County of Tulare
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 22 procedure codes: 90837 at 5.8× median, 99233 at 39.8× 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
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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:
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 $494.02 per claim for 90837 (Psychotherapy, 60 minutes) — 5.8× the national median of $85.66.
Bills $1,405.74 per claim for 99233 (Subsequent hospital care, per day, high complexity) — 39.8× the national median of $35.30.
Bills $364.24 per claim for 90834 (Psychotherapy, 45 minutes) — 5.7× the national median of $63.65.
Billing in the top 1% nationally for 10 procedure codes: 90837, 99233, 90834.
This is a statistical summary, not an accusation. See our methodology.
Total Paid
$273.7M
$273,741,644
Total Claims
2.9M
Beneficiaries
820K
3.5 claims/patient
Avg Cost/Claim
$96
#290 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
County of Tulare is a Clinic/Center Public Health State or Local provider based in Visalia, CA. From the 2018–2024 period, this provider received $273.7M in Medicaid payments across 2.9M 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 $273.7M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 34,217 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 (H2015 (Comprehensive community support services, per 15 min)) accounts for 27% of total spending.
$74.6M
408K claims
$183.00
$96.24
Comprehensive community support services, per 15 min
$74.6M
408K claims · 27.3%
$48.1M
253K claims
$190.21
$91.63
Psychosocial rehabilitation services, per 15 min
$48.1M
253K claims · 17.6%
$23.5M
160K claims
$146.39
$62.69
Comprehensive medication services, per 15 min
$23.5M
160K claims · 8.6%
$20.2M
171K claims
$117.96
$69.56
Targeted case management, per 15 min
$20.2M
171K claims · 7.4%
$19.8M
1.3M claims
$14.90
$18.95
Alcohol/drug services; methadone administration
$19.8M
1.3M claims · 7.2%
Psychotherapy, 60 minutes
$11.8M
24K claims · 4.3%
$11.4M
81K claims
$141.29
$357.16
Behavioral health; residential, per diem
$11.4M
81K claims · 4.2%
$10.0M
94K claims
$105.89
$74.63
Behavioral health counseling & therapy, per 15 min
$10.0M
94K claims · 3.6%
$8.9M
6K claims
$1,405.74
$35.30
Subsequent hospital care, per day, high complexity
$8.9M
6K claims · 3.3%
$7.5M
35K claims
$216.55
$80.64
Mental health service plan development
$7.5M
35K claims · 2.7%
Psychotherapy, 45 minutes
$5.4M
15K claims · 2.0%
$5.4M
11K claims
$491.99
$72.96
Prolonged office/outpatient E/M, each additional 15 min
$5.4M
11K claims · 2.0%
$3.3M
7K claims
$449.65
$215.80
Crisis intervention service, per 15 minutes
$3.3M
7K claims · 1.2%
$3.0M
9K claims
$329.36
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$3.0M
9K claims · 1.1%
$2.5M
3K claims
$800.07
$74.09
Office/outpatient visit, high complexity
$2.5M
3K claims · 0.9%
$2.2M
5K claims
$427.53
$77.33
Family psychotherapy with patient, 50 min
$2.2M
5K claims · 0.8%
$2.1M
11K claims
$181.70
$56.90
Medication training and management, per 15 min
$2.1M
11K claims · 0.8%
$1.6M
3K claims
$642.32
$467.51
Behavioral health; short-term residential, per diem
$1.6M
3K claims · 0.6%
Psychotherapy, 30 minutes
$1.6M
6K claims · 0.6%
$1.4M
22K claims
$63.33
$47.35
Alcohol and/or drug services, group counseling
$1.4M
22K claims · 0.5%
$1.2M
617 claims
$2,010.29
$67.32
Initial hospital care, per day, high complexity
$1.2M
617 claims · 0.5%
$990K
768 claims
$1,288.66
$259.38
Supported employment, waiver, per diem
$990K
768 claims · 0.4%
$936K
11K claims
$82.00
$43.10
Alcohol and/or drug services, case management
$936K
11K claims · 0.3%
$929K
636 claims
$1,460.91
$43.85
Hospital discharge day management, more than 30 minutes
$929K
636 claims · 0.3%
$862K
23K claims
$37.64
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$862K
23K claims · 0.3%
$804K
2K claims
$435.81
$84.12
Therapeutic behavioral services, per 15 min
$804K
2K claims · 0.3%
Psychiatric diagnostic evaluation
$698K
5K claims · 0.3%
$510K
1K claims · 0.2%
$408K
3K claims
$130.33
$49.05
Nursing assessment/evaluation, per visit
$408K
3K claims · 0.1%
$383K
1K claims
$276.23
$23.99
Subsequent hospital care, per day, moderate complexity
$383K
1K claims · 0.1%
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