County of Santa Clara
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $441.46 per claim for T1015 (Clinic visit/encounter, all-inclusive), which is 3.6× 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.
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 $106.6M is at the 25th percentile among 24 Clinic/Center Federally Qualified Health Center (FQHC) providers.
Total Paid
$106.6M
$106,565,670
Total Claims
873K
Beneficiaries
674K
1.3 claims/patient
Avg Cost/Claim
$122
🔍 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 $106.6M in Medicaid payments across 873K 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 $106.6M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 13,320 Medicaid beneficiaries for a full year at average per-enrollee costs.
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