 $132.4M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 16,546 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 93% of total spending.
$123.1M
295K claims
$417.87
$121.16
Clinic visit/encounter, all-inclusive
$123.1M
295K claims · 93.0%
Anesthesia services
$5.8M
11K claims · 4.3%
$1.2M
8K claims
$152.20
$21.91
Federally qualified health center visit, mental health
$1.2M
8K claims · 0.9%
$603K
225K claims
$2.68
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$603K
225K claims · 0.5%
$311K
55K claims
$5.62
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$311K
55K claims · 0.2%
$264K
1K claims
$197.43
$66.78
Coordination of long-term care services, per month
$264K
1K claims · 0.2%
$123K
11K claims
$11.12
$39.70
COVID-19 SARS-CoV-2 amplified probe detection
$123K
11K claims · 0.1%
$111K
65K claims
$1.71
$25.06
Office/outpatient visit, low complexity
$111K
65K claims · 0.1%
$100K
25K claims
$3.96
$75.18
Preventive medicine, established patient, age 1-4
$100K
25K claims · 0.1%
$77K
18K claims
$4.23
$69.35
Preventive medicine, established patient, infant (under 1)
$77K
18K claims · 0.1%
$74K
18K claims
$4.24
$74.82
Preventive medicine, established patient, age 5-11
$74K
18K claims · 0.1%
$64K
1K claims
$57.43
$137.85
Other specified case management service, per 15 minutes
$64K
1K claims · 0.0%
$45K
11K claims
$4.18
$80.15
Preventive medicine, established patient, age 12-17
$45K
11K claims · 0.0%
$36K
35K claims
$1.01
$6.61
Screening audiometry, pure tone, air only
$36K
35K claims · 0.0%
HPV vaccine, 9-valent
$30K
6K claims · 0.0%
$29K
4K claims
$7.28
$24.95
Chlamydia detection, nucleic acid, amplified probe
$29K
4K claims · 0.0%
$28K
4K claims
$7.34
$23.39
Neisseria gonorrhoeae detection, nucleic acid, amplified probe
$28K
4K claims · 0.0%
$28K
2K claims · 0.0%
$25K
4K claims · 0.0%
$25K
13K claims · 0.0%
$24K
289 claims · 0.0%
$23K
18K claims
$1.25
$5.50
Hemoglobin A1c (glycated hemoglobin)
$23K
18K claims · 0.0%
$17K
29K claims
$0.59
$7.18
Influenza virus vaccine, quadrivalent, preservative-free, IM
$17K
29K claims · 0.0%
$17K
483 claims · 0.0%
$15K
4K claims
$3.48
$19.06
Cytopathology, cervical or vaginal, ThinPrep
$15K
4K claims · 0.0%
Psychotherapy, 30 minutes
$15K
2K claims · 0.0%
Lipid panel
$15K
9K claims · 0.0%
$14K
1K claims · 0.0%
$14K
3K claims
$4.94
$47.08
Ophthalmological exam, comprehensive, established patient
$14K
3K claims · 0.0%
$12K
1K claims
$10.00
$74.09
Office/outpatient visit, high complexity
$12K
1K claims · 0.0%
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
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